Tests for Testicular Cancer

Testicular cancer is usually found as a result of symptoms that a person is having. It can also be found when tests are done for another condition. The next step is an exam by a doctor.

The doctor will feel the testicles for swelling or tenderness and for the size and location of any lumps. The doctor will also examine your belly (abdomen), lymph nodes, and other parts of your body carefully to look for signs of cancer spread. Often the results of the exam are normal other than the changes in the testicles. If a lump or other sign of testicular cancer is found, testing will be needed to look for the cause.

Ultrasound of the testicles

An ultrasound is often the first test done if the doctor thinks you might have testicular cancer. It uses sound waves to produce images of the inside of your body. It can be used to see if a change is a certain benign condition (like a hydrocele or varicocele) or a solid tumor that could be a cancer. If the lump is solid, it’s more likely to be a cancer. In this case, the doctor might recommend other tests or even surgery to remove the testicle.

Blood tests for tumor markers

Some blood tests can help diagnose testicular tumors. Many testicular cancers make high levels of certain proteins called tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). When these tumor markers are in the blood, it suggests that there's a testicular tumor.

Rises in levels of AFP or HCG can also help doctors tell which type of testicular cancer it might be.

• Non-seminomas often raise AFP and/or HCG levels.
• Pure seminomas occasionally raise HCG levels but never AFP levels.

This means any increase in AFP is a sign that the tumor has a non-seminoma component. (Tumors can be mixed and have areas of seminoma and non-seminoma.) Sertoli and Leydig cell tumors don't make these substances. It's important to note that some cancers are too small to elevate tumor markers levels.

A testicular tumor might also increase the levels of an enzyme called lactate dehydrogenase (LDH). A high LDH level often (but not always) indicates widespread disease. But, LDH levels can also be increased with some non-cancerous conditions.

Tumor marker tests sometimes are also used for other reasons, such as to help estimate how much cancer is present (see Testicular Cancer Stages) to see how well treatment is working, or to look for signs the cancer might have come back.

Surgery to diagnose testicular cancer

Most types of cancer are diagnosed by removing a small piece of the tumor and looking at it under a microscope for cancer cells. This is known as a biopsy. But a biopsy is rarely done for a testicular tumor because it might risk spreading the cancer. The doctor can often get a good idea of whether it's testicular cancer based on the ultrasound and blood tumor marker tests, so instead of a biopsy the doctor will very likely recommend surgery (a radical inguinal orchiectomy) to remove the tumor as soon as possible.

The entire testicle is sent to the lab, where a pathologist (a doctor specializing in laboratory diagnosis of diseases) looks at pieces of the tumor with a microscope. If cancer cells are found, the pathologist sends back a report describing the type and extent of the cancer.

In very rare cases, when a diagnosis of testicular cancer is uncertain, the doctor may biopsy the testicle before removing it. This is done in the operating room. The surgeon makes a cut above the pubic area, takes the testicle out of the scrotum, and examines it without cutting the spermatic cord. If a suspicious area is seen, a piece of it is removed and looked at right away by the pathologist. If cancer is found, the testicle and spermatic cord are then removed. If the tissue is not cancer, the testicle can often be returned to the scrotum.

If testicular cancer is found, your doctor will order imaging tests of other parts of your body to check for spread outside the testicle. These tests may also be done before the diagnosis is confirmed by surgery.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Ultrasound of the testicles, described above, is a type of imaging test. Other imaging tests may be done for a number of reasons after a testicular cancer diagnosis, including:

• To learn if and how far the cancer might have spread
• To help determine if treatment worked
• To look for possible signs of cancer coming back after treatment

Chest x-ray

Your chest may be x-rayed to see if cancer has spread to your lungs.

Computed tomography (CT) scan

CT scans can be used to help determine the stage (extent) of the cancer by showing if it has spread to the lymph nodes, lungs, liver, or other organs.

Magnetic resonance imaging (MRI) scan

MRI scans are very good for looking at the brain and spinal cord. They are only done in patients with testicular cancer if the doctor has reason to think the cancer might have spread to those areas.

Positron emission tomography (PET) scan

A PET scan can help spot small collections of cancer cells in the body. It's sometimes useful to see if lymph nodes that are still enlarged after chemotherapy contain cancer or are just scar tissue. PET scans are often more useful for seminomas than for non-seminomas, so they are less often used in patients with non-seminoma. Many centers have special machines that can do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed images of the CT.

Bone scan

A bone scan can help show if a cancer has spread to the bones. It might be done if there is reason to think the cancer might have spread to the bones (because of symptoms such as bone pain) and if other test results aren’t clear.