Testicular cancer is an uncommon neoplasm in the general population, but it is especially relevant because it predominantly affects young men and has high chances of cure with appropriate treatment.
Most malignant testicular tumors are germ cell tumors.
In practical terms they are divided into:
This distinction is important because it changes subsequent treatment.
The classic presentation is a painless testicular mass.
The patient may report:
Key concept
A solid testicular mass must be considered potentially malignant until proven otherwise.
Not every scrotal mass is cancer. The differential diagnosis includes hydrocele, epididymitis, epididymal cysts, varicocele, and testicular torsion.
The following should be performed:
Inspection → palpation of both testicles → epididymis and spermatic cord → inguinal regions → abdominal evaluation when appropriate.
It is important to differentiate whether the lesion is intratesticular or extratesticular.
When a testicular mass is suspected, the fundamental initial study is testicular ultrasound.
It allows determination of:
Before treatment, the following should be ordered:
They are important for diagnosis, staging, prognostic classification, and follow-up.
Exam pearl
A pure seminoma does not produce AFP. If AFP is elevated, we should consider the presence of a non-seminomatous component.
NOT via the scrotal route
With a highly suspicious testicular lesion, the standard approach is not to perform a transscrotal biopsy.
The usual diagnostic and therapeutic procedure is radical orchiectomy via an inguinal approach.
Orchiectomy is usually the first treatment and also provides the definitive histologic diagnosis.
After diagnosis, the extent of disease is assessed by means of:
Retroperitoneal lymph nodes are particularly important in the spread of testicular cancer.
The usual initial treatment is inguinal radical orchiectomy.
Afterward, depending on histology + stage + markers + risk factors, the patient may continue with:
Not all patients need additional treatment after orchiectomy; surveillance is an established strategy in certain early-stage tumors.
It is particularly important because many patients are young.
Before certain treatments, fertility preservation should be discussed, including sperm cryopreservation when appropriate.
Some treatments can transiently or permanently affect fertility.
Testicular cancer and penile cancer are evaluated differently from the start:
| Suspicious testicular mass | Suspicious penile lesion | |
|---|---|---|
| Initial study | Ultrasound | Exam + biopsy |
| Routine local biopsy | NOT transscrotal | YES |
| Classic diagnostic surgery | Inguinal orchiectomy | Depends on lesion/stage |
| Relevant first-echelon lymph nodes | Retroperitoneal | Inguinal |
| Organ preservation | Selected situations | A priority when oncologically safe |
Final pearl
Testicular mass: think ultrasound, markers, and inguinal orchiectomy; do not biopsy through the scrotum.
Key takeaways from this lesson
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