The goals of testing are to:
- Detect and diagnose testicular cancer
- Determine which type of testicular cancer is present
- Determine whether the cancer has spread and, if so, what other organs and tissues are affected
- Monitor the effectiveness of treatment and monitor for the return (recurrence) of cancer
The process of diagnosing testicular cancer begins with a medical history and physical exam. During the physical exam, a health practitioner will:
- Examine the patient's testicles for signs of swelling, tenderness or hardening
- Press on the lymph nodes that lie beneath the skin in the groin, abdomen, upper chest, and neck to check for swelling or hardness
- Examine the patient's abdomen for signs of liver enlargement
- Examine the patient's breasts and nipples for signs of enlargement and tenderness
To obtain a medical history, a health practitioner will ask about any recent changes in the person's health or new symptoms that he may have noticed. The patient will also be asked about his past health history, particularly whether he has any of the conditions that put him at increased risk for testicular cancer. Finally, he will be asked about the health of close family members, especially those who have had testicular cancer.
An ultrasound exam of the scrotum and testicles is often the first diagnostic test performed when testicular cancer is suspected. Ultrasound uses sound waves to create images of organs and tissues. Those images, called sonograms, can be viewed on a monitor while the exam is being performed. Ultrasound can detect the presence, size, and consistency of a testicular tumor, and it can be used to help differentiate cancer from other conditions, such as infection or structural abnormalities within the testicle.
Blood tests to check for elevated amounts of the following proteins, or tumor markers, that are made by some testicular cancers may be performed.
- AFP (alpha-fetoprotein)—Nonseminoma germ cell tumors often make AFP. Seminoma germ cell tumors do not. Therefore, if someone's AFP level is elevated, his health care team will know that his tumor is composed, at least in part, of nonseminoma cells and the cancer should be treated as a nonseminoma.
- hCG (human chorionic gonadotropin)—Both seminomas and nonseminomas can cause hCG blood levels to rise.
Stromal tumors (Leydig cell tumors and Sertoli cell tumors) do not make AFP or hCG, so they will not cause blood levels of these tumor markers to rise.
- LD (lactate dehydrogenase) levels can rise in the presence of most types of testicular cancer. LD 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; many other health conditions can cause LD levels to rise. When testicular cancer is present, high LD levels may indicate that the cancer is widespread.
When a solid mass is detected in a testicle during an ultrasound exam, health practitioners often recommend surgery to remove the entire testicle. After surgery, the affected person's tumor marker levels will be measured again to help his health care team determine the extent (stage) of his cancer. Elevated tumor marker levels after surgery may be an indication that the cancer has spread to other parts of the body.
Tumor marker tests are likely to be a part of a testicular cancer patient's ongoing cancer care. They can be helpful in monitoring the person's response to treatment as well as detecting the recurrence of testicular cancer.
Other Diagnostic Procedures
The standard procedure for confirming a diagnosis of testicular cancer is removal of the affected testicle. A pathologist will look at pieces of the mass and testicular tissue under a microscope. If cancer cells are found, the pathologist will report what types of cancer cells are present.
The procedure used to remove a testicle is called radical inguinal orchiectomy. In addition to providing a diagnostic specimen, it is the preferred treatment for most testicular cancers. The procedure involves making an opening in the groin through which the testicle and spermatic cord are released from the scrotum and removed. The spermatic cord is removed because it contains the vas deferens, blood and lymph vessels, all of which could carry cancer cells out of the testicle to other parts of the body.
Once a diagnosis of testicular cancer has been made, additional procedures may be recommended to find out whether the cancer has spread.
- A chest X-ray may be done to look for masses in the lungs.
- CT scans of the abdomen, pelvis, and possibly the chest may be done to determine whether the cancer has spread to lymph nodes, organs, or tissues in any of those areas.
These procedures are likely to be a part of someone's ongoing cancer care. They can be helpful in monitoring the body's response to treatment as well as detecting recurrence of testicular cancer.