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Diagnostics of testicular cancer

The work-up for testicular cancer includes:

  • anamnesis
  • clinical examinations
  • blood tests
  • radiology examinations
  • biopsy
  • sperm tests 

Ananamnesis

  • Are there others in the family with germ cell tumors?
  • Has the patient had descendency problems?
  • Has the patient had fertility problems?
  • Has the patient had orchitis previously?
  • Has the patient used anabolic steroids?
  • Has the patient previously undergone groin or scrotal surgery (change of lymphatic drainage)?

Clinical examinations

  • Examination of the testes, abdomen, lymph nodes in the groin and neck
  • Examination of the breasts for gynecomastia

Blood tests

  • Tumor markers (APF, hCG, LD) AFP and hCG should be taken at least twice, preferably in 2 consecutive days to assess changes in marker values. AFP has a half-life of 5-7 days and hCG has a half-life of 1-2 days. 
  • Hormone tests (FSH, LH, testosterone, estradiol, SHBG, prolactin)
  • Virus serology (HIV, Hepatitis B/C)

Radiology examinations

  • X-ray of thorax
  • CT of thorax, abdomen and pelvis to determine if there are metastases
  • Ultrasound of the testes

Biopsy

  • A biopsy is usually unnecessary for an orchiectomy because the ultrasound is usually sufficient to determine if there is a malignant tumor. If there is uncertainty, an open exploration of the testes is performed with frozen section diagnostics.
  • A biopsy of the contralateral testicle should be taken if there are germ cell tumors in the family, descent problems, infertility, or an atrophic testicle (volume < 12 ml).  
  • Biopsy from both testicles for extragonadal germ cell tumors, even if the ultrasound is normal.

Sperm tests 

  • Cryopreservation of sperm should be performed before chemotherapy, a retroperitoneal node dissection, or radiation. It is becoming more common to cryopreserve sperm before an orchiectomy. 

Alfa-fetoprotein (AFP) is elevated in 50–60% of patients with nonseminomas while seminomas do not produce AFP. Positive AFP tests therefore exclude seminoma.  hCG (human chorionic gonadotropin) is elevated in 30–35% of nonseminomas and 10–25% of seminomas.

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