Cacer of testis affects mainly younger men in the second and third decade of life. It is a rare cancer and carries a good prognosis with modern treatments.
Clinical Approach in Primary Care
Presenting Symptoms: Usual presenting symtom is painless lump in the testis. The lump should be in the substance of the testis. Some times paitents may present with the swellings in the surrounding structures such as epidydimis. Rarely patients can present with painful testis due to sudden bleeding or trauma affecting the pre-existing cancer
Approach to the Management
1. Clinical Examination: It is important to ascertain if the swelling in question is in the substance of the testis or in the surrounding tisssues. Some times the swelling can be embedded ont he surface of the testis in conditions such as severe epidydimitis at the settling phase. However the initial onset history may be more characteristic of inflammation in such patients.
2. Tumour markers: It is important to do the blood tests to look for some substances that are produced by tumours called tumour markers. Tumour markers for testicular cancers are Alfa feto protein (AFP), HCG, and LDH.
3. Ultrasound scan of Testis: The ultra sound scan is the current diagnostic imaging standard for Testicular cancers. It will also help to differentiate swelllings caused by other conditions.
4. If testicular cancer is suspected by clinical examination or confirmed by scan, immediate referral to an Urologist is advisable. General practitioners in UK can refer such patients under 2-week suspected cancer rule to the local NHS Urology service or urgent referral to a private Urologist.