Difference between testicular cancer and hydrocele

Introduction

A hydrocele is a disorder wherein there is accumulation of fluid in sac containing the testes i.e. scrotal sac, whereas testicular cancer is an uncontrolled, cancerous growth of the cells of the testes. Hydrocele is the result of accumulation of fluid due to remanants of the linings of the abdomen called as peritoneum in the scrotum.

Difference in causes

The exact cause of testicular cancer is not clear as it initiates due to a mutation in the gene especially in persons with a strong family history of cancer. A hydrocele occurs either due to a defective absorption of fluid from the scrotal sac or due to altered mechanism of lymphatic drainage due to an infection like filariasis of the testes.

Hydroceles commonly occur in the first year of birth and subside spontaneously. They may occur later in adulthood due to inflammation of testes (orchitis), infection (filariasis), or trauma.

Difference in presentation

Hydroceles develop slowly but testicular cancer grows rapidly.  Testicular cancer is more common in adolescents whereas hydrocele is more common in young infants.

Testicular cancer typically presents as a swelling and growth in the testicles, commonly without pain. Clinically, both begin with the appearance of a swelling of the testes but a hydrocele has swelling due to retention of fluid and hence the testes feel very soft,  but are not painful.  Apart from the dragging sensation and heaviness of an enlarged scrotum, hydroceles often remain ignored for long. On examination, testicular cancer feels like hard lumps or knots in the testes, irregular in size and shape.

The other clinical features of testicular cancer are loss of appetite, weight loss,  pain in the lower abdomen and a heavy feeling in the scrotum.  The size of the tumor may vary from being as small as a pea to a large coin size growth of tumor cells. Fatigued feeling and getting tired very easily is an important symptom of testicular cancer.

Difference in diagnosis

An important differentiating feature is that a hydrocele will allow passage of light when a ‘transillumination test’ is conducted whereas a testicular cancer will not allow passage of light through it. A strong light source is pressed on the testes and checked to see if light is visible through the other side.  This is a very important diagnostic clue before undergoing any other confirmatory tests as both the disorders tend to give rise to painless swellings. An Ultrasonography is done to get a confirmatory diagnosis.

Difference in treatment

The treatment for hydrocele varies according to the age of the patient. If the hydrocele occurs within the first year of life, then it needs no treatment but if it occurs during the latter years of life and is persistent then it needs to be operated surgically. Hydrocele can be treated by aspirating the fluid by a needle and bringing about a reduction of the swelling. Testicular cancer will need chemotherapy along with surgical removal of the metastatic cells present in the testes. Testicular cancer has good cure rates and high survival rate.

Summary

Hydrocele is a benign condition whereas testicular cancer is a malignant, metastatic condition. Hydrocele literally means water enclosed in a sac around the testis. The fluid is generally serous in nature whereas testicular cancer is a condition in which there is growth of cancerous cells in the testis.

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