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 initial treatment in most cases.
Infertility can be a complication of surgery.
The most common malignancy in young adult men (20-34 years of age), which is 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
- 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 color Doppler of testis
- CT scan (abdomen and pelvis)
- serum beta-human chorionic gonadotropin (beta-hCG)
- serum alpha-fetoprotein (AFP)
- serum lactate dehydrogenase (LDH)
- histologic exam of testicular mass postorchiectomy
Investigations to consider
- serum placenta alkaline phosphatase
- serum gamma glutamyl transpeptidase (gamma-GT)
- MRI scan (abdomen and pelvis)
- CT scan chest
suspicious testicular mass
seminoma or nonseminoma: advanced cancer/metastasis (stage IIC or stage III disease)
seminoma or nonseminoma: relapsing disease
Al B. Barqawi, MD, FRCS
Associate Professor of Surgery/Urology
Director of Prostate Cancer Fellowship Program
School of Medicine
University of Colorado Denver
ABB declares that he has no competing interests.
Brandon Bernard, MD, FRCPC
University of Colorado Denver School of Medicine
University of Colorado Cancer Center
BB declares that he has no competing interests.
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.
ERK and TWF declare that they have no competing interests.
Elisabeth Heath, MD
Assistant Professor of Medicine and Oncology
Karmanos Cancer Institute
Wayne State University
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
GB declares that he has no competing interests.
Emilio Porfiri, MD, PhD
Senior Lecturer in Medical Oncology
School of Cancer Sciences
University of Birmingham
EP declares that he has no competing interests.
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