Diagnosis

Doctors use many tests to diagnose cancer and determine 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, the first test that usually is performed is an ultrasound (see below) of the testicles. If the ultrasound shows an abnormality that looks like a tumor, then blood tests are done and the testicle is surgically removed and examined under a microscope to see whether cancer is present. Imaging tests, such as x-rays, computed tomography (CT or CAT) and/or magnetic resonance imaging (MRI) scans, may also be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
  
  
• The 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. This allows doctors to detect growths in the testicles. The sound waves produced by the ultrasound bounce off tissue in the scrotum. The echoes of the sound waves produce an image called a sonogram that can help the doctor detect the presence, size, and solidness of a tumor. Solid tumors are much more likely to be cancerous.

Blood tests/tumor markers. A sample of blood may be collected to test for levels of serum tumor markers, which are substances produced by a cancer that are found at abnormally high levels in the blood of a person with cancer. Different types of cancer produce different tumor markers. High levels of any one of three tumor markers may indicate testicular cancer, but it is also possible to have this type of cancer and not have high tumor marker levels. Tumor marker levels can also indicate the type of testicular cancer, such as seminoma or non-seminoma. Alpha-fetoprotein (AFP) is a tumor marker that is not made by seminomas, so an elevated level of AFP indicates that some other type of cancer is probably present. Two other tumor markers, beta human chorionic gonadotropin (hCG) and/or lactase dehydrogenase (LDH), can be higher if a man has a seminoma. Placental alkaline phosphatase (PLAP) is another tumor marker doctors may test for, although it is not commonly measured.

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 are rarely used to diagnose testicular cancer. Instead, if cancer is suspected in a testicle, the standard procedure is to surgically remove the entire testicle. In fact, a biopsy using a needle through the skin should NOT be performed because this can complicate future treatment options. Occasionally, a biopsy may be taken from the lung or the retroperitoneum 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 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 pathology specimen: choriocarcinoma, embryonal cell 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 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 if the blood vessels and spermatic cord (the structure that connects the testicle to the rest of the body) were not cut. However, such a procedure is very rare.

If cancer is found, other tests may be required to determine the stage of the cancer and whether it has spread to other areas of the body. These tests may include:

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.

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 shows any abnormalities or tumors. Often, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.

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 are often preferred to MRIs for imaging the body, but there are certain specific situations when MRI may preferred. Your doctor will explain which test is appropriate for you.

Learn more about what to expect when having common tests, procedures, and scans.

Find out more about common terms used during a diagnosis of cancer.