How early can we predict the risk of testicular cancer? 

Cancer
testicular cancer

A study published in the British Journal of General Practice sought to identify clinical features that can help clinicians with a faster prediction of testicular cancer.

Testicular cancer is one of the most prevalent cancers in males between the ages of 15-29 in Canada. However, it has a very good prognosis and is one the most easily cured cancers with five-year survival rates ranging from 96 to 99% for cancers that have not spread to distant organs. Nevertheless, a quick diagnosis and frequent examination is the key for prevention and cure in this type of cancer.

A study published in the British Journal of General Practice in 2018 sought to identify relevant clinical symptoms and features that stand out when patients first report to the general doctors. Furthermore, the study was done to systematically assign different symptoms a score to effectively and efficiently predict the risk of testicular cancer.

The study was funded National Institute of Health Research and carried out by researchers from the University of Exeter in the United Kingdom. Researchers mined data electronic databases that house patient history and compared data from almost 1400 patients with testicular cancer and almost 5000 people of similar age who did not have the diseases.

Symptoms associated with the risk of testicular cancer

The researchers found that there are about nine symptoms that were associated with the risk of testicular cancer. About two-thirds of patients had reported one of these symptoms to their clinicians in the year before diagnosis. The most common features that were helpful in the prediction of testicular cancer risk were testicular swelling, the presence of lumps within testes, and scrotal (pouch of skin that protects testicles) swelling.

Clinicians and scientists can calculate the predictive values of symptoms and how they influence the likelihood of getting cancer. Urgent referral in the UK requires that predictive value (chance of getting cancer) of symptoms towards the disease is at least 3%. The predictive value of testicular lump and testicular swelling were around 2.5%, which is very close to this threshold, suggesting that this symptom could be of great importance in the prompt diagnosis of the diseases.

When multiple systems were presented to the clinicians, the study showed that these symptoms were much more useful in predicting cancer risk in comparison to when patients presented with only one the symptoms. For instance, the combined predictive value of testicular pain and swelling with testicular lumps indicted a very high probability of getting testicular cancer (ranging from 10%-17%). Other symptoms that were useful in predicting this risk were abdominal pain, increase in inflammatory markers, groin pain, and fluid accumulation in scrotal sacs (hydrocele).

Study may provide better guidelines for predicting testicular cancer risk

The authors concluded that this study provides much better guidelines to general practitioners in predicting testicular cancer risk in patients and referring them to cancer specialist based on physical examination.

Written by Vinayak Khattar, Ph.D., M.B.A.

Reference: Shephard, E. A., & Hamilton, W. T. (2018). Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records. Br J Gen Pract, 68(673), e559-e565. doi:10.3399/bjgp18X697949

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