Testicular Cancer Presentation and Diagnosis
Clinical Presentations
- The most common presentation of testicular cancer is a painless testicular mass or nodule, which should be further evaluated with transscrotal ultrasound with Doppler to confirm the diagnosis, as recommended by the National Comprehensive Cancer Network 1, 2, 3, 4
- Testicular cancer can sometimes present with scrotal pain, present in approximately 27% of cases, or back or flank pain, present in approximately 11% of cases, typically indicating more advanced disease, according to the Annals of Oncology 5
- Gynecomastia is present in approximately 1% of cases, as reported by the Annals of Oncology 5
Diagnostic Approach
- The primary diagnostic tool to confirm the presence of an intratesticular mass is transscrotal ultrasound with Doppler, which should use a high-frequency (>10 MHz) probe, as recommended by the National Comprehensive Cancer Network and the Annals of Oncology 1, 2, 3, 4, 5, 6
- Serum tumor markers, including alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH), should be measured before orchiectomy, as recommended by the National Comprehensive Cancer Network and the Annals of Oncology 1, 2, 3, 4, 5, 6
- Radical inguinal orchiectomy provides definitive histological diagnosis and should be performed via inguinal approach, never scrotal, as recommended by the National Comprehensive Cancer Network and Praxis Medical Insights 1, 2, 3, 4, 6, 7
Important Clinical Considerations
- Testicular cancer primarily affects young men between 20-34 years of age, with approximately 95% of testicular cancers being germ cell tumors (GCTs), as reported by the National Comprehensive Cancer Network 1, 2, 3, 4
- Risk factors include cryptorchidism, family history of testicular cancer, and infertility, as reported by the National Comprehensive Cancer Network 1, 2, 3, 4
- Delay in diagnosis correlates with higher stage at presentation, as reported by Praxis Medical Insights 6
- Approximately 55-60% of GCTs are pure seminomas and 40-45% are non-seminomas, as reported by the Annals of Oncology 5