© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Doctors use many tests to diagnose cancer and find out if it has metastasized. Some tests may also determine which treatments may be the most effective.
When a man develops a testicular lump or something else that could be testicular cancer, it is important that he see his primary doctor, who may send him to a urologist (the doctor who specializes in treating a man with testicular cancer). A physical examination and an ultrasound (see below) of the testicles are usually the first tests performed. If these tests show an abnormality that appears to be a tumor, then blood tests are done. It may be necessary to surgically remove the testicle, so it can be examined under a microscope to find out whether cancer is present. Imaging tests, such as computed tomography (CT or CAT) scans and x-rays, may also be used to find out whether the cancer has spread. Your doctor may consider these factors when choosing a diagnostic test:
- Age and medical condition
- Type of cancer suspected
- Severity of symptoms
- Previous test results
If the doctor suspects testicular cancer, he or she will ask about a man's medical history and general health. The following tests may be used to diagnose testicular cancer:
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.
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.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer, but biopsies of a testicle is almost never used to diagnose testicular cancer. Instead, if cancer is suspected in a testicle, the standard procedure is to surgically remove the entire testicle (called an orchiectomy; see below). In fact, a biopsy of the testicle using a needle through the skin of the scrotum should NOT be performed because this can complicate future treatment options. Occasionally, a biopsy may be taken from the lung or the retroperitoneum or other location in the body if it appears that cancer may have spread.
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 (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) will examine very thin slices of tissue from the testicle under a microscope to diagnose the type of cancer. For a cancer to be considered a seminoma, it must be pure seminoma. Non-seminoma is diagnosed if any of the following are found in the tissue: choriocarcinoma, embryonal carcinoma, yolk sac tumor, or teratoma. Each of these can occur alone or in any combination. Sometimes, seminoma cancer can be found as a part of non-seminoma at any percentage level. For example, a tumor that is 99% seminoma and 1% yolk sac tumor is still diagnosed and treated as non-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 is evidence 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 back into the scrotum during the same surgery. However, this procedure is very rare.
Blood tests/tumor markers. If a decision is made to perform an orchiectomy, a sample of blood will be collected before surgery to test for levels of serum tumor markers, which are substances made by a cancer that are found at abnormally high levels in the blood of a person with cancer. Serum tumor marker levels do not help decide whether or not the orchiectomy is recommended, but they can help confirm whether a tumor is a pure seminoma and help determine the stage of the cancer. Different types of cancer make different tumor markers. High levels of any one of three tumor markers (see below) may indicate testicular cancer. It is also possible to have this type of cancer and have normal tumor marker levels.
The three tumor markers used to help diagnose and plan treatment for testicular cancer are alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG), and lactase dehydrogenase (LDH). AFP is a tumor marker that 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 when examined by a pathologist. The tumor marker beta-hCG can be high from either seminoma or non-seminoma. However, it is important to note that AFP and beta-hCG levels are normal in up to 40% of men with non-seminomas and in most men with seminomas. LDH can be elevated in any type of testicular cancer, as well as in many other cancers and non-cancerous diseases, such as liver disease or heart disease. 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.
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 Staging). Usually, doctors recommend imaging tests of the abdomen, pelvis and chest. Images of the brain or bones are not as common. Imaging tests may 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 lung 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. Often, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. CT scans are the most common imaging test for men with testicular cancer, and they can be used to evaluate the abdomen, pelvis, chest (including the lungs), brain and other areas. For men who have a normal CT scan of the abdomen and pelvis and normal serum tumor markers, a CT scan of the chest is usually not needed and a chest x-ray (see above) is used instead. CT scans of the brain are rarely needed for men with 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. A computer then combines the images in a detailed, cross-sectional view that shows any abnormalities or tumors. 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.
MRI is used only in specific situations. For instance, an MRI of the brain might be recommended if the patient has neurological symptoms or abnormalities on a physical examination 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 Staging) with very high serum tumor markers or if the cancer has spread to the liver or bones. Rarely, an MRI may be used to look at the abdomen, pelvis, or other parts of the body. 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 substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues 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. 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.
Find more about what to expect when having common tests, procedures, and scans.
After these 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. Learn more about the first steps to take after a diagnosis of cancer.