Editing Germ Cell Tumours (section)

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">Signs and Symptoms</span>'''
**'''<span style="color:#ff0000">Most common presentation of testicular cancer: painless scrotal mass</span>'''
**'''Symptoms related to metastatic disease (e.g. shortness of breath)''' are the presenting complaint in 10-20% of patients

==== Physical exam ====
* '''Genitourinary'''
** Palpate for any testicular or extra-testicular masses. Note relative size and consistency of affected and normal contralateral testicle. 
***'''A firm intratesticular mass should be managed as a malignant neoplasm until proven otherwise and should be evaluated further with a scrotal ultrasound scan.'''
** '''<span style="color:#ff0000">Differential diagnosis of a scrotal mass (8):</span>'''
**# '''<span style="color:#ff0000">Painless</span>'''
**##'''<span style="color:#ff0000">Testicular neoplasm</span>'''
**##'''<span style="color:#ff0000">Paratesticular neoplasm (benign or malignant)</span>'''
**## '''<span style="color:#ff0000">Hernia</span>'''
**## '''<span style="color:#ff0000">Varicocele</span>'''
**## '''<span style="color:#ff0000">Spermatocele</span>'''
**#'''<span style="color:#ff0000">Painful</span>'''
**##'''<span style="color:#ff0000">Torsion</span>'''
**## '''<span style="color:#ff0000">Hematoma</span>'''
**## '''<span style="color:#ff0000">Epididymoorchitis</span>'''
* '''Sites of metastases'''
** '''Supraclavicular lymph nodes'''
** Inguinal lymph nodes, if prior inguinal or scrotal surgery
* '''Gynecomastia'''
** '''Occurs in 2% of males with GCT'''
** Results from elevated serum hCG levels, decreased androgen production, and/or increased estrogen levels