Testicular Cancer

Diagnosis

Testicular cancer is often first noticed as lumps, swelling or other changes in the testicles. These may be found during self-exam or during a routine check by a health care provider. To confirm the cause of these symptoms, several diagnostic tests are used.

Common tests that help diagnose testicular cancer include:

Ultrasound
An ultrasound uses sound waves to create images of the scrotum and testicles. During this test, you lie on your back while a gel is applied to the scrotum. A small handheld device is moved across the skin to capture images.

An ultrasound helps your provider understand whether a lump is inside or outside the testicle. Lumps inside the testicle are more likely to be cancerous. The ultrasound images also help determine whether a lump looks like cancer or something less serious.

Blood tests
Blood tests can identify proteins, called tumor markers, that may be produced by testicular cancer cells. These include beta-human chorionic gonadotropin, alpha-fetoprotein and lactate dehydrogenase. Higher-than-typical levels do not always mean cancer, but they help guide the diagnostic process.

Surgery to remove a testicle
If a lump appears suspicious for cancer, you may need surgery to remove the testicle. It is then examined in a lab to determine whether cancer is present.

Determining the type of cancer

Testing the removed cancer cells helps identify the specific type of testicular cancer. This information guides treatment decisions.

The main types include:

Seminoma
Seminomas typically develop at an older age and generally grow more slowly than other types.

Nonseminoma
Nonseminomas tend to occur earlier in life and grow quickly. Types include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.

Other rare types of testicular cancer also exist but are much less common.

Staging the cancer

Staging determines whether cancer has spread beyond the testicle. This helps your care team understand your outlook and recommend appropriate treatment.

Tests used for staging include:

Computerized tomography (CT) scan
A CT scan produces cross-sectional images of the abdomen, chest and pelvis. These images help detect whether cancer has spread.

Blood tests
Tumor marker tests are often repeated after the testicle is removed. The results show whether more treatment might be needed and are also used to monitor your recovery.

Testicular cancer stages range from 0 to 3. Stage 0 and stage 1 cancers are limited to the testicle and nearby areas. Stage 2 cancers have spread to the lymph nodes. Stage 3 cancers may spread to other parts of the body or show very high tumor marker levels, even if spread is not visible.

Treatment

Treatment for testicular cancer often involves surgery, chemotherapy or radiation therapy. The best approach depends on the cancer type, stage, your overall health and your personal preferences.

Surgery

Surgery is a primary treatment for most testicular cancers. Procedures include:

Surgery to remove the testicle
Called a radical inguinal orchiectomy, this is the first treatment for most cases. The surgeon removes the testicle through an incision in the groin. A prosthetic testicle can be inserted if desired. If the cancer is early stage, this may be the only treatment needed.

Surgery to remove nearby lymph nodes
If cancer may have spread, some lymph nodes in the abdomen may be removed and examined. This surgery is more common for nonseminoma cancers. There is a small risk of nerve damage, which may affect ejaculation but not the ability to have erections. Ask about sperm preservation options before surgery.

Chemotherapy

Chemotherapy uses strong medicines that travel throughout the body to kill cancer cells. It is often recommended after surgery to destroy remaining cancer cells. In advanced cases, chemotherapy may be used before surgery.

Side effects vary but may include fatigue, increased infection risk and hearing loss. Chemotherapy can temporarily or permanently reduce sperm production. Talk to your provider about fertility preservation before starting treatment.

Radiation therapy

Radiation therapy uses powerful energy beams to kill cancer cells. It is mainly used for seminoma-type testicular cancer and may be recommended after testicle removal.

Side effects can include nausea, fatigue and temporary reduction of sperm count. Ask about options for preserving sperm before treatment.

Radiation therapy is generally not effective for nonseminoma cancers.

Immunotherapy

Immunotherapy helps the immune system recognize and destroy cancer cells. It may be used for advanced testicular cancer that does not respond to standard treatments.