Testicular Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 11/2017

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 this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

This list describes options for diagnosing this type of cancer. Not all tests listed below 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 medical condition

  • 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.

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 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.

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 Introduction). 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) levels are often, but not always, increased in men with non-seminoma. AFP is not made by a seminoma, so an increased level of AFP is a sign that the tumor is not a pure seminoma.

    • Beta human chorionic gonadotropin (beta-hCG) is often, but not always, increased in men with either seminoma or non-seminoma.

    High 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 increased levels of these markers without having cancer.

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

    • Lactate dehydrogenase (LDH), which is only used to determine how much chemotherapy to give for metastatic non-seminoma (see Treatment Options). 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) 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 testicular cancer, the pathologist determines if the tissue from the testicle contains cancer cells. And, if it does, the pathologist determines what type of cancer cells they are.Most testicular cancers are germ cell tumors, which are divided into seminoma and non-seminoma. For a cancer to be considered a seminoma, it must be pure seminoma. See the Introduction section for more information on the different types of non-seminoma.If a man 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 rare.

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. 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, those who have a type of non-seminoma called choriocarcinoma, and those who have very high tumor marker levels of AFP and beta-hCG (see above).

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, 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 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can 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. Sometimes, both types of dye are given. A CT scan can also 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 3-dimensional picture of the inside of the body. MRI can 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 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, contrast medium may be given by mouth or injected into a vein.

    MRI 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 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. 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 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 can be helpful for men with metastatic pure seminoma that does not entirely disappear after chemotherapy. In such instances, the PET scan 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 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. It explains the system doctors use to describe the extent of the disease. You may use the menu to choose a different section to read in this guide.