TESTICULAR CANCER

It was about 1600 in the family practice office. There were a couple of new patients in the examination rooms waiting to be seen by the nurse practitioner. Both had already said it would be alright for the nurse practitioner student (me) to see them. That was always a benefit for me because it gave me more experience. I looked at one of the charts which were placed by the medical assistant in the plastic rack located on the outside of the door. The chief complaint and the reason for seeking medical attention was “swollen right testicle.” I looked at the age of my new patient and saw he was 24-years-old. I was ready to see my patient. His name was Michael.

I lightly knocked on the door before entering the exam room. Sitting on the examination table was a nice looking young male with a nice smile. That told me he was not in any acute distress. I introduced myself as the nurse practitioner student that would be getting the history and performing his examination. He was okay with that. I sat down on the roller stool and began getting the history. It was important to determine when the patient noticed the problem and how long it had been going on. Also if the problem had been going on a while, why seek medical attention now versus when the problem was noticed. My pen was writing my SOAP note as I asked the patient questions and he gave me the history.

He had noticed right scrotal swelling and intermittent pain about 4 months ago. He knew it was there but it never really bothered him. He had no history of fever or urinary problems. Michael did not perform monthly testicular exams on himself. He noticed two weeks prior to his visit that the pain in his right scrotum started to come more frequently and more intense. He stated his right scrotum seemed to feel heavy. Michael also had pain in his lower abdomen which began about the same time. He then did a testicular examination on himself and found an unusual mass on his right testicle. It scared him so he made an appointment with his family practice office. There was no history of testicular cancer in his family that he knew of.  

It was now time for the physical examination. Michael remained pleasant and nice. I first wanted to do my basic exam by listening to the heart and lungs. I also wanted to do an abdominal exam since he complained of lower abdominal pain. During the exam Michael had slight generalized tenderness over his lower right quadrant as well as the supra pubic area. He told me it felt a little uncomfortable but it was not bad. I felt no masses or abnormalities. It was then time for the scrotal exam. I put gloves on and had Michael stand in front of me. I then palpated the left scrotum and then the right. After palpating the entire testicle and comparing it to the opposite side I found an approximate 1.5 cm round mass on the medial side of his right testicle. It was slightly tender to palpation, solid, and fixed. It was now time for Michael to get dressed and for me to discuss my findings with my preceptor.

It was decided to get an ultrasound to determine what type of mass was in the right scrotum. Michael was also referred to a urologist for further care. Both of these needed to be done as soon as possible. Michael was told the mass could be benign or could be something as serious as cancer. He got a scared look on his face. He promised he would follow through. Michael walked out of the office with the referral slips in his hand. I hoped he would take it seriously.

Michael did get the ultrasound the following day. The report showed a mass on the right testicle suspicious of cancer. Michael needed further follow-up to determine the stage of the cancer and what treatment would be necessary. Michael was called with the ultrasound report. The medical assistant called the urologist’s office to see if Michael had an appointment. He had an appointment for the following week.

If you would like to learn more about testicular cancer click here. This type of cancer affects males between the ages of 15 to 40 years. It is important for men to do monthly testicular exams. Click here for the correct way for doing this. This cancer is treatable if caught early.