Testicular Cancer Evaluation
The initial evaluation of a possible testis cancer should involve:
Testicular tumor markers
Advanced imaging (optional)
Scrotal ultrasound often demonstrates an intratesticular, hypoechoic (dark) mass. Testis cancers are often vascular (or hypervascular), although the absence of blood flow does not rule out a testis cancer. Even in patients with suspicion of metastatic cancer, a scrotal ultrasound should be used to identify an active primary tumor or a "burned out" testicular mass, which is typically a small, impalpable scar or calcification. Radical orchiectomy should strongly be considered for any intratesticular mass and suspicion of testis cancer.
Testicular Tumor Markers
Testicular cancer is one of the few cancers associated with tumor markers. These markers are well established to help in the diagnosis, prognosis, treatment and monitoring of testis cancer.
Additional imaging can be performed before or after the diagnosis of cancer is confirmed, based on the strength of suspicion for cancer. Abdominal and pelvic computed tomography (CT) scan can be performed before or after orchiectomy to evaluate the retroperitoneum. Once cancer is confirmed, an initial chest X-ray should be performed to rule out involvement in the lungs. Chest CT is only warranted if there is a suspicion of pulmonary disease on X-ray. Routine imaging of the brain or bones — with magnetic resonance imaging (MRI), positron emission tomography (PET) or bone scan — is not recommended unless specific symptoms are present and are therefore not routinely performed in the initial evaluation of testis cancer.
Biopsy (or removal of just a portion of the tumor) is not recommended for testis cancers, as this can spread the cancer. Therefore, surgical removal of the testicle is diagnostic (confirming the clinical suspicion provided by physical examination, ultrasound and tumor markers) and therapeutic in most cases.