The initial evaluation of a possible testis cancer should involve:
- Scrotal ultrasound
- Testicular tumor markers
- Advanced Imaging (optional)
- Or chiectomy
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 intra-testicular mass and suspicion of testis cancer.
Testicular Tumor Markers (see Testis Cancer Tumor Markers for more details)
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 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 suspicion of pulmonary disease on x-ray. Routine imaging of the brain or bones (with MRI, PET or Bone Scan) is not recommended unless specific symptoms and are therefore not routinely performed in the initial evaluation of testis cancer.
Orchiectomy (see Treatment of Testis Cancer for details)
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. Surgical options are discussed in more details under Treatment of Testis Cancer.