Testicular Cancer - The Great Masquerader

Purpose:  Testicular cancer is rare with increasing incidence worldwide. Testicular cancer can mimic many other diseases leading to delay in diagnosis. Delays in diagnosis and management of testicular cancer are associated with advanced stage, increased morbidity and poor prognosis. This case report aims to highlight a case of testicular cancer who presented with metastasis due to delays in testicular cancer diagnosis and ways to improve diagnosis. Methodology: The study focused on a 17-year-old boy presented with severe intermittent abdominal pain for a month. He was reviewed by the general physicians, internists, haematologists, radiologists, general surgeons and urologists. He was given several diagnoses before he was correctly diagnosed as advanced right testicular cancer. It took a total of 31 days in a tertiary institution to reach this diagnosis. Findings: The boy had a radical right inguinal orchidectomy. He had 4 courses of bleomycin, etoposide and cisplatin chemotherapy. He made remarkable recovery after treatment. A follow up was recommended closely with abdominal CT, and serum tumour markers (reverted to normal after treatment). Recommendations: Prompt diagnosis of testicular cancer can reduce treatment delays. Physician education, adequate patient evaluation, investigations, and a high index of suspicion would aid diagnosis. Health awareness campaign, testicular self-examination, and good health insurance schemes would reduce patient-related factors which result in delays. Reduction in diagnostic delay is expected to improve outcome and reduce cost of management of the disease.