A 28-year-old man presents with a painless, firm swelling in the body of his right testis. On examination, the swelling feels hard, lies within the testis and does not transilluminate.
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The most likely diagnosis, in this case, is testicular cancer. Testicular cancer is the most common malignancy affecting men aged 20-34 years. Recent campaigns have highlighted the importance of self-examination to aid early detection.
Presentation is usually with a painless testicular swelling that typically:
- Feels hard on palpation
- Lies within the testis
- Can be gotten above
- Does not transilluminate
60% are seminomas that are slow growing and usually confined to the testis on diagnosis. This type has a 98% 5-year survival rate if diagnosed as stage 1 disease (confined to testis only). Other types are teratomas, which can grow faster, and 40% occur within seminomas. Where the tumours are mixed type, they are treated as teratomas as these are the more aggressive. Surgical treatment +/- chemo- and radiotherapy are the mainstays of treatment.
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Risk factors include undescended testes, which, if bilateral, increase the risk 10-fold. A previous history of testicular cancer gives around a 4% risk of developing a second cancer.
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Differential diagnoses that should be considered include:
- Epididymitis
- Epididymo-orchitis
- Haematocoele
- Varicocoele
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This patient should have an ultrasound scan of his testes arranged urgently.
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