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Suspected testicular cancer — MSRA MCQ

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ModerateUrologySuspected testicular cancerMSRA

A 29-year-old man presents with a 3-week history of painless enlargement of his left testis. He has no dysuria, urethral discharge, fever, scrotal trauma or recent strenuous exercise. Examination confirms that the left testis itself is enlarged and has a firm, irregular area within it; the epididymis is not tender or enlarged. There is no transillumination. What is the most appropriate next management step?

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Correct answer: D — Make a suspected cancer pathway referral for testicular cancer

This is a non-painful enlargement with a change in testicular texture, confirmed to arise from the testis rather than the epididymis or scrotal contents. NICE recommends considering a suspected cancer pathway referral in this situation. The absence of infective symptoms and epididymal tenderness makes epididymo-orchitis unlikely, while lack of trauma makes a traumatic lesion less likely. A direct-access ultrasound is appropriate for unexplained or persistent testicular symptoms, particularly where the examination is non-diagnostic. However, this patient already meets the more specific NICE criterion for suspected cancer pathway referral, so imaging should not delay referral. Routine referral is insufficiently urgent. Serum tumour markers may contribute to specialist assessment and staging but should not be used to determine whether referral is made. Empirical anti-inflammatory treatment and review would risk delaying assessment of a possible testicular malignancy.

Reference: NICE NG12: Suspected cancer: recognition and referral — Testicular cancer (2015; current NICE page checked 15 August 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer NICE NG12: Recommended actions organised by symptom and findings of primary care investigations — Testicular symptoms (2015; current NICE page checked 15 August 2026) — https://www.nice.org.uk/guidance/NG12/chapter/recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations