Painful Testicular Enlargement May Indicate Cancer

Peter Russell

July 03, 2018

Patients with painful testicular lumps or swelling should be referred urgently by their GP to a specialist as the symptoms are strongly associated with testicular cancer, a UK study found.

The research, published in the British Journal of General Practice, found that painful testicular enlargement was a major risk factor for the disease, contrary to traditional understanding.

The study by Dr Elizabeth Shephard and Prof Willie Hamilton of the University of Exeter Medical School was the first to examine symptoms of testicular cancer using data from general practice surgeries in the UK.

"We know early and accurate diagnosis saves lives in cancer," said Dr Shephard, a PhD research fellow. "The findings of our study give greater clarity on which patients GPs should refer for further investigation for suspected testicular cancer in order to get the best outcome for patients."

Testicular Cancer Rates Increasing

Testicular cancer is the 16th most common cancer among men in the UK with nearly 2300 new cases diagnosed each year. Testicular cancer incidence rates have risen by more than 27% since the early 1990s and are expected to rise by 12% between 2014 and 2035.

The study compared anonymised patient records of 1398 men with testicular cancer to 4956 patients in the year before they were diagnosed with the disease.

The presence of a testicular lump had the highest predictive value for men aged 17 to 49 of 2.5% – close to the current National Institute for Health and Clinical Excellence (NICE) threshold of 3% for referring a patient to a specialist for suspected testicular cancer.

When the researchers combined a testicular lump with testicular swelling or testicular pain it produced a predictive value of 17% and 10% respectively.

Other non-lump combinations also had risk estimates above the NICE 3% threshold, including testicular pain with raised inflammatory markers, or with groin pain, which both had a predictive value of 3.7%.

Poor UK Cancer Survival Rates

"These results largely support the UK recommendations for investigation of possible testicular cancer, though they provide additional information as to which symptoms or symptom combinations warrant ultrasound," the authors said.

Prof Hamilton said: "Despite recent improvements, the UK still lags well behind other countries on cancer survival. Our study showed that some cancers could be confused initially with other testicular conditions, likely leading to delays in diagnosis.

"We design the risk assessment tools we use in our studies to help GPs assess risk in 20 cancers and we're rolling out this work as part of efforts to help improve the number of lives that can be saved."

Dr Richard Roope, clinical lead for cancer at the Royal College of GPs (RCGP) commented: "Testicular cancer affects a growing number of men but it is one of the most treatable types of cancer – in fact, in England and Wales, almost all men (99%) survive for a year or more after being diagnosed with testicular cancer, and 98% survive for 5 years or more after diagnosis.

"This new research indicates a promising breakthrough in understanding the biggest risk factors for testicular cancer. Any testicular swelling should be checked out by the patient's GP and these findings could assist GPs in better identifying symptoms of testicular cancer and knowing when to make an urgent referral so that men with the disease receive better outcomes.

"Furthermore, it is encouraging to see this research, the first of its kind, focussing on the symptoms of testicular cancer reported in general practice, and we hope the findings will be considered by NICE in the development of their guidelines on the disease."

The RCGP said it welcomed plans drawn up by NHS England to pilot a series of 'one-stop' cancer clinics for diagnosis and assessment.

Funding was provided by the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis. The views expressed in the research paper are those of the authors and not necessarily those of the NHS, the Department of Health, or the Policy Research Unit, which receives funding for a research programme from the Department of Health Policy Research Programme.

William Hamilton was clinical lead on the 2015 revision of the NICE guidance on investigation of suspected cancer. His contribution to this article is in a personal capacity, and does not represent the view of the Guideline Development Group, or of NICE itself. Elizabeth Shephard has
declared no competing interests.

Elizabeth A Shephard and William T Hamilton. Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records. Br J Gen Pract 2 July 2018. Abstract.

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