Diagnosis is the process of finding the underlying cause of a health problem. If cancer is suspected, the healthcare team will confirm if it is present or not, and what type of cancer it is. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis.
Diagnostic tests for testicular cancer are usually done when:
- the symptoms of testicular cancer are present
- the doctor suspects testicular cancer after talking with the man about his health and completing a physical examination
Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following:
Medical history and physical examination
The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor diagnose testicular cancer.
In taking a medical history, the doctor may ask questions about:
- a personal history of
- previous testicular cancer
- abnormal development of the testicles
- cryptorchidism – undescended testicle
- Klinefelter syndrome – a genetic condition that causes the testicles to waste away (atrophy) and not make sperm, a man’s breasts to grow and a lack of male sexual characteristics
- occupational or environmental chemical exposure
- past medical or surgical treatment for a testicular disorder
- history of any injury or trauma to the testicles
- decreased fertility
- a family history of testicular cancer
- signs and symptoms
A physical examination allows the doctor to look for any signs of testicular cancer. During a physical examination, the doctor may:
- evaluate the man’s general health
- examine the testicles and scrotum for lumps, swelling or pain
- check for enlarged lymph nodes in the groin, neck and armpit
- listen to the lungs
- feel the abdomen for an enlarged liver or other lumps
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Ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:
- confirm the presence of a lump in the testicle
- determine the size, shape, location and density of the lump
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Complete blood count
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:
- rule out any abnormality, such as anemia or an infection
- assess a man’s general health before starting treatment
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Blood chemistry tests
Blood chemistry tests measure specific chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to diagnose or stage testicular cancer.
- If there is no lump or swelling in the testicles, liver or kidney function tests may be ordered to investigate abdominal pain or discomfort.
- Liver function tests may detect spread of the testicular cancer to the liver. (For example, increased alanine aminotransferase (ALT) and aspartate transaminase (AST) may indicate that the cancer has spread to the liver.)
- Kidney function tests may detect spread of the testicular cancer to the kidneys.
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Tumour marker tests
Tumour markers are substances – usually proteins – in the blood that may indicate the presence of testicular cancer. Tumour marker tests are used to check a person's response to cancer treatment, but they can also be used to diagnose testicular cancer.
The main tumour markers that may be measured are:
- alpha-fetoprotein (AFP) – AFP levels may be higher in non-seminomas, but never in pure seminomas.
- human chorionic gonadotropin (HCG) – High levels may indicate the presence of testicular cancer.
- lactate dehydrogenase (LDH) – High levels may indicate increased tumour burden and growth rate.
Tumour markers may help determine:
- the type of cancer
- Non-seminomas, also known as non-seminomatous germ cell tumours, often have higher AFP and HCG levels.
- Seminomas occasionally have increased HCG, but they never have increased AFP.
- Sertoli and Leydig cell tumours do not produce these substances.
- how much cancer is present
- response to treatment
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Chest x-ray
An x-ray uses small doses of radiation to make an image of the body's structures on film. It is used to detect the spread of testicular cancer to the lungs and lymph nodes in the chest cavity (mediastinal lymph nodes).
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Biopsy
During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.
The biopsy used for testicular cancer is an orchiectomy. In this biopsy, the affected testicle and spermatic cord are removed. This biopsy has 2 purposes:
- It helps in the diagnosis and staging of the testicular cancer.
- It is the primary surgical treatment for testicular cancer.
A retroperitoneal lymph node dissection may be done to remove some or all of the lymph nodes in the back of the abdomen as part of surgery for some types of testicular cancer. Microscopic examination of these lymph nodes for testicular cancer cells gives doctors important staging information.
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Computed tomography (CT) scan
CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:
- locate tumours
- determine if the tumour can be completely removed by surgery
- find out if testicular cancer has spread to organs and tissues in the pelvis, abdomen and chest
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Bone scan
A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to:
- check if the cancer has spread to the bones (bone metastases) – if the person has aches and pains that may be caused by bone metastases (also known as bony involvement)
- see how bone metastases are responding to treatment
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Magnetic resonance imaging (MRI)
MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is sometimes used to visualize the anatomy of blood vessels before surgery.
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Positron emission tomography (PET) scan
A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolism of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. It does not detect small lymph node enlargement due to testicular cancer and is not useful in staging.
PET scans are used to find seminomas larger than 3 cm that are still present after chemotherapy.
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See a list of questions to ask your doctor about diagnostic tests.