Metastatic testicular cancer presenting as lower back pain in a pilot

Lower back pain is ubiquitous in the helicopter community and testicular cancer is the most common solid organ tumor that affects approximately 1% of men ages 15 to 35. However, rarely is lower back pain caused by testicular cancer and, in an otherwise healthy male, it is generally low on the differential diagnosis. Literature review discovered the most recent case report where lower back pain was the presenting symptom for testicular cancer was in 1987.

A 26-yr-old male helicopter pilot presented to clinic complaining of lower back pain for greater than 1 yr for which conservative treatment had failed. The pain was so severe he was unable to sleep and had to remove himself from the flight schedule. The patient was seen by physical therapy and a chiropractor and treated with NSAIDs and other pain medications, including narcotics. After further investigation, it was discovered that the patient's lower back pain was a result of a retroperitoneal metastatic tumor originating from his right testicle.

It is important to consider that, although most aviators in their twenties have been screened for chronic illness, they are still at risk for developing cancer. In this case, the patient never complained of testicular mass or pain and even denied symptoms during review of systems questioning. Proper education regarding the importance of self-examination and reporting of abnormalities is key to early detection and intervention. The 5-yr survival for metastatic testicular cancer is greater than 95%.