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Suggest Treatment For Lump On Testicle
Question: My 26 year old son is in Mexico (an athlete with Cirque du Soleil) and is concerned about a small painless lump in the testicle that is size of pea. He has an appointment with a urologist but was cancelled twice and now must wait another week. He has none of the risk factors except that he is Caucasian and we have reviewed the other things it could be (hydrocele, varicocele, spermatocele, inguinal hernia, swollen epididymis, etc) as he is anxious about it. My question is with respect to urgency of investigation given that this is his only symptom. How confident will an urologist be about the diagnosis based on palpation alone, and what is the likelihood that he will need an ultrasound and blood work to confirm diagnosis. What are the protein and enzyme markers that must be ordered on a lab requisition, and should he go ahead to get this blood work done before seeing the urologist to accelerate a diagnosis? If he were to need a biopsy is this an excision of a small piece of tissue or does it require removal of the affected testes? What is the probability that this might be a tumor (I am assuming low?).
I would just like to add that the lump is hard and seems to be attached to the testicle according to my son's report.
I would just like to add that the lump is hard and seems to be attached to the testicle according to my son's report.
Brief Answer:
A scrotal ultrasound would be the best course of action.
Detailed Answer:
Good day and thank you for being with healthcare magic!
Physical examination could determine whether the lump/mass in the testis is intratesticular or extratesticular. And this would be confirmed by using a scrotal ultrasound. Intratestiscular tumors are almost always malignant (cancerous) while extra testicular masses are almost always benign. It would be best to get a scrotal ultrasound now while waiting for the Urologist appointment then present the result of the ultrasound during his check up. In terms of tumor markers or laboratory examinations, only ultrasound would be needed at this point in time and there is no need for any enzymes etc.
In terms of urgency, I believe it is urgent that we do the ultrasound and from there we could determine if he needs further treatment or observation would suffice. In case that ultrasound showed the lump to be a soild intratesticular testicular tumor then the next step would be to get a blood sample for tumor markers. These are alpha feto protein, beta-HCG and LDH. This would more or less say what kind of tumor is present. Then regardless of the results of the tumor markers surgery is needed to remove the entire testis with a procedure we call RADICAL ORCHIECTOMY. Biopsy of testicular tumors is not done because it would upstage the cancer and it would just spread the cancer to surrounding tissues and scrotal wall.
Majority of lumps felt in the testis are extra testicular in origing and are mostly cystic benign lesions without clinical sequela. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://www.HealthcareMagic.com/doctors/dr-manuel-c-see-iv/66014 I would gladly help you. Best wishes.
A scrotal ultrasound would be the best course of action.
Detailed Answer:
Good day and thank you for being with healthcare magic!
Physical examination could determine whether the lump/mass in the testis is intratesticular or extratesticular. And this would be confirmed by using a scrotal ultrasound. Intratestiscular tumors are almost always malignant (cancerous) while extra testicular masses are almost always benign. It would be best to get a scrotal ultrasound now while waiting for the Urologist appointment then present the result of the ultrasound during his check up. In terms of tumor markers or laboratory examinations, only ultrasound would be needed at this point in time and there is no need for any enzymes etc.
In terms of urgency, I believe it is urgent that we do the ultrasound and from there we could determine if he needs further treatment or observation would suffice. In case that ultrasound showed the lump to be a soild intratesticular testicular tumor then the next step would be to get a blood sample for tumor markers. These are alpha feto protein, beta-HCG and LDH. This would more or less say what kind of tumor is present. Then regardless of the results of the tumor markers surgery is needed to remove the entire testis with a procedure we call RADICAL ORCHIECTOMY. Biopsy of testicular tumors is not done because it would upstage the cancer and it would just spread the cancer to surrounding tissues and scrotal wall.
Majority of lumps felt in the testis are extra testicular in origing and are mostly cystic benign lesions without clinical sequela. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://www.HealthcareMagic.com/doctors/dr-manuel-c-see-iv/66014 I would gladly help you. Best wishes.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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