Testicular Cancer

Your provider may diagnose testicular cancer after investigating a lump or other change in your testicle you found during a self-exam. Sometimes testicular cancer gets diagnosed during a routine physical exam.

Common procedures and tests to help diagnose testicular cancer include:

• A physical exam and history: Your provider will ask about your symptoms and examine you closely to check for signs of testicular cancer. They may feel your testicles for lumps and inspect your lymph nodes for signs of cancer spread.
• Ultrasound: If your provider notices an abnormality during the exam, they’ll likely order an ultrasound. An ultrasound is a painless medical procedure that uses high-energy sound waves to create pictures of tissue inside your body.
• Inguinal orchiectomy and biopsy: If the ultrasound shows evidence of cancer, your provider will remove the affected testicle through an incision (cut) in your groin. A specialist will examine tissue from your testicle using a microscope to check for cancer cells.

Other tests may include:

• A serum tumor marker test: This procedure examines a blood sample to measure the amounts of certain substances linked to specific types of cancers. These substances are called tumor markers. The tumor markers that are often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH). Different types of tumors elevate different markers. For example, seminomas sometimes raise HCG but not AFP. Non-seminomas may raise AFP but not HCG. Elevated LDH levels may indicate cancer spread.
• CT scans, X-rays and MRIs: A CT scan (or CAT scan) uses X-rays to form pictures of the inside of your body. Your provider may perform a CT scan of your abdomen and pelvis to see if your cancer’s spread to your abdominal organs. They may order a CT scan or standard X-ray to see if cancer’s spread to your lungs. If your provider suspects cancer has spread to your central nervous system (brain and spinal cord), you may get an MRI. An MRI uses magnets and radio waves to form pictures of the inside of your body.

What are the stages of testicular cancer?

Diagnosis also involves cancer staging. Staging provides important information that will guide treatment decisions, such as tumor size and whether the cancer’s spread.

• Stage 0: Abnormal cells have developed but are still inside the testicles where sperm cells start to develop. Stage 0 is also called germ cell neoplasia in situ (GCNIS).
• Stage I: Cancer is confined to the testicle, which may include nearby blood or lymph vessels. Tumor markers may or may not be elevated.
• Stage II: Cancer has spread to the lymph nodes in the back of your abdomen (also called the retroperitoneum) but not anywhere else. If you have cancer in your lymph nodes along with moderately or highly elevated tumor markers, then you’re in stage III rather than stage II.
• Stage III: Cancer has spread to lymph nodes beyond your abdomen or to an organ.