Diagnosis of testicular cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing testicular cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for testicular cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as testicular cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of testicular cancer.

The following tests are usually used to rule out or diagnose testicular cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest testicular cancer
• undescended testicle (cryptorchidism)
• testicular cancer
• a precancerous condition called germ cell neoplasia in situ (GCNIS)
• Klinefelter syndrome

Your doctor may also ask about a family history of:

• testicular cancer
• risks for testicular cancer
• other cancers

A physical exam allows your doctor to look for any signs of testicular cancer. During a physical exam, your doctor may:

• check the testicles for lumps, swelling, hardening or tenderness
• feel your abdomen, groin and upper chest for enlarged lymph nodes
• listen to your lungs
• feel your abdomen for enlarged organs
• look at your breasts and nipples to see if they are larger and more tender

Find out more about physical exams.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to confirm that there is a tumour in the testicle and check its size and shape, where it is and how solid it is.

An ultrasound can help your doctor tell non-cancerous (benign) tumours from tumours that are more likely to be cancerous (malignant).

Find out more about ultrasounds.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health.

Find out more about a complete blood count (CBC)..

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. For testicular cancer, the following blood chemistry tests are measured to see generally how healthy you are before surgery.

Liver function tests (a liver panel) may be done to find out what is causing abdominal pain or discomfort. High levels of certain substances in the blood may mean that testicular cancer has spread to the liver.

Kidney function tests are used to check how well the kidneys are working. They are often done before and after surgery to remove one or both testicles (called a radical inguinal orchiectomy, or an orchiectomy).

Doctors often order blood chemistry tests before treatments for testicular cancer. The levels in these tests help create a starting point used to compare future levels. This is known as a baseline.

Find out more about blood chemistry tests.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a certain tumour marker may mean that a person has testicular cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose testicular cancer.

The following tumour markers may be measured for testicular cancer.

Alpha-fetoprotein (AFP) levels are often higher when you have a type of testicular cancer called non-seminoma germ cell tumour. AFP is never higher for seminoma, which is another type of testicular cancer.

Human chorionic gonadotropin (hCG) levels can be higher with either a seminoma or a non-seminoma tumour. It can also be higher if you have liver disease.

Lactate dehydrogenase (LDH) levels may be higher with either a seminoma or a non-seminoma tumour. High levels can also mean advanced testicular cancer. LDH may also be high with some non-cancerous conditions.

High tumour marker levels can indicate that the tumour is large, there is a large amount of cancer in the body or the cancer is growing quickly.

Find about more about tumour markers.

Based on the results of an ultrasound and tumour marker tests, doctors usually know if a lump in a testicle is cancerous or non-cancerous. If doctors believe a lump is cancer, they will do an orchiectomy. This surgery removes all of the testicle and spermatic cord. The testicle is removed to definitely diagnose the cancer, and this surgery is the first treatment for testicular cancer.

All of the tissue removed during surgery is sent to a lab. A pathologist examines the tissues under a microscope to confirm that cancer is present and find out what type of cancer it is.

Doctors do not usually use a needle to remove tissue from the testicle to find out if a lump is cancer because doing this could spread the cancer to the scrotum and lymph nodes in the pelvis.

Sometimes having a testicle removed can cause fertility problems. Find out more about fertility problems under supportive care for testicular cancer.

A retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes from the back of the abdomen (called the retroperitoneum).

An RPLND may be done to find out if cancer has spread to these lymph nodes. It is also used as a treatment for some testicular cancers.

Find out more about a lymph node dissection.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to check for cancer in the lungs and lymph nodes in the chest.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to see if the cancer has spread to lymph nodes in the abdomen or chest. It can also check if testicular cancer has spread to the brain, bones or other organs.

Find out more about CT scans.

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to check if cancer has spread to the bones.

Find out more about bone scans.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.