Testicular cancer

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    If symptomatic from volume of disease or CNS metastases, should discuss with medical oncologist on call or ED presentation

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Symptomatic malignant hypercalcaemia
    • Suspected tumour lysis syndrome
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia
    • Refer to local HealthPathways or local guidelines
    • Patients with testicular mass should be referred to Urologists
    • Discuss sperm banking with the patient prior to treatment. Perform a sperm count (with or without banking as appropriate) if fertility is a concern
    • In very rare cases where there is a possibility of a benign tumour, excisional biopsy with a frozen section should be performed prior to definitive orchiectomy to allow for possibility of organ-sparing partial orchiectomy. This decision is usually made by the Urologists in conjunction with the multi-disciplinary team.
    • If there are signs suggestive of metastases consider additionally performing urgent imaging in conjunction with referral:
      • Chest CT
      • Brain and Spine contrast CT or MRI
      • Bone scan
      • Liver USS
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Patients with suspected Testicular cancer should be referred to the Urology surgical team for evaluation and further investigation and expedited management. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

  • Metastatic germ cell tumour (GCT) confirmed (via biopsy, or orchidectomy) not requiring emergency treatment (see emergency). For optimum care, patient should be seen within 2 weeks.
  • Resected GCT (after orchidectomy) for consideration of adjuvant chemotherapy or surveillance
Category 2
(appointment within 90 calendar days)
  • Transfer of care from another health service
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Past medical history, current medications
  • Previous cancer treatment details
  • Histopathology
  • FBC, ELFT, Alpha-fetoprotein, ß-human chorionic gonadotropin, Lactate dehydrogenase (LDH) results
  • Any relevant XR results and/or relevant CT results
  • Testicular ultrasound and CT abdomen, pelvis and chest x-ray

3. Additional referral information Useful for processing the referral

  • Any other relevant imaging

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 January 2025

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