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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
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
Disposition
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.
