Testicular Cancer

Discussion in 'Men's Health Forum' started by Michael Scally MD, Jul 3, 2018.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Selection of Men for Investigation of Possible Testicular Cancer in Primary Care

    [Contrary to traditional teaching, painful testicular enlargement is a strong predictor of testicular cancer, a general practice study has shown. The research, published in the British Journal of General Practice, found that testicular enlargement—a lump or swelling—was the biggest risk factor for testicular cancer.]

    Background Testicular cancer incidence has risen over the last two decades and is expected to continue to rise. There are no primary care studies on the clinical features of testicular cancer, with recent National Institute for Health and Care Excellence (NICE) guidance based solely upon clinical consensus.

    Aim To identify clinical features of testicular cancer and to quantify their risk in primary care patients, with the aim of improving the selection of patients for investigation.

    Design and setting A matched case–control study in males aged ≥17 years, using Clinical Practice Research Datalink records.

    Method Putative clinical features of testicular cancer were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for those aged <50 years.

    Results In all, 1398 cases were available, diagnosed between 2000 and 2012, 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 to 690), testicular lump (OR 270, 95% CI = 100 to 740), and scrotal swelling (OR 170, 95% CI = 35 to 800). The highest PPV for 17–49-year-olds was testicular lump, at 2.5% (95% CI = 1.1 to 5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively.

    Conclusion Testicular enlargement carries a risk of cancer of 2.5% — close to the current 3% threshold in UK referral guidance. Contrary to traditional teaching, painful testicular enlargement may signify cancer. Some initial hydrocele diagnoses appear to be wrong, with missed cancers, suggesting an ultrasound may be useful when a hydrocele diagnosis is uncertain. These results support the existing NICE guidelines, and help to characterise when an ultrasound should be considered in symptomatic men.

    Shephard EA, Hamilton WT. Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records. British Journal of General Practice 2018. Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

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  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Cheng L, Albers P, Berney DM, et al. Testicular cancer. Nature Reviews Disease Primers 2018;4:29. Testicular cancer | Nature Reviews Disease Primers

    Testicular cancer is the most common malignancy among men between 14 and 44 years of age, and its incidence has risen over the past two decades in Western countries. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. Progress has been made in our understanding of the disease since the initial description of carcinoma in situ of the testis in 1972 (now referred to as germ cell neoplasia in situ), which has led to improved treatment options. The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer, although some patients become refractory to chemotherapy or have a late relapse; an improved understanding of the molecular determinants underlying tumour sensitivity and resistance may lead to the development of novel therapies for these patients. This Primer provides an overview of the biology, epidemiology, diagnosis and current treatment guidelines for testicular cancer, with a focus on germ cell tumours. We also outline areas for future research and what to expect in the next decade for testicular cancer.
     

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