Testicular cancer is the most common solid cancer in men aged 15 to 35, and nearly all are germ cell tumors, either seminoma or nonseminoma. The main risk factor is an undescended testicle, and even when it has spread it is one of the most curable cancers.
Key symptoms
- Painless lump or swelling in one testicle
- Heaviness or a dull ache in the scrotum or lower belly
- Breast tenderness or growth (gynecomastia)
- Back pain, cough or breathlessness when it has spread
What you find on exam
- Firm, non-tender mass within the testicle that does not light up with a penlight
- Compare both testicles and feel the epididymis separately
- Abdominal exam for masses
- Check the supraclavicular lymph nodes and breast tissue
Tests
- Scrotal ultrasound first: solid mass inside the testicle
- Tumor markers before surgery: AFP, beta-hCG and LDH
- CT of the abdomen and pelvis, plus chest imaging, for staging
Treatment basics
- Radical inguinal orchiectomy for diagnosis and treatment; never a cut through the scrotum
- Offer sperm banking before treatment
- By stage: surveillance, radiation for seminoma or cisplatin-based chemotherapy
- Retroperitoneal lymph node dissection in selected cases
- Long-term follow-up with tumor markers and imaging
Red flags
- Any firm, painless testicular mass in a young man
- Back pain, breathlessness or coughing blood, which suggest spread
- A scrotal mass that does not improve after treatment for presumed epididymitis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.