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WEEKLY TOP 7 – Top 7 clinical signs of testicular cancer

These days medical students are just flooded with a huge amount of information –different description of diseases, fresher and fresher publications – available online. It is really difficult to pick the clinically relevant data, especially when you do not have those years of practice behind your back. In our blog series, You will find short and straightforward lists of clinical signs and symptoms most typical and pathognomonic in certain diseases.

At the end of World Men’s Health Week, we discuss the most frequent solid malignancy affecting the gentlemen between the ages of 15 to 35: the testicular cancer. Testicular germ cell tumor is one of the most curable solid malignancies, even when it is metastatic! That is why you should recognize its symptoms in time and teach male patients how to perform self-examination. Break the taboos!

1. Nodule or swelling in the testicles

Why? Abnormal mass is a key symptom  of many cancers. A painless lump in the testicle is the most common sign of testicular cancers; however sometimes it may appears with a dull ache or heavy feeling in the lower abdomen, perianal area or scrotum.

2. Metastases

Why? At times the symptoms caused by the metastases warn you earlier about malignancy than the signs of the primary tumor. Here is some good news though: testicular germ cell tumors are curable even in an advanced stage, even with metastases! The most common metastatic signs are:

Locaion of metastases

Symptom

Cancer spread to the retroperitoneal lymph nodes

Lumbar back pain

Retroduodenal metastases

Nausea, vomiting, gastrointestinal hemorrhage

Supraclavicular lymph node metastasis

Neck mass

Pulmonary metastases

Cough, dyspnea, chest pain

Nervous system involvement

Headaches or confusion

3. Gynecomastia

Why? Half of the malignant testicular cancers contain more than one single cell type. Tumors with trophoblastic cells can produce hCG that leads to the growth of the breast in males as well. This symptom appears approximately in 5% of patients with testicular germ cell tumor.

4. Palpitation, weight loss, nervousness, tremor

Why? Does this list of symptoms remind you about a disease? They should: the answer is hyperthyroidism. Patients who have hCG overproduction can present the symptoms of hyperthyroidism as the TSH and the hCG have a common α-subunit and a β-subunit with a strong homology.

5. Young boys with deepening voice and facial hair growth

Why? Testicular germ cell tumors with mixed cell types can produce androgens, too. The overproduction of these hormones maynot have substantial effects on male adults but  they result in precocious puberty in young boys.

6. Personality changes, irritability, dementia

Why? Paraneoplastic limbic encephalitis is a rare condition in testicular cancer. There is an antigen called Ma2 which is exclusively expressed in the neuronal nucleoli of normal brain tissue and the patient’s testicular tumor. The presence of anti-Ma2 antibodies  prompts cancer screening.

7. Cryptorchidism in the anamnesis

Why? It is always difficult to quantify risk factors and choose the clinically relevant ones. However, there is one condition which shows a significant correlation with testicular germ cell tumors: cryptorchidism. Men with the history of an undescended testicleare at increased risk for testicular cancer in both testes.

 

After learning the basics, test your knowledge in practice by solving cases in InSimu Patient app! You can download it for iOS or Android.

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Sources:

https://emedicine.medscape.com/article/279007-overview
https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-staging-of-testicular-germ-cell-tumors?search=testicular%20cancer&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
https://www.uptodate.com/contents/epidemiology-of-and-risk-factors-for-testicular-germ-cell-tumors?topicRef=16286&source=see_link
https://www.cancer.org/cancer/testicular-cancer/do-i-have-testicular-cancer.html
https://www.ncbi.nlm.nih.gov/pubmed/10869059