Investigations in testicular cancer

NICE recommends that all patients with a swelling or mass in the body of the testis should be referred urgently for investigation (1).

These include:

• scrotal ultrasound
  • investigation of choice
  • has a sensitivity of almost 100% in diagnosing testicular tumour
  • used to explore the contralateral testis (2)
  • urgent ultrasound should be carried out in men with
    • a scrotal mass that does not transilluminate
    • when the body of the testis cannot be palpated, such as when there is a reactive hydrocele (1)
      
      
• tumour markers -
  • are prognostic factors used in diagnosis and staging (2)
  • includes -
    • serum beta human chorionic gonadotrophin (HCG)
    • lactate dehydrogenase (LDH) - measured specially in advanced disease
    • alpha-fetoprotein (AFP) *
  • lack of an increase does not exclude the disease
    
    
• chest radiography for metastases
  
  
• CT scan of the chest, abdomen and pelvis in order to stage the disease
  
  
• testicular exploration and biopsy

* Note that elevated serum AFP levels indicate the presence of yolk sac elements, i.e. mixed germ cell tumours (especially embryonal carcinoma and yolk sac tumours).

Reference:

• (1) Horwich A et al. Testicular germ cell tumour. BMJ. 2013;347:f6205
• (2) Albers P et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol. 2011;60(2):304-19