genitourinary disorders
Testicular Cancer
Diagnosis of Testicular Cancer
Ultrasonography for scrotal masses Exploration if testicular mass is present Staging by abdominal, pelvic, and chest CT as well as tissue examination Serum tumor markers such as AFP (alpha-fetoprotein) and beta-HCG (human chorionic gonadotropin) Many patients discover the mass themselves during self-examination. Monthly self-examination should be encouraged among young men. The origin and nature of scrotal masses must be determined accurately because most testicular masses are malignant, but most extratesticular masses are not; distinguishing between the two during physical examination may be difficult. Scrotal ultrasonography can confirm testicular origin. If a testicular mass is confirmed, serum tumor markers (AFP, beta-HCG, and lactate dehydrogenase [LDH]) should be measured and a chest x-ray taken. Serum markers may help differentiate benign from cancerous masses but results are not definitive. Then, radical orchiectomy via an inguinal approach is indicated; the spermatic cord is exposed and clamped before the abnormal testis is manipulated. If cancer is confirmed, abdominal, pelvic, and chest CT is needed for clinical staging using the standard TNM (tumor, node, metastasis) system (see tablesand). Tissue obtained during treatment (usually radical inguinal orchiectomy) helps provide important histopathologic information, particularly about the proportion of histologic types and presence of intratumoral vascular or lymphatic invasion. Such information can predict the risk of occult lymph node and visceral metastases. Patients with nonseminomas have about a 30% risk of recurrence despite having what appears to be localized disease. Seminomas recur in about 15% of such patients. 