Typical Symptoms of Testicular Cancer
The most common presentation of testicular cancer is a painless testicular mass or nodule, which occurs in the majority of patients and should always be considered malignant until proven otherwise. 1, 2, 3
Primary Clinical Presentations
Most Common Symptom
- Painless testicular mass or swelling is the classic and most frequent presentation, occurring in the majority of cases 1, 3, 4
- Any palpable solid testicular mass or nodule is pathognomonic for testicular tumor and must be evaluated immediately 2
- Patients may describe a sensation of scrotal heaviness or a dull ache 5
Pain-Related Symptoms
- Scrotal pain is present in approximately 27% of cases, making it a significant minority presentation 1
- Acute testicular pain can occur, though less common than painless presentations 5
- Back or flank pain occurs in approximately 11% of cases and typically indicates more advanced disease with retroperitoneal lymph node involvement 1
Less Common Presentations
- Gynecomastia (breast enlargement) is present in approximately 1% of cases, caused by β-hCG production by the tumor 1
- Persistent tenderness or any palpable abnormality warrants immediate evaluation 2
Important Clinical Context
Age and Demographics
- Testicular cancer primarily affects young men between 20-34 years of age, with a mean age at diagnosis of 33 years 1, 3
- It is the most common solid malignancy in males aged 15-40 years 3, 6
Risk Factors to Elicit in History
- Cryptorchidism (undescended testis) is the most significant risk factor, increasing risk up to 11-fold 1, 4
- Family history of testicular cancer in first-degree relatives 1, 3
- Infertility or subfertility 1, 3
- Personal history of contralateral testicular tumor 7
Critical Diagnostic Pitfall
A common and dangerous pitfall is misdiagnosing testicular cancer as epididymitis or attributing back pain to vertebral disc problems, leading to delayed diagnosis. 7 Physicians must maintain a high level of suspicion in young men presenting with:
- Any testicular mass or swelling 7
- Persistent scrotal symptoms despite antibiotic treatment 8
- Back pain in the appropriate age group 7
Delay in diagnosis directly correlates with higher stage at presentation and worse outcomes 1.