Although researchers don’t know the immediate cause of testicular cancer, they suspect that cryptorchidism (even when surgically corrected) plays a role in the developing disease. A history of mumps orchitis, inguinal hernia in childhood, or maternal use of diethylstilbestrol (DES) or other estrogen-progestin combinations during pregnancy also increases the risk for this disease.

Disease progression may induce back or abdominal pain (from retroperitoneal adenopathy), dyspnea, cough, hemoptysis from lung metastases, and ureteral obstruction.

The patient’s history may disclose previous injuries to the scrotum, viral infections (such as mumps), or the use of DES or other estrogen-progestin drugs by the patient’s mother during pregnancy. The patient may describe a feeling of heaviness or a dragging sensation in the scrotum. He may also report swollen testes or a painless lump found while performing testicular self-examination. In late disease stages, the patient may complain of weight loss, a cough, hemoptysis, shortness of breath, lethargy, and fatigue.

On inspection, you may notice that the patient has enlarged testes. Gynecomastia, a sign that the tumor produces chorionic gonadotropins or estrogen, may also be obvious. In later stages of testicular cancer, the patient may appear lethargic, thin, and pallid.

Palpation findings include a firm, smooth testicular mass and enlarged lymph nodes in surrounding areas. In later disease stages, palpation may disclose an abdominal mass as well.

On auscultation, you may hear decreased breath sounds.

Treatment includes surgery, radiation therapy, and chemotherapy. Treatment intensity varies with the tumor cell type and stage.

Surgical options include orchiectomy and retroperitoneal node dissection to prevent disease extension and assess its stage. Most surgeons remove just the testes and not the scrotum. The patient may need hormonal replacement therapy after bilateral orchiectomy.