Case study highlights importance of early detection of testicular cancer

A case study in this week’s issue of THE LANCET highlights how young men put their lives at risk by hiding large testicular lumps. HD de Boer and colleagues from UMC St Radboud, Nijmegen, Netherlands, describe a case in which a young man was in a motor-vehicle accident. He was examined by his family doctor who noted only minor injuries. Unexpectedly, the man died 4 days later of a pulmonary embolism (blood clot in the lung), which was thought to be associated with the impact of the accident. A post-mortem examination revealed that the fatal pulmonary embolism was a result of cancer that had spread from a testicular tumour, which had probably been present (but undetected by the man and his family doctor) for months.

HD de Boer comments: “Early recognition of testicular carcinoma is essential as it has been shown that a treatment delay of more than 3 months is correlated with a significantly decreased 5-year survival rate. Delay in diagnosis may depend on several factors including patient’s lack of knowledge, embarrassment, ignorance, or fear of cancer and of emasculation. It is important to encourage testicular self-examination and to emphasise the need for prompt medical advice in the event of change in a previously normal testicle.”

In an accompanying Commentary (p 1632), Jeremy Steel from St Bartholomew’s Hospital, London, UK, concludes: “…examination of the external genitalia is an essential part of the abdominal system examination and should be taught to medical students at the beginning of their training. Some men with large testicular lumps continue to evade the medical profession despite all efforts. The 17-year-old man in the Case report may have contributed to his own death by not seeking medical advice earlier...Medical professionals and the general population, especially men, need to be educated to recognise that testicular lumps are a medical emergency.”

Contact: Dr HD de Boer, Department of Anaesthesiology, UMC St Radboud, PO Box 9101, 6500 HB Nijmegen, Netherlands; T) +31 24 361 4406; F) +31 24 354 0462; E) hadobo@hotmail.com

Professor Jeremy PC Steele, Department of Medical Oncology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK; T) F) E) j.p.steele@qmul.ac.uk

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