What specialist should a patient with testicular cancer diagnosed via ultrasound be referred to?

Testicular Cancer Referral After Ultrasound Diagnosis

Patients with testicular cancer diagnosed via ultrasound should be promptly referred to a urologist for definitive management. 1, 2

Initial Diagnostic Process

• A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise 1
• Scrotal ultrasound with Doppler is the recommended initial imaging study for patients with a suspicious testicular mass 1, 2
• Any hypoechoic mass with vascular flow on ultrasound is highly suggestive of malignancy 1
• Before referral, serum tumor markers (alpha-fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH]) should be drawn 1, 3

Specialist Referral

• Urologist referral is the first step in management for definitive diagnosis and surgical treatment (radical inguinal orchiectomy) 2, 4
• Radical inguinal orchiectomy with division of the spermatic cord at the internal inguinal ring is both diagnostic and therapeutic 2, 5
• A scrotal approach should be avoided as it is associated with higher local recurrence rates 2

Pre-Treatment Considerations

• Patients should be counseled about risks of hypogonadism and infertility before any treatment 1, 2
• Sperm banking should be offered before any therapeutic intervention, including surgery 1, 2
• In patients without a normal contralateral testis or with known subfertility, sperm banking should be considered prior to orchiectomy 1

Multidisciplinary Management

• After initial urologic management, patients may require referral to:
  • Medical oncologist for chemotherapy if indicated based on stage and risk classification 1, 2
  • Radiation oncologist for radiotherapy in select cases (particularly for seminoma) 2
• The National Comprehensive Cancer Network recommends management by a multidisciplinary team at high-volume, experienced medical centers 4

Post-Orchiectomy Pathway

• Following orchiectomy and pathological diagnosis, further management is guided by:
  • Histology (pure seminoma vs. nonseminoma) 1, 2
  • Stage (I, II, or III) 2, 4
  • Risk classification according to the International Germ Cell Consensus Classification 1, 2
• Treatment options may include active surveillance, chemotherapy, retroperitoneal lymph node dissection, or radiation therapy 4, 5

Common Pitfalls to Avoid

• Delaying referral to a urologist when a solid testicular mass is identified on ultrasound 1, 6
• Failing to obtain tumor markers before orchiectomy, which can make it difficult to establish baseline values 3
• Not discussing sperm banking before treatment, which may lead to irreversible infertility 2, 5
• Using a scrotal approach for orchiectomy rather than the recommended inguinal approach 2