Testicular Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Signs and symptoms

  • Previous test results

When a man develops a testicular lump or something else that could be testicular cancer, it is important that he see his primary care doctor, who may send him to a urologist. A urologist is a doctor who specializes in treating testicular cancer.

The following tests are usually the first performed.

  • Physical examination. The doctor will feel the testicles for any sign of swelling, tenderness, or hardening. The doctor will also feel the abdomen, neck, upper chest, armpits and groin for evidence of enlarged lymph nodes, which may indicate that the cancer has spread. The breasts and nipples will also be examined to look for enlargement and the legs will be examined for swelling. Leg swelling can result from blood clots in veins in the legs, pelvis or abdomen.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. The sound waves produced by the ultrasound bounce off tissue in the scrotum. The echoes of the sound waves produce a series of images called a sonogram. These images of the testicle help the doctor find any tumors or other abnormalities. If a tumor is found and is large enough to be seen on an ultrasound, then the sonogram will show the size, location, and solidness of the tumor. A solid tumor inside the testicle is very likely to be cancerous.

If these tests show an abnormality that appears to be a tumor, then blood tests are done. In addition, the testicle may need to be surgically removed to look for signs of cancer.

  • Blood tests/tumor markers. The levels of serum tumor markers are measured before surgery to remove a testicle. Tumor markers are substances made by a cancer that are found at abnormally high levels in the blood of some people with cancer. For testicular cancer, serum tumor marker levels are used to find out the cancer’s stage (see Stages) and confirm whether a tumor is a pure seminoma (see Overview). Different types of cancer make different tumor markers. The following tumor markers are used to help stage and plan treatment for testicular cancer:

    • Alpha-fetoprotein (AFP) is not made by seminomas, so an elevated level of AFP indicates the tumor is not a pure seminoma, even if it looks like a pure seminoma. However, AFP levels are normal for many men with non-seminomas.

    • Beta human chorionic gonadotropin (beta-hCG) can be high from either seminoma or non-seminoma. However, beta-hCG is normal for many men with non-seminomas or seminomas.

    High levels of these tumor markers may indicate testicular cancer. However, it is also possible to have this type of cancer and have normal tumor marker levels. It is also possible to have higher levels of these markers without having cancer.

    Other tumor markers that may be used for testicular cancer include:

    • Lactate dehydrogenase (LDH) is only used in a specific situation for men with testicular cancer (see Treatment Options). This is because LDH can be elevated in many other cancers and non-cancerous diseases. LDH is not used to find testicular cancer.

    • Placental alkaline phosphatase (PLAP) is another tumor marker doctors may test for, although it is not commonly measured.

    Learn more about tumor markers for testicular cancer.

  • Orchiectomy/surgical pathology tests. If testicular cancer is suspected, a surgeon will perform a radical inguinal orchiectomy, in which the entire testicle is removed through an incision in the groin. Then, a pathologist will examine very thin slices of tissue from the testicle under a microscope to diagnose the type of cancer. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. For a cancer to be considered a seminoma, it must be pure seminoma.

    If the man has one testicle to begin with or the diagnosis is uncertain, the surgeon may remove only a small sample of tissue from the testicle. The testicle may still need to be removed if there are signs of cancerous cells. If the tissue sample does not show cancer, it may be possible to repair the damage from the tissue removal and replace the testicle in the scrotum during the same surgery. However, this procedure is very rare.

Other tests

If cancer is found, other tests will be needed to determine the stage of the cancer and whether it has spread to other parts of the body (see Stages). Usually, doctors recommend imaging tests of the abdomen, pelvis, and chest. Images of the brain or bones are not as common, but images of the brain may be need for patients who have choriocarcinoma, which is a type of non-seminoma. Tests that may be used to stage testicular cancer and find out if it has spread include:

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A chest x-ray is used to determine the stage of the cancer and for follow-up screening. If a more detailed picture of the lungs is needed, then the doctor may recommend a chest CT scan (see below) but in many situations an x-ray is preferred.

  • CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that can be examined to look for any abnormalities or tumors. A CT scan can also be used to measure a tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. A CT scan is the most common imaging test for men with testicular cancer, and it can be used to evaluate the abdomen, pelvis, chest/lungs, brain and other areas. A CT scan of the brain is rarely needed for testicular cancer because it is uncommon for it to spread to the brain. However, if a scan of the brain is needed, MRI (see below) is generally preferred because the skull bones interfere with the ability of CT scans to show certain parts of the brain.

  • MRI scan. An MRI scan uses magnetic fields to create a three-dimensional picture of the inside of the body. MRI can also be used to measure the tumor’s size. For testicular cancer, MRI is generally only used to examine the brain or the spine. A contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein. For men with testicular cancer, CT scans (see above) are generally preferred to MRI for viewing the abdomen because accurately reading MRI scans of the abdomen requires extensive experience. When MRIs of the abdomen are needed, the contrast medium may be given by mouth.

    MRI is used only in specific situations. For instance, an MRI of the brain might be recommended if a patient is experiencing signs or symptoms that suggest that the cancer may have spread to the brain. In addition, brain MRIs are often recommended for men who have poor-risk metastatic testicular cancer (see Stages) with very high serum tumor markers or if the cancer has spread to the liver, bones, or lungs. Your doctor will explain which test is appropriate for you.

  • PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Studies of PET scans have shown that they are not helpful for diagnosing or staging testicular cancer and should not be used at these times. However, they may be helpful for men with metastatic pure seminoma that does not entirely disappear after chemotherapy, but should not be done until at least six weeks after chemotherapy ends.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Occasionally, a biopsy may be taken from the lung, retroperitoneum, or other location in the body if it appears that cancer may have spread.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.