Initial Presentation and Symptoms
Most testis cancers present as a mass confined to the testicle. Therefore, the most common presentation is a painless testicular mass. Most of these masses are palpable and of significant size (a few to several centimeters). Small, non-palpable lesions without pain and in the absence of distant disease have a higher likelihood of being a benign tumors. In a number of studies, upwards of 80% of non-palpable, asymptomatic masses that are 2cm or smaller will be benign tumors. Benign lesions may include testicular cysts, small infarcts, or small Leydig cell or Sertoli cell tumors.
Serious, acute pain is associated with rapidly growing tumors and associated hemorrhage or infarction (if the tumor outgrows its blood supply). Most patients with pain complain of dull scrotal discomfort or heaviness. Rarely trauma can lead to a diagnosis, mostly because it brings a mass or pain to the patient's awareness.
For the upwards of 30% of men who present with metastatic cancer, symptoms of metastases can be the presenting complaint. Bulky retroperitoneal lymphadenopathy can lead to abdominal mass; abdominal, flank or back pain due to direct invasion or obstruction of muscles, blood vessels or the ureters; lower extremity swelling if the IVC is compressed or gastrointestinal symptoms if the intestines are involved. Pulmonary metastases can present as chest pain, shortness of breath and cough.
As testis cancers can lead to diminished spermatogenesis, infertility can be the initial presentation in rare men.