Signs of Testicular Cancer
The most common presentation of testicular cancer is a painless testicular mass or nodule, which is pathognomonic for testicular tumor. 1, 2, 3
Primary Clinical Presentations
Most Common Sign
- Painless testicular mass or swelling is the classic and most frequent presentation, occurring in the majority of cases 1, 2, 3, 4
- Any palpable solid testicular mass should be considered malignant until proven otherwise 1, 4
Pain-Related Symptoms
- Testicular discomfort or pain occurs in approximately 27% of cases, often mimicking epididymitis or orchitis 1
- Back or flank pain is present in approximately 11% of cases, typically indicating more advanced disease with retroperitoneal lymph node involvement 1
- Scrotal heaviness or dull ache may be reported by patients 5, 6
Less Common Presentations
- Gynecomastia occurs in approximately 1% of cases, resulting from hormone production by germ cell or sex cord tumors 1
- Acute testicular pain can occur, though less common than painless presentations 5
Important Clinical Caveats
When Symptoms Mimic Benign Conditions
- Patients often initially present with symptoms suggestive of epididymitis or orchitis 1
- A trial of antibiotics may be given in this circumstance, but persistent tenderness, swelling, or any palpable abnormality after antibiotic treatment warrants immediate further evaluation 1
- Delay in diagnosis correlates with higher stage at presentation, making prompt evaluation critical 1, 2
Incidental Findings
- Testicular masses may be discovered incidentally during ultrasound performed for other reasons, such as fertility evaluation 1
- Elevated serum tumor markers may be the first indication of disease in asymptomatic patients 1
Key Diagnostic Considerations
Age and Demographics
- Testicular cancer primarily affects young men between 20-34 years of age 1, 2, 3
- It is the most common solid malignancy in males aged 15-40 years 3, 6
Risk Factors to Consider
- Cryptorchidism (undescended testis) is the most significant risk factor, increasing risk up to 11-fold 1, 4
- Family history of testicular cancer increases risk substantially 1, 3
- Infertility is associated with elevated testicular cancer risk 1, 3
- Testicular atrophy increases risk 1
Physical Examination Findings
- The contralateral testis should be examined for synchronous tumors or abnormalities 1
- Testicular microcalcifications may be present and are associated with increased cancer risk in high-risk populations 1
Critical Action Points
Any solid testicular mass requires immediate evaluation with testicular ultrasound using a high-frequency (>10 MHz) probe, as this is the primary diagnostic tool to confirm an intratesticular mass 1, 2, 7. The distinction between intra- and extratesticular masses is crucial, as intratesticular masses are considered malignant until proven otherwise 1, 4.