Your doctor will ask about your symptoms, and medical and family history. The testicles and surrounding areas will be carefully examined. Your doctor may recommend different tests in order to identify tumors and confirm a diagnosis.
If you are having symptoms or your doctor detects abnormalities, you may need further testing. Tests can help confirm a cancer diagnosis or another condition, such as epididymitis or orchitis. Tests may include:
Blood tests may identify markers in the blood. Tumor markers or specific blood proteins may be elevated in the presence of cancer. Testicular cancer produces 2 markers: alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG). Another substance in the blood, the liver enzyme LDH, is usually elevated in advanced cases of cancer.
Checking blood levels of these chemicals can help with diagnosing cancer and/or monitoring the success of treatment.
Imaging tests may be used to look for the presence of tumors. They can also help assess their size and location, and to see if cancer has spread to other parts of the body, including lymph nodes. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
During an excisional biopsy, a testicle is removed and the tissue is examined under a microscope. In most cases, testicles with suspicious masses seen on ultrasound are completely removed via the groin rather than through the scrotum. This helps minimize the potential for the spread of cancer cells if they are present. A biopsy is the only way to confirm a diagnosis.
The physical exam, combined with blood, imaging, and biopsy test results will determine the stage of the cancer. Staging is used to identify where and how far the cancer has spread. It is also used to guide your treatment plan. Treatment and outcomes depend on several factors, such as location, tumor size, stage, and overall health. For most stages of disease the cure rate is currently over 95%.
Nearly all testicular cancers are of a type called germ cell tumors. There are 2 major types of germ cell tumors: seminomas and nonseminomas. There are several types of nonseminomas, all of which tend to be more aggressive than most seminomas. They are distinguished with microscopic examination as well as by blood tests for tumor markers. Some tumors may have more than one cell type. Nonseminomas are less easily cured than seminomas.
Tis ( in situ )—The cancer is very localized and has not spread to other areas.
T1 —The tumor is limited to the testis and epididymis, without having spread to nearby blood vessels.
T2 —The tumor is limited to the testis and epididymis and has spread to the blood vessels or into the thin skin surrounding the inside of the scrotum (called the tunica vaginalis).
T3 —The tumor has spread to the spermatic cord.
T4 —The tumor has spread into the wall of the scrotum.
N1 —Lymph node with 2 centimeters (cm) or less of cancer
N2 —Lymph node with 2-5 cm of cancer
N3 —Lymph node with more than 5 cm of cancer
Testicular cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003142-pdf.pdf. Accessed September 8, 2016.
Testicular cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 12, 2016. Accessed September 8, 2016.
Testicular cancer. Merck Manual Professional Version. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/testicular-cancer. Updated November 2013. Accessed September 8, 2016.
2/1/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Aytekin O, Yacoub JH, Casalino DD, et al. ACR Appropriateness Criteria. 2012; Jun 16. Available at: https://acsearch.acr.org/docs/69375/Narrative. Updated June, 2012. Accessed September 6, 2016.
Last reviewed September 2016 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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