Some patients admit to being afraid of visiting doctors

Dr Jeremy Steele, St Bartholomew's Hospital

The young man had been examined by his GP - but the tumour had not been spotted, probably because the doctor did not examine his genitals.

Doctors from the University Medical Centre St Radboud, Nijmegen, Netherlands wrote in the Lancet that this case was a reminder of the importance of early diagnosis.

Self-examination

Dr HD de Boer and his colleagues said: "Early recognition of testicular carcinoma is essential as it has been shown that a treatment delay of more than three months is correlated with a significantly decreased five-year survival rate.

"Delay in diagnosis may depend on several factors including patient's lack of knowledge, embarrassment, ignorance, or fear of cancer and of emasculation.

He added: "It is important to encourage testicular self-examination and to emphasise the need for prompt medical advice in the event of change in a previously normal testicle."

Testicular cancer is the most common cancer affecting men aged between 15 and 49.

There are more than 1,600 new cases in the UK each year. Nine out of 10 patients are cured.

Men who seek advice within a month of noticing a lump have a very high chance of a cure.

Fear and embarrassment

In an editorial in The Lancet, Dr Jeremy Steele, of the Department of Medical Oncology at St Bartholomew's Hospital, London said the GP's failure to examine the patient's genitalia in the Dutch case was "regrettable".

He said such a check was an essential part of an abdominal examination and should be taught to medical students at the beginning of their training.

But he said the 17-year-old may have contributed to his own death by not seeking medical advice earlier.

"Sadly, such cases are not exceptional."

Dr Steele, who sees around 50 new cases of testicular cancer each year at his unit, said: "Typically, four of these present with unmistakable, huge masses that they have concealed for months.

"Usually, no single reason is given, although some patients admit to being afraid of visiting doctors."

Colin Osborne, a former testicular cancer patient who started the Orchid Cancer Appeal to raise awareness of men's cancers, told BBC News Online: "The initial thing for men to do is ignore the lump and hope it will go away.

"That could be partly men's attitude. And if you go to the doctor, you have to be examined, so there's the embarrassment factor as well."

Mr Osborne, who was finally persuaded to see a doctor by his wife, said: "Men should carry out a regular self-examination, once a month.

"And when men go to the doctor's, they should be made aware they are of an age where they could be at risk."