Sign | Management of testicular germ cell tumours

Most of this is not new for us, or is for secondary care. Worthwhile noting is:

  • 2 week wait refer if epididymo-orchitis/orchitis is suspected but is not resolving in 2 to 3 weeks.
  • Patients have an increased risk of cardiovascular disease, because of chemo and radiotherapy, so ensure that they are given appropriate lifestyle advice. The exact risk may be up to about 2.5x background levels if treated with chemo and radiotherapy.
  • Patients are also at increased risk of non-germ cell tumours (2 to 3 times).

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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2 Responses

  1. julian
    Hmmm. I was surprised by the suggestion of 2WR referral for (epididymo)orchitis not resolving after 2-3 weeks and note the link refers only to "urgent" referral. The 2WR criterion are well documented, do not include this and I don't think they are amenable to alteration by a guideline without agreement of the applicable Cancer Network. (In this particular instance I would also wonder about the applicability to English practice. NHS Scotland is a very different beast, so whilst SIGN is a good source of evidence-based guidelines it is particularly unlikely to be definitive on local referral pathways) Thanks very much for these in general, Louise. I had reason to refer to the reduced FMs one in a consultation only recently and it was very handy to have it.
  2. Thankyou Julian. You are right that the link just suggests 'urgent' referral and not 2 week wait. The full guideline is a little ambiguous on what exactly 'urgent' means and states: "Those patients suspected of harbouring a testicular malignancy, ie a lump in the testis,doubtful epididymo-orchitis or orchitis not resolving within two to three weeks, should be referred urgently for urological assessment". Above that it talks specifically about lumps and defines 'urgent' as within 2 weeks. I suppose that in reality, we will have to assess each case individually and decide on our level of suspicion. I agree that the criteria on the 2ww form shouldn't be added to by us. Urgent cases are seen pretty quickly normally anyway.

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