Exams and Tests

Many medical conditions can cause the symptoms or physical findings of testicular cancer. On hearing your symptoms, or finding a lump, swelling, or other change on physical examination, your 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. He or she will start by asking you questions about your symptoms, your medical and surgical history, your lifestyle and habits, and any drugs or medications you take.

The next step 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, fluid collection within the scrotum, and blood flow. In most cases, any abnormalities in 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.

You will probably have blood drawn for lab tests.

• 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 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.

You may have urine tested for signs of damage to the organs of your urinary tract, which are closely related to your 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 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.
  
  
• Stage IIB: Tumor is in the testicle and has spread to a large number of retroperitoneal lymph nodes.
  
  
• Stage III: Cancer has spread beyond the retroperitoneal lymph nodes, typically to the lungs or brain.

Many experts also break testicular tumors down into "good-risk" and "bad-risk" groups.

• Bad-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 bad-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 surgery.

• The testicle is removed in a procedure called orchiectomy.
  
  
• 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 is not an option, 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.