Synopsis
Treat a solid intratesticular mass as cancer until proved otherwise, measure markers before inguinal orchidectomy, avoid trans-scrotal biopsy and deliver risk-adapted surveillance, chemotherapy or retroperitoneal treatment with fertility and cure central.
- Painless intratesticular mass is a pivotal clue in Testicular germ-cell tumour: A firm unilateral lump, change in consistency or diffuse enlargement is the common presentation and needs urgent ultrasound.
- Immediate priority in unstable Testicular germ-cell tumour: Use immediate urological exploration for suspected torsion without delaying for tumour markers, and stabilise metastatic emergencies with the germ-cell centre because precipitous chemotherapy can cause tumour lysis or pulmonary haemorrhage in heavy choriocarcinoma burden.
- Scrotal ultrasound is used early to distinguish an intratesticular solid lesion from epididymal, cystic or inflammatory pathology. A solid vascular intratesticular mass is malignant until assessed; ultrasound of the contralateral testis documents baseline and additional lesions.
Key red flags
A painless firm intratesticular lump or enlarged testis persists despite lack of constitutional symptoms.
Cough, dyspnoea or haemoptysis suggests lung or mediastinal spread and can become critical with high-volume choriocarcinoma.
Investigation priorities
Distinguish an intratesticular solid lesion from epididymal, cystic or inflammatory pathology.
Management branches
Examination or ultrasound identifies a suspicious solid intratesticular lesion.
- Take AFP, hCG and LDH before surgery, assess the contralateral testis and arrange urgent referral to the germ-cell pathway.
- Offer sperm banking before orchidectomy when a solitary testis or fertility context makes this important and delay is safe.
Key medicines
BEP chemotherapyA standard 21-day good-risk regimen gives bleomycin 30,000 international units IV on days 1, 8 and 15, etoposide 100 mg/m² IV on days 1–5 and cisplatin 20 mg/m² IV on days 1–5 for 3 cycles.
EP chemotherapy when bleomycin is unsuitableFor good-risk metastatic disease when bleomycin is contraindicated, a standard alternative is etoposide 100 mg/m² IV and cisplatin 20 mg/m² IV on days 1–5 every 21 days for 4 cycles.