Testicular tumor: Difference between revisions
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===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 | |||
==Treatment== | ==Treatment== | ||
Revision as of 23:14, 25 May 2016
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
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
Diagnosis
Work-Up
- testicular US
- UA
- 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[1]
- 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
Treatment
- Urgent urology referral
Disposition
- Outpatient
See Also
References
- ↑ Testicular Cancer: Version 1.2015. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.