Last updated: 06-Oct-2026
Send your ultrasound, marker and CT reports ahead of your appointment, so the consultation starts with them already read · +91-63590-11009
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Testicular Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Shah’s Gastro, Cancer & Robotic Surgery Centre. 18 years of experience in cancer surgery. ★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 33 (Apollo, Bhat)
IN SHORT
AFP, beta-hCG and LDH are drawn before the testis is removed and repeated afterwards; the value after surgery sets the stage.
The testis is removed through a cut in the groin, never through the scrotum, and that operation gives both the diagnosis and the first treatment.
The pathology report, the repeat markers and a contrast CT of the chest, abdomen and pelvis together decide between surveillance, one added dose, or chemotherapy.
Testicular cancer responds well to treatment, even when it has spread. The tests follow a fixed order because two early steps cannot be repeated later: the blood markers taken before surgery, and the route by which the testis is removed.
Done in order, the tests answer three questions in turn: is it a tumour, what type is it, and has it spread.
The first test is a scrotal ultrasound with a high-frequency probe, of both testes. It shows whether the swelling is a solid lump inside the testis.
What it decides: whether the next steps are the marker blood tests and an operation. It also checks the other side. A tumour in both testes, or tiny specks of calcium in the other testis (microlithiasis), changes the plan.
Three blood tests are drawn before the testis is removed: AFP, beta-hCG and LDH. These are the tumour markers.
What they decide: on their own, not the stage. They are the starting values. They are repeated after the operation, and it is the later value that sets the stage and the treatment group. A set missed before surgery cannot be recovered, and the staging stays weaker from then on.
One result changes the order. A very high hCG in a young man who is breathless or coughing blood can mean bleeding in the lungs from spread. That is an emergency: chemotherapy is started urgently, without waiting for the operation.
These are not tests, but they sit in the sequence because they cannot wait. Sperm banking is offered to every man before treatment, married or not, and his answer is written down. Semen is often already weaker at diagnosis, so even one sample is worth storing.
A testicular prosthesis, an artificial testis, can be placed at the same operation if he wishes.
The diagnosis is made by removing the testis through a cut in the groin (radical inguinal orchidectomy). The cord is controlled high up, in the groin, before the testis is brought out.
Never a biopsy through the scrotum, and never removal through the scrotum. A cut through the scrotal skin opens a new path for spread to the groin and pelvis, and changes staging and follow-up for good. It cannot be undone.
Keeping part of the testis is considered only in special cases, such as a tumour in a man’s only testis or tumours on both sides, with a frozen section during surgery and a plan agreed by the tumour board. If the other testis is small, was undescended, or the man is young, a biopsy of that testis may be discussed.
The removed testis is examined under the microscope, and the report answers three questions:
What it decides: for a cancer still confined to the testis, these features shape the choice between surveillance, which is the usual first choice, and a single dose of added treatment. Surveillance works only for a man who will keep his appointments. If that is genuinely hard, because of distance or work, the single dose is discussed openly instead.
After the operation the markers are repeated, timed to how fast each one clears from the blood: about a week for AFP, a few days for hCG. A contrast CT of the chest, abdomen and pelvis is done in every man.
What they decide together:
In seminoma that has spread, a markedly raised LDH can mean a longer course of chemotherapy than the risk group alone would suggest.
Some scans are asked for often but are not part of the first work-up:
| Test | When | What the result decides |
|---|---|---|
| Ultrasound of both testes | First visit | Solid lump or not; tumour or calcium specks in the other testis |
| AFP, beta-hCG, LDH | Before the operation | Starting values; a very high hCG with breathlessness means chemotherapy first |
| Radical inguinal orchidectomy | Soon after the markers | The diagnosis, and the tumour type |
| Pathology report | After the operation | Size, rete testis or vessel invasion: surveillance or a single added dose |
| Repeat markers | Timed to how fast each clears | Whether any tumour remains; the marker part of the stage |
| Contrast CT of chest, abdomen and pelvis | After the operation | Confined, spread to nodes, or spread further |
| PET-CT | Only after chemotherapy, for a seminoma mass left behind | Whether that mass needs surgery |
Every case is discussed by the tumour board after the operation and before any further treatment. That includes every man whose cancer is confined to the testis, because surveillance or added treatment is a shared decision, made with him. Treatment is decided at the consultation, after examination, with all of these results in hand.
Yes. Some testicular tumours, seminoma in particular, do not raise the markers. The ultrasound and the removed testis decide the diagnosis. Normal markers do not rule it out.
Because the value after surgery shows whether tumour remains elsewhere in the body. The test is timed to how fast each marker clears, and this later value is the one that sets the stage.
Not at the start. The staging scan is a contrast CT of the chest, abdomen and pelvis. PET-CT is kept for one situation: a seminoma mass left after chemotherapy, scanned weeks after the last cycle.
In non-seminoma it means a higher chance of the cancer coming back. It does not mean it has spread. It shapes the choice between surveillance and a single cycle of added chemotherapy, which is discussed with the tumour board and with you.
It is always scanned. A biopsy of it is discussed only if it is small, was undescended, or you are young.
Testicular cancer as a whole is covered on the testicular cancer surgery page. Once the diagnosis is made, the next decisions are on surgery, sperm banking and fertility.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Testicular Cancer Surgeon
Consultation at Gota OPD, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
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