Symptoms and early management of germinal tumours of the testis.

The symptomatology and delay in diagnosis in a series of 502 germinal tumours of the testis were surveyed. Pain is much more commonly a feature than is usually appreciated and often leads to the condition being treated as inflammatory for much longer than it should be. Most surgical textbooks are not helpful in this regard. Delay in exploring the testis, and, particularly, delay in initiating follow-up therapy after orchidectomy, were associated with a higher stage of disease and poorer results, most clearly seen in nonseminomatous tumours. As the incidence of testicular tumours seems to be rising, a high index of suspicion in any abnormality of the testis in a post-pubertal male is advocated. Exploration through an inguinal incision for any mass or enlargement of the body of the testis not associated with dysuria and pyuria is essential. If a tumour is found, supplementary treatment must be given without delay. Judicious X-ray therapy, surgery and cytotoxic drugs can save most patients. Seminoma, in particular, can be cured, even in the advanced case.