The diagnosis of testis cancer may be suspected clinically but can only be proven by examination of excised tissue. This article is concerned with germ cell tumors only. Germ cell tumors are those which are derived from germinal epithelium versus those which are of gonadal stroma origin. Currently at least six methods of staging are used in the United States. This allows for complete opacification of the lymphatic drainage system to the level of the thoracic duct.
Criteria exist for interpretation of lymphangiography.
However, since CT scan, especially in the very thin young patient, often produces false negative results, lymphangiography combined with plain x-ray and CT probably offers the greatest staging accuracy especially for seminoma patients because most will not undergo lymph node dissection. A liver scan is of little value unless a suspicious lesion is found on CT scan. Bone scans are rarely positive unless disseminated disease is present, and are probably necessary only in patients with advanced disease. A brain scan is indicated only when diffuse metastatic disease is present or when focal neurologic signs are present. The accuracy of clinical assessment is imperative if the physician is to be able to make a logical decision as to therapy.