Regarding Testicular Cancer

Which one of the following scenarios is the most common presentation of testicular cancer?

A. Painful testicular lump in a 56-year-old man
B. Painless testicular lump in a 27-year-old man
C. Painless testicular lump in a 43-year-old man
D. Painful testicular lump in a 25-year-old man
E. Painful testicular lump associated with dysuria in a 38-year-old man

Answer:
B. Painless testicular lump in a 27-year-old man

Discussion:

Testicular cancer is the most common malignancy in men aged 20-30 years.
Around 95% of cases of testicular cancer are germ-cell tumours.

Germ cell tumours may essentially be divided into:
 seminomas
 teratomas
Other type of germ cell tumours include yolk sac tumours.

Non-germ cell tumours include Leydig cell tumours and sarcomas.

The peak incidence for teratomas is 25 years and seminomas is 35 years.

Risk factors include:
 cryptorchidism
 infertility
 family history
 Klinefelter's syndrome
 mumps orchitis

Features 
 a painless lump is the most common presenting symptom
 pain may also be present in a minority of men
 other possible features include hydrocele, gynaecomastia

Diagnosis 
 ultrasound is first-line

Management 
 orchidectomy
 chemotherapy and radiotherapy may be given depending on staging

Prognosis is generally excellent
 5 year survival for seminomas is around 95% if Stage I
 5 year survival for teratomas is around 85% if Stage I