Identifying testicular cancer

A large matched-control study (click here for study) in men over 17 has identified clinical markers of testicular cancer that could facilitate earlier diagnosis and more accurate referral for investigation.

A total of 1398 cases of testicular cancer were identified on the Clinical Practice Research Datalink database, diagnosed between 2000 and 2012, along with 4956 age-, sex-, and practice-matched controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling (odds ratio [OR] 280, 95% confidence interval [CI] = 110–690), testicular lump (OR 270, 95% CI = 100–740), and scrotal swelling (OR 170, 95% CI = 35–800). The highest positive predictive values (PPV) for 17–49-year-olds was testicular lump, at 2.5% (95% CI = 1.1–5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively.

The results support the current NICE guidance for testicular cancer which recommends urgent specialist referral for men with non-painful enlargement or a change in shape or texture of the testis. A direct-access ultrasound should be considered for men with persistent or other unexplained testicular symptoms.

The study shows that recorded hydrocele, epididymis/orchitis, or testicular pain (especially when these lead to a second consultation) appear to be important features of testicular cancer in primary care. According to the researchers the fact that these presumptive or possibly erroneous diagnoses have an association with cancer makes them candidates for investigation. This study suggests that recurrent testicular pain, unresolving epididymis-orchitis, or hydrocele should prompt further investigation.

Testicular cancer tends to be diagnosed early and GPs are generally referring promptly and appropriately. However, the authors point out that earlier diagnosis is likely to be accompanied by better outcomes and fewer complications.

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