25-year-old Kyle comes to the office after palpating a lump on his left testicle while showering this morning. On physical examination, there is a nontender, round, firm, rubbery mass in the left testicle that does not transilluminate with light. Scrotal ultrasound shows a 1.4-cm solid mass with no cystic components. Laboratory tests reveal normal serum human chorionic gonadotropin or hCG level, and normal α-fetoprotein or AFP level. Later that day, 32-year-old William comes to the physician's office complaining of heat intolerance, excessive sweating, palpitations, frequent bowel movements and recent weight loss despite increased appetite. His past medical history is insignificant. On examination, the thyroid gland is normal with no signs of goiter or nodules. However, a hard nodule is palpated in the right testicle which does not transilluminate with light and appears solid on scrotal ultrasound. Laboratory studies show increased serum T4 and T3 levels as well as extremely elevated hCG levels.
Based on the initial presentation, Kyle and William both have some form of testicular mass. In fact, testicular tumors are the most common solid malignancy in males between 20 and 35 years old.
Okay, now, for your exams, it’s important to know that the main risk factors for developing testicular cancer, especially the germ cell variety, include cryptorchidism, which is when the testicles fail to descend to the scrotum or get stuck in the inguinal canal, as well as Klinefelter syndrome, where biological male individuals inherit more than one X chromosome leading to small, undeveloped testicles.
For symptoms, a testicular tumor most often comes up as a small, firm lump that is typically painless, but can sometimes cause a sharp or dull pain in the testicles and lower abdomen. In more severe cases, symptoms may arise from a malignant tumor metastasizing to other organs. This is most commonly hematogenous to the lungs, leading to dyspnea or hemoptysis, which is the coughing of blood, or to the brain, leading to headache, nausea, vomiting or seizures. Another way for the cancer cells to metastasize is by the testicular lymphatic system that drains into retroperitoneal lymph nodes. Metastasis to these lymph nodes leads to symptoms like lower back pain.
