Early DetectionP r i m a ry care providers shouldp e rf o rm testicular exams whenthey conduct physical exams onmale patients. At that time, educa-tion also should be off e red con-c e rning testicular self-exam. Manystudies have shown that primaryc a re providers do not examine oreducate their patients re g a rd i n gthe occurrence and early detectionof testicular cancer. Genetics mayplay a role in early detection of tes-ticular cancer. Significantly higherlevels of an overactive hiwi genehave been discovered in men withtesticular cancer. Early detectionof this gene and development of ameans to inactivate the gene maybe beneficial in eliminating testicu-lar cancer (NCI, 2008b). At thistime, genetic testing is being evalu-a t e d .Signs and SymptomsThe signs and symptoms oftesticular cancer may be vague.One of the signs is a painless lumpin the testicle that may be associ-ated with diffuse swelling ore n l a rgement of the testicle.Gynecomastia (swelling of theb reast) also may occur. Somesymptoms in men with metastaticdisease could include shortness ofbreath, masses in the neck, andback pain (Stevenson & McNeil,2004).Diagnosis Although the number ofdeaths is decreasing, the inci-dence of testicular cancer is ris-ing. Delay in diagnosis has beenc o rrelated with a lower responserate to treatment, a higher stage ofcancer, and a higher mortality rate(Vasudev, Joffe, Cooke, Richards,& Jones, 2004). Early diagnosisand treatment are keys to curingtesticular cancer. Physical exam,tumor marker measurement, andradiological tests assist with diag-nosis of testicular cancer. A thor-ough physical exam shouldinclude careful palpation of thetestes, the abdomen, and anylymph nodes. A firm mass often ispalpated on physical exam andmay be mistaken for epididymitis,an inflammation of the epididymis( s p e rm maturation and storagesite). The health care providermay initiate antibiotics in anyquestionable case to treat epi-didymitis. For all others, a testicu-lar ultrasound is indicated to eval-uate the mass. The ultrasound willdistinguish between hydrocele (acollection of fluid in the scrotu m ) ,epididymitis, or a testicular mass(Stevenson & McNeil, 2004). Tumor markers are extre m e lyi m p o rtant and sensitive indicatorsof testicular cancers (see Ta b le 1 ) .S e rum markers, such as alphaf e t o p rotein, human chorionicgonadotropin, and lactate dehy-drogenase, are important bloodtests to diagnose and monitor tes-ticular cancer. Serum markersmay detect testicular cancerb e f o re a small tumor appears(NCI, 2008b). A testicular needlebiopsy or trans-scrotal orch ie c to-my is contraindicated because ofthe chance of metastatic spre a d(Stevenson & McNeil, 2004). If atesticular tumor is confirmed byultrasound, additional diagnosticsFigure 2.