Testicular cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Nov 2024

Last updated: 16 Jan 2024

Testicular cancer most commonly presents as a hard, painless nodule on one testis noticed by the patient or at a regular clinic exam.

Elevated serum tumor 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 histologic diagnosis is the initial treatment in most cases.

Infertility can be a complication of surgery.

Definition

Testicular cancer can derive from any cell type found in the testes. More than 95% of testicular cancers arise from germ cells and are further classified as either seminoma or nonseminoma.[1] Testicular cancer is rare; however, it is the most common solid tumor in young adult men and is highly curable when diagnosed early.[2] This topic focuses on testicular germ cell tumors.

History and exam

Key diagnostic factors

age 20 to 34 years
testicular mass

Full details

Other diagnostic factors

extratesticular manifestation

Full details

Risk factors

cryptorchidism
gonadal dysgenesis
family history of testicular cancer
personal history of testicular cancer
testicular atrophy
white ethnicity
HIV infection
occupational exposures
inguinal hernia
genetic abnormality

Full details

Diagnostic tests

1st tests to order

ultrasound with color Doppler of testis
chest imaging
CT scan abdomen and pelvis with contrast
serum beta-human chorionic gonadotropin (beta-hCG)
serum alpha-fetoprotein (AFP)
serum lactate dehydrogenase (LDH)
histologic exam of testicular mass postorchiectomy

Full details

Tests to consider

serum placental alkaline phosphatase
MRI abdomen and pelvis
CT scan chest

Full details

Treatment algorithm

INITIAL

suspicious testicular mass

ACUTE

early-stage seminoma

early-stage nonseminoma

ONGOING

seminoma or nonseminoma: stage IIC or stage III disease

seminoma or nonseminoma: relapse disease

Contributors

Authors

Al B. Barqawi, MD, FRCS

Professor of Surgery/Urology

University of Colorado Anschutz Medical Campus

Aurora

Disclosures

ABB declares that he has no competing interests.

Corbin J. Eule, MD

Assistant Professor of Medical Oncology

University of Colorado Anschutz Medical Campus

Aurora

Disclosures

CJE declares that he has no competing interests.

Acknowledgements

Dr Al B. Barqawi and Dr Corbin J. Eule would like to gratefully acknowledge Dr Elizabeth R. Kessler, Dr Thomas W. Flaig, and Dr Brandon Bernard, previous contributors to this topic.

Disclosures

ERK, TWF, and BB 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

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

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

Disclosures

EP declares that he has no competing interests.

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Testicular cancer

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

suspicious testicular mass

early-stage seminoma

early-stage nonseminoma

seminoma or nonseminoma: stage IIC or stage III disease

seminoma or nonseminoma: relapse disease

Contributors

Authors

Al B. Barqawi, MD, FRCS

Disclosures

Corbin J. Eule, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Elisabeth Heath, MD

Disclosures

Gianfilippo Bertelli, MD, PhD, FRCP (Edin)

Disclosures

Emilio Porfiri, MD, PhD

Disclosures

Differentials

Guidelines

Patient information

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Log in or subscribe to access all of BMJ Best Practice

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