Cancer of the Testicle (cont.)
Testicular Cancer Diagnosis
Many medical conditions can cause the symptoms or physical findings of testicular cancer. On hearing the symptoms, or finding a lump, swelling, or other change on physical examination, the health-care provider will develop a list of possible causes. He or she will then do a systematic evaluation to try to pinpoint the diagnosis. The provider often starts by asking questions about the person's symptoms, medical and surgical history, lifestyle and habits, and any drugs or medications the person takes.
The next step, in most instances, should be an ultrasound of the scrotum.
- Ultrasound is a noninvasive method of evaluating the scrotum and testicle.
- Sound waves are emitted via a probe that is moved over the scrotum. These are transmitted as visual images to a video monitor.
- The images show the contour of the testicle, potential fluid within the scrotum, and blood flow. In most cases, abnormalities of the testicle show up very well.
If testicular cancer is found, a chest
X-ray and CT scan of the abdomen and pelvis are used to look for further spread of the disease.
Patients will probably have blood drawn for lab tests listed below.
- The most important is for tumor markers, which are substances released into the blood by the tumor tissue.
- These substances are alpha-fetoprotein (AFP), beta human chorionic gonadotropin (bHCG), and lactate dehydrogenase (LDH).
- High levels of these substances may indicate the presence of cancer.
- Tumor markers may assist in predicting the type of cancer, its extent, and how it might respond to treatment.
- An effective treatment causes the tumor markers to return to a normal level. If the tumor markers do not return to normal after treatment, this usually means that the cancer has spread to another part of the body.
- Tumor markers are checked regularly throughout and after treatment to detect response to treatment and remaining disease.
Some individuals may have their urine tested for signs of damage to the organs of the urinary tract, which are closely related to the reproductive organs.
Tumor stage is a critical measure of how much the cancer has spread. Knowing the stage is important because it guides treatment. Preliminary staging is based on the results of the imaging studies and lab tests. Testicular cancer typically spreads in a step-by-step fashion. If it spreads from the testicle, the first place it typically goes is in the area near the kidneys, called the retroperitoneum. It then can spread to the lungs, brain, or liver.
- Stage I: Tumor is limited to testicle without any evidence of disease in the abdomen, chest, or brain.
- Stage IIA: Tumor is in the testicle and has spread to a small number of retroperitoneal lymph nodes measuring less than 2 cm in greatest diameter.
- Stage IIB: Tumor is in the testicle and has spread to a retroperitoneal lymph node(s) measuring between 2
cm and 5 cm in greatest diameter.
- Stage IIC: Tumor is in the testicle and has spread to the retroperitoneal lymph nodes measuring greater than 5 cm in greatest diameter.
- Stage III: Tumor has spread beyond the retroperitoneal lymph nodes, typically to the lungs or brain.
Many experts also break testicular tumors down into "good-risk" and "poor-risk" groups.
- Poor-risk tumors are linked with very high levels of tumor markers or spread beyond the retroperitoneal lymph nodes and lungs.
- The cure and survival rates are significantly lower for poor-risk tumors than they are for good-risk tumors.
Staging can only be estimated from imaging studies and tumor markers. The only way to confirm the diagnosis of testicular cancer is through surgical removal of suspected tumor tissue that is biopsied; often it means that a testicle is removed.
- The testicle is removed in a procedure called radical orchiectomy, which requires an incision in the groin (inguinal region) and complete removal of the testicle and spermatic cord.
- A small piece of the tumor (biopsy) is examined by a physician who specializes in diagnosing disease by examining cells and tissues (pathologist).
- Removing the tumor without removing the testicle (partial orchiectomy) is rarely an option in adults, since this carries a risk of leaving residual cancer cells in the testicle that could spread to the other testicle or other parts of the body.
Steven C Campbell, MD, PhD
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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