Testicular cancer
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- age 20 to 34 years
- testicular mass
Other diagnostic factors
- extratesticular manifestation
Risk factors
- cryptorchidism
- gonadal dysgenesis
- family history of testicular cancer
- personal history of testicular cancer
- testicular atrophy
- white ethnicity
- HIV infection
- chemical carcinogens and low sperm count
- rural residence
- higher socioeconomic status
- inguinal hernia
- genetic abnormality
Diagnostic investigations
1st investigations to order
- ultrasound with colour Doppler of testis
- CXR
- CT scan (abdomen and pelvis)
- serum beta-human chorionic gonadotrophin (beta-hCG)
- serum alpha-fetoprotein (AFP)
- serum lactate dehydrogenase (LDH)
- histological examination of testicular mass post-orchiectomy
Investigations to consider
- serum placenta alkaline phosphatase
- serum gamma glutamyl transpeptidase (gamma-GT)
- MRI scan (abdomen and pelvis)
- CT scan chest
Treatment algorithm
suspicious testicular mass
early-stage seminoma
early stage non-seminoma
seminoma or non-seminoma: advanced cancer/metastasis (stage IIC or stage III disease)
seminoma or non-seminoma: relapsing disease
Contributors
Authors
Al B. Barqawi, MD, FRCS
Associate Professor of Surgery/Urology
Director of Prostate Cancer Fellowship Program
School of Medicine
University of Colorado Denver
Aurora
CO
Disclosures
ABB declares that he has no competing interests.
Brandon Bernard, MD, FRCPC
Assistant Professor
University of Colorado Denver School of Medicine
University of Colorado Cancer Center
Aurora
CO
Disclosures
BB declares that he has no competing interests.
Acknowledgements
Dr Al B. Barqawi and Dr Brandon Bernard would like to gratefully acknowledge Dr Elizabeth R. Kessler and Dr Thomas W. Flaig, previous contributors to this topic.
Disclosures
ERK and TWF declare that they have no competing interests.
Peer reviewers
Elisabeth Heath, MD
Assistant Professor of Medicine and Oncology
Karmanos Cancer Institute
Wayne State University
Detroit
MI
Disclosures
EH declares that she has no competing interests.
Gianfilippo Bertelli, MD, PhD, FRCP (Edin)
Consultant/Honorary Senior Lecturer in Medical Oncology
SW Wales Cancer Institute/Department of Oncology
Singleton Hospital
Sketty
Swansea
UK
Disclosures
GB declares that he has no competing interests.
Emilio Porfiri, MD, PhD
Senior Lecturer in Medical Oncology
School of Cancer Sciences
University of Birmingham
Birmingham
UK
Disclosures
EP declares that he has no competing interests.
Differentials
- Testicular torsion
- Epididymo-orchitis
- Scrotal hernia
More DifferentialsGuidelines
- Canadian consensus guidelines for the management of testicular germ cell cancer
- AUA White Paper on implementation of shared decision making into urological practice
More GuidelinesPatient leaflets
Testicular cancer
Testicular cancer: questions to ask your doctor
More Patient leaflets
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