Fast Five Quiz: Testicular Cancer

Elwyn C. Cabebe, MD


June 15, 2021

In patients with localized disease, painless swelling or a nodule in one testicle is the most common presenting sign. On physical examination, this mass or nodule cannot be separated from the testis. Patients with atrophic testes will feel enlargement. A dull ache or heavy sensation in the lower abdomen could be the presenting symptom. Patients who experience a hematoma with trauma should undergo evaluation to rule out testicular cancer.

Gynecomastia may occur in about 5% of patients with testicular germ cell tumors that produce human chorionic gonadotropin (hCG), such as choriocarcinoma. Marked overproduction of hCG can result in hyperthyroidism because hCG and thyroid-stimulating hormone have a common alpha subunit and a beta subunit with considerable homology.

Patients with disseminated disease can present with manifestations of lymphatic or hematogenous spread. With supraclavicular lymph node metastasis, the presenting sign can be a neck mass. Metastatic disease may also result in anorexia, nausea, and other gastrointestinal symptoms. Bulky retroperitoneal disease can present as back pain. Cough, chest pain, hemoptysis, and shortness of breath can be presenting symptoms of mediastinal adenopathy or lung metastasis. Central nervous system disease could rarely present as neurologic symptoms. Bone pain is rare.

Read more about the presentation of testicular cancer.


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