Some young men put their lives at risk by hiding large testicular lumps, said researchers in The Lancet (Vol. 359:1632, 1666).

Testicular cancer that has spread to other parts of the body has a high rate of cure (more than 80%). And even those who have a type of high-risk disease can be easily cured if caught early.

In a case reported by H. D. de Boer, MD, and colleagues at the University Medical Centre in St. Radboud, the Netherlands, a 17-year-old man died in a car accident, and it was later discovered that he had testicular cancer.

His medical history showed no abnormalities, and except for complaints of abdominal pain after the accident, he had been without any symptoms, de Boer said.

In trying to learn of the cause of the young man's death, doctors found a large tumor of the right testicle. His cancer had spread to the liver, bone, and other areas of the body, De Boer said. They found that a blood clot that reached his lungs caused his death.

The authors believed the delay in diagnosis may have been due to the patient's lack of knowledge, embarrassment, ignorance, or fear of cancer.

"This tragic case reminds us…early recognition of testicular carcinoma is essential," said the authors. It has been shown that treatment delay of more than three months, de Boer said, is linked to shorter survival rates.

The lump had probably been noticeable for months, according to Jeremy P.C. Steele and R. Timothy Oliver, medical oncologists at St. Bartholomew's Hospital in London, who commented on the case in the same journal.

Such cases are not exceptional, they said. In their experience they treat about 50 new patients with testicular cancer each year, and four of these have huge testicular masses that have been hidden for months.

They said that no single reason is given, but some patients admit to being afraid of seeing doctors, and in some, the family doctor said nothing was wrong.

Steele and Oliver said doctors should teach men to check for testicular lumps, and when spotted, know that they are a medical emergency.

The Dutch authors agreed: "It is important to encourage testicular self-examination and to emphasize the need for prompt medical advice in the event of change in a previously normal testicle."