Clinical features/presenting features of testicular cancer

In 95% of cases the patient or his partner notices a lump in the body of the testis or that one testis is larger than the other.

• it is usually painless while some may cause episodic pains, possibly due to haemorrhage
  • lack of pain results in delayed medical consultation usually for several months
• a decrease in testicular size may also occur (2)
• other presenting symptoms include:
  • hydrocoele - either primary or which has developed secondary to invasion of the scrotum. This may contain bloodstained fluid
  • metastases: - metastatic growths in lung resulting in cough, pain or haemoptysis- abdominal mass and backache due to enlarged para-aortic lymph nodes - cervical lymphadenopathy (1)

SIGN have suggested the following (1):

• presenting symptoms/history of patients with testicular cancer include:
  • a painless, solid, unilateral mass in the scrotum (majority of cases)
  • enlarged testicle
  • scrotal pain (20% of cases)
  • backache (10%) - a non specific symptom
  • gynaecomastia (7%)
    • commonly in nonseminomatous tumours (3)
  • dragging sensation in the scrotum
  • incidental recent trauma (It is not thought that the trauma causes the cancer, but rather that it brings an existing tumour to the attention of the patient and physician) (2).

The testicular mass is hard, lies within the testis, can be gotten above, and does not transilluminate.

Reference:

• (1) Horwich A et al. Testicular germ cell tumour. BMJ. 2013;347:f6205
• (2) SIGN (March 2011).Management of adult testicular germ cell tumours
• (3) Albers P et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol. 2011;60(2):304-19