The goals with testing are to detect and diagnose testicular cancer, distinguish between different types, determine how far it has spread, monitor the effectiveness of treatment, and monitor for recurrence.
Diagnosis of testicular cancer begins with a physical examination. While there is no specific laboratory blood test to detect testicular cancer at this time, the following are useful in establishing a diagnosis:
- Tumor markers such as AFP (alpha-fetoprotein) and hCG (human chorionic gonadotropin) may be elevated. AFP is almost always elevated in nonseminomas, while hCG may be elevated in both seminomas and nonseminomas. These tests can be used to help diagnose testicular cancer and, if the initial levels are elevated, can be used to monitor response to treatment as well as recurrence.
- LDH (lactate dehydrogenase) may be elevated in most types of testicular cancer. LDH is an enzyme found in many body tissues that is released into the bloodstream when cellular damage occurs. It is not specific for testicular cancer but can give the doctor additional information and is particularly useful in staging and risk assessment for both tumor types.
An ultrasound also may be done during an initial evaluation. This technology uses sound waves to visualize the presence, size, and consistency of a testicular mass (tumor) and is used to help differentiate cancer from other conditions, such as infection.
If, after initial testing, cancer is suspected, the testicle is usually removed and submitted to a pathologist for examination. An incision is made in the groin and the testicle and spermatic cord (which contains the vas deferens) are taken out of the scrotum. Often times, an intra-operative consultation with a pathologist can provide a preliminary diagnosis at the time of surgery.
If the lump is cancerous, a pathologist will establish what type of testicular cancer is present and assist in staging the cancer (three stages that determine how far the cancer has spread to other organs). Genetic testing for mutations of certain genes, such as KIT (D816V) and PDE11A, may be performed in some cases on tumor tissue in the definitive diagnosis of these tumors. Cytogenetic studies have shown an abnormality of chromosome 12 in 80% of cases. Treatment options will depend on the type of cancer present and the stage.
For more on this, visit the web site produced by the College of American Pathologists, Mybiopsy.org: Testis.