# Testicular cancer

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD28.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Testicular Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK563159/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
TESTICULAR CANCER
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD28.03 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Testicular Cancer - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK563159/
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (8)
    - Most patients notice a painless lump on one testicle, often found incidentally  [skin nodule]
    - Pain occurs less often - dull pain in roughly a third of patients and sudden acute pain in
      about 10%
    - Metastatic disease can bring loss of appetite, malaise, and weight loss  [malaise · poor
      appetite · weight loss]
    - Lung spread may cause cough or breathlessness  [breathlessness · cough]
    - Bulky retroperitoneal spread can cause back pain or a new varicocele from gonadal vein
      compression  [back pain]
    - Retroduodenal spread can cause nausea, vomiting, or gastrointestinal bleeding  [bleeding ·
      nausea · vomiting]
    - Vascular obstruction or clotting from spread can cause leg swelling  [leg swelling]
    - Spread to the brain, spinal cord, or nerve roots can cause central or peripheral neurologic
      symptoms
  SIGNS - what you find (4)
    - Exam typically reveals a firm mass within the testicle itself  [skin nodule]
    - Neck or collarbone-area lymph node swelling can indicate lymphatic spread  [lymphadenopathy]
    - A tumor is present in the opposite testis at the same time in about 0.6% of patients, so both
      sides need examination
    - A coexisting hydrocele can block full palpation, so ultrasound is used to confirm any
      underlying lesion
  TESTS (8)
    - Scrotal ultrasound combined with the physical exam gives close to 100% diagnostic sensitivity
    - A hypoechoic, solid, vascular mass within the testis on ultrasound is suspicious for cancer
    - Serum AFP, hCG, and LDH tumor markers are checked before any surgical intervention
    - Biopsy through the scrotum raises local recurrence risk to 2.9% versus 0.4% with standard
      orchiectomy, so it is avoided
    - All patients get abdominal and pelvic CT staging; chest CT is added when tumor markers are
      elevated
    - Brain imaging is added when beta-hCG is very high, because choriocarcinoma can spread there
      through the bloodstream
    - Higher LDH levels tend to track with greater tumor burden, though LDH itself is a nonspecific
      marker
    - AFP is never raised in pure seminoma or pure choriocarcinoma, which helps distinguish tumor
      subtype
  IF NOT THIS - what else fits (10)
    - Epididymo-orchitis
    - Hematoma
    - Inguinal hernia
    - Hydrocele
    - Spermatocele or epididymal head cyst
    - Varicocele
    - Lymphoma is the most common cause of a bilateral testicular lesion in an older man
    - Metastasis from other cancers (lung, melanoma, prostate) can mimic a primary testicular tumor
    - Syphilitic gumma
    - Tuberculoma
  Source  StatPearls "Testicular Cancer" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    Testicular malignancy typically presents as a painless testicular lump; the GP's role is
            prompt recognition and urgent urology/oncology referral, not treatment. - Refer
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Testicular malignancy typically presents as a painless testicular lump; the GP's role is
            prompt recognition and urgent urology/oncology referral, not treatment.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - A painless testicular mass or swelling, testicular hardness or irregularity,
            or gynecomastia or back pain suggesting metastatic spread.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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