Testicular cancer Farooq A Khan and David E Neal
Q. A 26-year-old previously healthy man is referred to the urology clinic on the 2-week wait pro forma with a right-sided testicular mass. How would you assess this patient in clinic?
A. I would take a pertinent history and perform a physical examination with specific reference to the following points:
History related to the mass • Duration of symptoms. • Painful or painless mass. • Change in size of mass. • Any previous history of surgery on the genitalia. • Sexual history: recent sexual contact or penile discharge. • Associated urinary symptoms. • Trauma (does not cause testicular cancer, but may be the cause of the testicu-
lar swelling). Previous relevant history and risk factors
• History of cryptorchidism (on either side) increases the risk of testicular cancer in the undescended testicle by 4-13 times, 1 with 7-10% of testicular tumours arising in an undescended testis.2 There still remains a 5-10% risk of developing testicular cancer in the contralateral testis in those with a history of cryptorchidism.3,4
• Family history of testicular cancer, especially in fathers and brothers, increases the risk by 6 and 8 times, respectively, with 1.35% of cases providing a positive family history.5,6
• Racial origin – testicular cancer is three times more common in Caucasians and in Northern Europe, with the highest incidence in Scandinavia (11 per 100 000 men in Norway and Denmark). In the UK, the incidence is 7.1 per 100 000 men.