Testicular cancer most commonly presents as a hard, painless nodule on one testis noticed by the patient or at a regular clinic examination.
Elevated serum tumour markers can be used for disease diagnosis and aid in monitoring the treatment response.
Ultrasound of the testis is 90% to 95% accurate in diagnosis.
Radical orchiectomy to confirm histological diagnosis is initial treatment in most cases.
Infertility can be a complication of surgery.
The most common malignancy in young adult men (20 to 34 years of age), and highly curable when diagnosed early. A precancerous condition termed carcinoma in situ is highly specific early in the natural history of the disease.
History and exam
Key diagnostic factors
- presence of risk factors
- age 20 to 34 years
- testicular mass
Other diagnostic factors
- extratesticular manifestation
- 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
1st investigations to order
- ultrasound with colour Doppler of testis
- 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
suspicious testicular mass
early stage non-seminoma
seminoma or non-seminoma: advanced cancer/metastasis (stage IIC or stage III disease)
seminoma or non-seminoma: relapsing disease
- Testicular torsion
- Scrotal hernia
- Canadian consensus guidelines for the management of testicular germ cell cancer
- AUA White Paper on implementation of shared decision making into urological practice
Testicular cancer: questions to ask your doctorMore Patient leaflets
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