Testicular cancer

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Evidence-based recommendationQuestion mark transparent.png Grade
AYAs with an unexplained swelling or mass that clinically is clearly in the body of the testis should be referred urgently to a specialist.
Evidence-based recommendationQuestion mark transparent.png Grade
An urgent ultrasound should be considered in AYAs with a scrotal mass that does not transilluminate and/or when the body of the testis cannot be distinguished.

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Symptoms and signs

Testicular cancers usually present as a firm mass where the tumour develops.[1][2] Testis enlargement may occur with or without pain and in some cases with signs of metastatic spread e.g. back pain, breathlessness.[3]

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Clinical assessment

Adolescents and young adults (AYAs) with a swelling or mass in the body of the testis should be referred urgently to a specialist, particularly if the mass is unexplained (no diagnosis to identify the cause).

General practitioners (GPs) may consider initial investigations (without delaying referral) such as FBC, LFTs, LDH, EUC, alpha fetoprotein (serum) and human chorionic gonadotrophin (beta subunit) and chest x-ray for a testicular mass.[4][5][6]

AYAs with a scrotal mass that does not transilluminate and/or when the body of the testis cannot be distinguished should be referred for an urgent ultrasound.

A trial of antibiotics may be given where there is testicular discomfort or swelling suggestive of epididymitis or orchitis, but persistent symptoms warrant further investigation.[4]

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Risk factors

Testicular cancer has been linked to a history of cryptorchidism and XY gonadal dysgenesis.[3] Exposure to endogenous steroid hormones (particularly high levels of androstenedione) in utero has also been associated with testicular cancer.[7]

However, testicular cancer can occur in AYAs without any of these risk factors.

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  1. Bleyer A. CAUTION! Consider cancer: common symptoms and signs for early detection of cancer in young adults. Semin Oncol 2009 Jun;36(3):207-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19460578.
  2. Adolescent and Young Adult Working Party of the Statewide Cancer Clinical Network. South Australian Adolescent and Young Adult Cancer Care Pathway: Optimising outcomes for all adolescent and young adult South Australians with a cancer diagnosis. Adelaide: South Australia Department of Health; 2010.
  3. 3.0 3.1 New Zealand Guidelines Group. Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities. Wellington: New Zealand Guidelines Group; 2009.
  4. 4.0 4.1 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) Testicular Cancer Version 2.2011. 2011 Abstract available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.
  5. Royal College of Pathologists of Australia. RCPA Manual. Sydney: Royal College of Pathologists of Australia; 2011.
  6. ACT Government Health Directorate, Canberra Hospital and Health Services, Capital Region Cancer Service. Referral pathway for suspected testicular cancer. Canberra: ACT Government Health Directorate; 2012.
  7. Holl K, Lundin E, Surcel HM, Grankvist K, Koskela P, Dillner J, et al. Endogenous steroid hormone levels in early pregnancy and risk of testicular cancer in the offspring: a nested case-referent study. Int J Cancer 2009 Jun 15;124(12):2923-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19330837.

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