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Part 2 book “Comprehensive textbook of genitourinary oncology” has contents: Testicular cancer, anatomy and pathology of testis cancer, staging of testicular cancer, management of advanced germ cell tumors, management of localized renal cell carcinoma, and other contents. | PAR T III TESTICULAR CANCER CHAPTER 28 ■ Testicular Cancer: Clinical Signs and Symptoms Timothy A. Masterson and Stephen D.W. Beck Testicular cancer, although relatively rare, is the most common malignancy among men aged 15 to 35 years. Prior to the introduction of cisplatin-based chemotherapy in the mid-1970s, testicular cancer accounted for 11.4% of all cancer deaths in the 25- to 34-year age group (1). With platinum-based regimens, it is now expected that 95% of patients with early-stage testicular cancer, and up to 70% to 80% of patients with advanced disease, will survive. The American Cancer Society estimates that in the year 2009, about 8480 new cases of testicular cancer will be diagnosed and 350 men will die of the disease in the United States (2). The diagnosis of testicular cancer is typically not difficult. Over 95% of solid testicular masses are neoplastic, and combined serum tumor markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are elevated in 90% of patients (3,4). For the vast majority of men, the diagnosis of testicular cancer can be included or excluded with scrotal examination and serum tumor markers. Nevertheless, occasionally, the diagnosis of testicular cancer can be problematic and must remain at least on the differential for young men presenting with an array of signs and symptoms. SIGNS AND SYMPTOMS Scrotum The most common presentation of testicular cancer relates to the site of origin and typically presents as a nodule or a painless swelling in one gonad (Table 28.1). A painful testis is the next most common symptom, and in 10% this pain is acute on onset (5). Testicular pain at presentation is possibly secondary to hemorrhage or mass effect and has been linked to rapid tumor growth observed in nonseminomatous germ cell tumors (NSGCT). Seminomas have a slower growth rate and more often present with a painless mass. Sandeman reported testicular pain as the initial presenting symptom in 47% and 38% of nonseminoma .
