The work-up for testicular cancer includes:
- clinical examinations
- blood tests
- radiology examinations
- sperm tests
- 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)?
- Examination of the testes, abdomen, lymph nodes in the groin and neck
- Examination of the breasts for gynecomastia
- 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)
X-ray of thorax
- CT of thorax, abdomen and pelvis to determine if there are metastases
- Ultrasound of the testes
- 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.
- 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.