Testicular tumor: Difference between revisions
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==Background== | ==Background== | ||
* | [[File:Gray1144.png|thumb|Scrotal anatomy]] | ||
* | [[File:Figure 28 01 03.jpg|thumb|Testicular anatomy]] | ||
*Most common malignancy in young men, 1% all cancers in men | |||
*Increased frequency in: infertile patients, whites, undescended testis, history of cryptorchidism | |||
*95% germ cell tumors: half seminomas, half mixed types (teratomas, choriocarcinomas, yolk sac tumors) | *95% germ cell tumors: half seminomas, half mixed types (teratomas, choriocarcinomas, yolk sac tumors) | ||
*5% sex cord stromal tumors | *5% sex cord stromal tumors | ||
==Clinical Features== | ==Clinical Features== | ||
* | *Typically present with painless scrotal mass, dull lower abdominal ache, or heaviness sensation | ||
*May have endocrine abnormalities from hCG elevations<ref>Harris M et al. Testicular tumour presenting as gynaecomastia. BMJ. 2006 Apr 8; 332(7545): 837.</ref><ref>Voigt W et al. Human chorionic gonadotropin-induced hyperthyroidism in germ cell cancer--a case presentation and review of the literature. Onkologie. 2007 Jun;30(6):330-4.</ref> | |||
**Gynecomastia | |||
**Hyperthyroid biochemical signs | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Testicular DDX}} | {{Testicular DDX}} | ||
== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
* | *Testicular US | ||
* | *[[Urinalysis]] | ||
*CT of chest/abdomen/pelvis helpful for staging, only necessary in ED if patient has complaints related to this part of body | *CT of chest/abdomen/pelvis helpful for staging, only necessary in ED if patient has complaints related to this part of body | ||
===Evaluation=== | ===Evaluation=== | ||
* | *Testicular US | ||
* | *If pain must rule out epididymitis, torsion | ||
* | *May present with mets at time of diagnosis | ||
**15% present with mets to regional lymph nodes | **15% present with mets to regional lymph nodes | ||
**5% present with mets to abdomen or pelvis | **5% present with mets to abdomen or pelvis | ||
*Urology may ask for LDH, AFP, hCG tumor markers<ref>Testicular Cancer: Version 1.2015. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.</ref> | |||
**Ensure follow up and document carefully, since EPs will not follow up on results | |||
**If no admission is arranged, consider deferring ordering tumor markers to consultants | |||
== | ==Management== | ||
*Urgent urology referral | *Urgent urology referral | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Urology]] | [[Category:Urology]] | ||
Latest revision as of 20:16, 4 June 2020
Background
- Most common malignancy in young men, 1% all cancers in men
- Increased frequency in: infertile patients, whites, undescended testis, history of cryptorchidism
- 95% germ cell tumors: half seminomas, half mixed types (teratomas, choriocarcinomas, yolk sac tumors)
- 5% sex cord stromal tumors
Clinical Features
- Typically present with painless scrotal mass, dull lower abdominal ache, or heaviness sensation
- May have endocrine abnormalities from hCG elevations[1][2]
- Gynecomastia
- Hyperthyroid biochemical signs
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
Work-Up
- Testicular US
- Urinalysis
- CT of chest/abdomen/pelvis helpful for staging, only necessary in ED if patient has complaints related to this part of body
Evaluation
- Testicular US
- If pain must rule out epididymitis, torsion
- May present with mets at time of diagnosis
- 15% present with mets to regional lymph nodes
- 5% present with mets to abdomen or pelvis
- Urology may ask for LDH, AFP, hCG tumor markers[3]
- Ensure follow up and document carefully, since EPs will not follow up on results
- If no admission is arranged, consider deferring ordering tumor markers to consultants
Management
- Urgent urology referral
Disposition
- Outpatient
See Also
References
- ↑ Harris M et al. Testicular tumour presenting as gynaecomastia. BMJ. 2006 Apr 8; 332(7545): 837.
- ↑ Voigt W et al. Human chorionic gonadotropin-induced hyperthyroidism in germ cell cancer--a case presentation and review of the literature. Onkologie. 2007 Jun;30(6):330-4.
- ↑ Testicular Cancer: Version 1.2015. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.