Testicular Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

How testicular cancer is diagnosed

There are many tests used for diagnosing testicular cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

If you develop a testicular lump or something else that could be testicular cancer, it is important to see your primary care doctor. After this visit, your doctor may refer you to a urologist for more tests. A urologist is a doctor who specializes in treating testicular cancer and other conditions of the urinary tract.

A physical examination and an ultrasound are usually the first tests performed. If they 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. More details on each test are below.

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 a cancer has spread. The breasts and nipples will also be examined to look for growth, and the legs will be examined for swelling. Leg swelling can be 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 there is a tumor 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.

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. Different types of cancer make different tumor markers. For testicular cancer, serum tumor marker levels are used to find out the cancer’s stage (see Stages) and to confirm whether a tumor is a pure seminoma (see Introduction). The following tumor markers are used to help stage and plan treatment for testicular cancer:

  • Alpha-fetoprotein (AFP). The AFP level is often, but not always, elevated in people with non-seminoma. AFP is not made by seminomas, so an increased level of AFP is a sign that the tumor is not a pure seminoma.

  • Beta human chorionic gonadotropin (beta-hCG). Beta-hCG is often, but not always, elevated in people with seminoma or non-seminoma. However, beta-hCG levels above 1,000 IU/L generally indicate that the cancer is a non-seminoma and not a seminoma.

Elevated levels of these tumor markers may indicate testicular cancer or another type of cancer. However, it is possible to have testicular cancer and have normal tumor marker levels. It is also possible to have elevated levels of these markers without having cancer.

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

  • Lactate dehydrogenase (LDH). LDH is only used to determine how much chemotherapy to give for metastatic non-seminoma (see Types of Treatment). This is because many other cancers and non-cancerous conditions can increase LDH levels. LDH is not used to find testicular cancer.

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

AFP, beta-hCG, and LDH levels will be tested regularly before and during the active treatment period to monitor the cancer. These tumor markers will also be tested at regular times during follow-up care (see the Follow-up Care section) after treatment is completed.

Learn more about ASCO's recommendations for tumor markers in adults with germ cell tumors. (Please note that this link takes you to a different ASCO website.)

Orchiectomy/surgical pathology tests. If testicular cancer is suspected, a surgeon will perform a radical inguinal orchiectomy. During this surgery, 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 testicular cancer, the pathologist determines if the tissue from the testicle contains cancer cells. If it does, the pathologist determines what type of cancer cells they are. Most testicular cancers are germ cell tumors, which are divided into 2 categories: seminoma and non-seminoma (see the Introduction for more information). If a person has only 1 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 cancer 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 rarely done.

Other tests

If cancer is found, other tests will be needed to determine the stage of the cancer and find out if it has spread to other parts of the body (see Stages). Usually, doctors recommend imaging tests of the abdomen, pelvis, and chest. Imaging tests show pictures of the inside of the body. Images of the brain or bones are not as common but may be needed for some patients. This can include patients who have cancer that has spread widely, those who have a type of non-seminoma called choriocarcinoma, and those who have very high tumor marker levels of AFP or beta-hCG (see above).

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, the doctor may recommend a chest CT scan (see below). But in many situations, an x-ray is preferred because it uses less radiation.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image of the body. This can help doctors find any abnormalities or tumors. If a tumor is visible on the CT pictures, the scan can be used to measure the tumor’s size. Often, a special dye called a contrast medium is given before the scan to provide a clearer image. Some dyes are injected into a patient’s vein, while others are given as a pill or liquid to swallow. Many times, both types of dye are given before a CT scan because they help your health care team see different parts of the body. A CT scan 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 this type of cancer to spread to the brain. However, if a scan of the brain is needed, MRI (see below) is generally preferred because the bones of the skull interfere with the ability of CT scans to show certain parts of the brain.

Magnetic resonance imaging (MRI) scan. An MRI scan uses magnetic fields to create a 3-dimensional picture of the inside of the body. An MRI can be used to measure the tumor’s size. For testicular cancer, MRI scans have recently begun to be used as an alternative to CT scans for imaging the abdomen and pelvis in patients who prefer to avoid CT scans, particularly for those undergoing surveillance for stage I seminoma. This depends on whether an MRI scanner is available as well as a radiologist with expertise in interpreting MRI scans. MRI scans are generally preferred to CT scans for examining the brain or the spine. A contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein. For testicular cancer, CT scans (see above) are used more often than MRI scans for viewing the abdomen and pelvis because accurately reading MRI scans of the abdomen and pelvis requires more experience than reading CT scans. When MRIs of the abdomen are needed, contrast medium may be given as a pill or liquid to swallow.

MRI scanning of the brain and/or spine is used only in specific situations. For instance, an MRI of the brain might be recommended if a patient has symptoms or changes on a physical exam that suggest that the cancer may have spread to the brain. In addition, brain MRIs are often recommended for poor-risk metastatic testicular cancer (see Stageswith very high serum tumor markers or if the cancer has spread to the liver, to the bones, or extensively to the lungs. Spine MRI scans are only ordered if there is reason to suspect that the cancer has spread to the spine, which is not common in testicular cancer. Your doctor will explain which test is appropriate for you.

Positron emission tomography (PET) or PET-CT scan. PET scans are not generally used for testicular cancer. When PET scans are done, they are usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a 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 more energy than healthy tissue, it absorbs more of the radioactive sugar. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects the sugar to produce images showing where the cancer is in 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 can be helpful in cases of metastatic pure seminoma that does not entirely disappear after chemotherapy. In such instances, if a PET scan is planned, it should not be done until at least 6 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 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. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.