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Suspected testicular cancer — MSRA MCQ

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HardUrologySuspected testicular cancerMSRA

A 32-year-old man presents with 5 weeks of a dull left scrotal ache. He has no fever, dysuria, urethral discharge, urinary frequency or recent genital trauma. Urine dipstick is negative and first-void urine NAAT for chlamydia and gonorrhoea is negative. Examination shows a 1.5 cm firm, non-tender irregular area within the upper pole of the left testis. The epididymis is not tender or swollen, and there is no transillumination. The right testis is normal. He is systemically well. 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 man has a firm, non-tender intratesticular change in texture. Although he reports a dull ache, the decisive finding is the painless focal testicular abnormality rather than non-specific scrotal discomfort. NICE advises considering a suspected cancer pathway referral for non-painful enlargement or change in shape or texture of the testis. The absence of epididymal tenderness or swelling, systemic features, urinary symptoms, pyuria and STI evidence makes epididymo-orchitis unlikely; empirical antibiotics would risk diagnostic delay. Testicular torsion is not the leading diagnosis because the presentation is subacute and there is no sudden severe pain or acute tender, high-riding testis. Urgent direct-access ultrasound is appropriate for unexplained or persistent testicular symptoms, but this option specifically delays referral pending imaging. In this case the examination already meets the more specific suspected testicular cancer referral criterion. A routine referral or interval review is inappropriate because a potentially malignant intratesticular lesion requires expedited assessment.

Reference: NICE NG12: Suspected cancer: recognition and referral — Testicular cancer recommendations (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer NICE NG12: Suspected cancer: recognition and referral — Testicular cancer recommendations (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer NHS: Testicle pain (2025) — https://www.nhs.uk/symptoms/testicle-pain/