Diagnosis of testicular cancer
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 commonly used to rule out or diagnose testicular cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. 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, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:
- symptoms that suggest testicular cancer
- undescended testicle, or cryptorchidism
- testicular cancer
- a precancerous condition called intratubular germ cell neoplasia, unclassified (IGCNU)
- Klinefelter syndrome
Your doctor may also ask about a family history of:
- testicular cancer
- risk factors 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 scrotum for lumps, swelling or tenderness
- feel your abdomen and groin for enlarged lymph nodes
- listen to your lungs
- feel your abdomen for enlarged organs
Find out more about physical exam.
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to confirm that there is a tumour in the testicle and check its size, shape, location and density.
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 ultrasound.
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 complete blood count (CBC).
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests are used to diagnose testicular cancer. These tests include the following:
Liver function tests, or 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 orchiectomy).
Doctors often order blood chemistry tests in preparation for testicular cancer treatments. These levels 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 in the blood that may mean testicular cancer is present. Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose testicular cancer.
These tumour markers may be measured for testicular cancer:
Alpha-fetoprotein (AFP) levels are often higher when a type of testicular cancer called non-seminoma germ cell tumour is present. AFP is never high for seminomas, which is another type of testicular cancer.
Human chorionic gonadotropin (HCG) levels can be higher in men with a seminoma or non-seminoma. HCG can also be high if the man has liver disease.
Lactase dehydrogenase (LDH) levels may be higher in men with a seminoma or non-seminoma. High LDH levels can indicate that the tumour is large, there is a large amount of cancer in the body, or the cancer is growing quickly. High levels can also mean that a man has advanced testicular cancer. LDH may also be high with some non-cancerous conditions.
Find about more about tumour marker tests.
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 a radical inguinal 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 rarely 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.
Retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes from the back of the abdomen (called the retroperitoneum). The lymph nodes are around the large blood vessels called the aorta and inferior vena cava.
RPLND may be done to find out if cancer has spread to these lymph nodes. It is also a treatment option for some testicular cancers.
Find out more about lymph node dissection.
An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to check for cancer in the lungs and lymph nodes in the chest.
Find out more about x-ray.
A computed tomography (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.
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.
Find out more about CT scan.
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 bone.
Find out more about bone scan.