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Old 05-17-2011
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Cool Approach to testicular swelling

I want to share with you people something which I found new while doing practice questions?
A patient while taking shower notices testicular swelling which is painless and originating from testis, what will be the next step of management?
Your answer should be inguinal orchiectomy and histology! never answer incisional biopsy, fine needle aspiration, excisional biopsy or detection of various tumor markers, This tumor is among those in which you have to follow "first shoot then ask question" strategy.
Because all other options increases risk of tumor spread and that is why avoided.
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Old 05-17-2011
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Thank you for the nice note.
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Old 05-17-2011
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Quote:
Originally Posted by insomnic View Post
I want to share with you people something which I found new while doing practice questions?
A patient while taking shower notices testicular swelling which is painless and originating from testis, what will be the next step of management?
Your answer should be inguinal orchiectomy and histology! never answer incisional biopsy, fine needle aspiration, excisional biopsy or detection of various tumor markers, This tumor is among those in which you have to follow "first shoot then ask question" strategy.
Because all other options increases risk of tumor spread and that is why avoided.
Could it be something else than testicular tumor? Although not too likely though!

Should it be any non invasive (also not enhance cancer spread) apprach before going ahead with orchiectomy, like ultrasound?
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Old 05-17-2011
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I remember getting a question similar to this in one of the question banks as well. (It advised the orchiectomy without biopsy.)

I took the real test today and this concept is definitely important.

It seems this approach (surgery without biopsy) is also encouraged for lung masses that are likely to be cancer.
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Old 05-18-2011
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depends on the age of the patient. Sure if he is young usually testicular cancer presents as a painless swelling or mass usually after trauma. First step would be inguinal orchiectomy. Depending on whether they are seminomatous or non-seminomatous and on the stage of each, management would be different.
Keep in mind that ddX for testicular swelling is ALOT and u need history!!!! i mean u have testicular torsion, epididymitis, hydrocele, varicocele, inguinal hernia, cancer, paratesticular tumours, testicular appendage, hematocele following trauma, u name it!
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