investigations in testicular cancer

Last reviewed 01/2018

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).