Testicular Cancer

Physical exam: A typical testicular tumor is firm and painless, distinct from the epididymis. Sometimes diagnosis can be complicated if a hydrocele or adjacent involvement is present.

Serum tumor markers

About 95% of testicular cancers are germ cell tumors, which often produce specific tumor markers:

• Alpha-fetoprotein (AFP)
• Human chorionic gonadotropin (β-hCG)
• Lactate dehydrogenase (LDH)

These markers are crucial for diagnosis, staging, and monitoring treatment response.

Ultrasound

The first-line diagnostic tool, with high sensitivity. A solid intratesticular mass is highly suspicious for malignancy, though histology cannot be determined by imaging alone.

CT scan

Commonly used for staging and follow-up, especially to assess retroperitoneal lymph node involvement. However, it cannot always confirm whether residual masses after treatment contain viable tumor cells.

Treatment depends on the histologic type (seminoma vs non-seminoma) and stage of disease.

Radical inguinal orchiectomy

• The primary surgery to remove the affected testicle.
• Provides both a definitive diagnosis and treatment for localized disease.
• In many early-stage cases, orchiectomy alone can be curative.

Seminoma

• Early-stage seminomas may be managed with surveillance after orchiectomy, or with radiation therapy or chemotherapy depending on risk factors.
• For higher-risk cases (tumor >4 cm, vascular/lymphatic invasion), adjuvant radiation or chemotherapy is often recommended.
• For patients with retroperitoneal lymph node metastases, chemotherapy is usually the most effective treatment.

Non-seminoma

• In stage I disease (confined to the testis, no vascular invasion, normalized tumor markers), active surveillance after orchiectomy may be appropriate.
• For patients with retroperitoneal lymph node involvement, retroperitoneal lymph node dissection (RPLND) or chemotherapy may be required.