Tests and diagnosis

By Mayo Clinic Staff

Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam.

To determine whether a lump is testicular cancer, your doctor may recommend:

  • Ultrasound. A testicular ultrasound test uses sound waves to create an image of the scrotum and testicles. During an ultrasound you lie on your back with your legs spread. Your doctor then applies a clear gel to your scrotum. A hand-held probe is moved over your scrotum to make the ultrasound image.

    An ultrasound test can help your doctor determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells your doctor whether lumps are inside or outside of the testicle. Your doctor uses this information to determine whether a lump is likely to be testicular cancer.

  • Blood tests. Your doctor may order tests to determine the levels of tumor markers in your blood. Tumor markers are substances that occur normally in your blood, but the levels of these substances may be elevated in certain situations, including testicular cancer. A high level of a tumor marker in your blood doesn't mean you have cancer, but it may help your doctor in determining your diagnosis.
  • Surgery to remove a testicle (radical inguinal orchiectomy). If it's determined that the lump on your testicle may be cancerous, surgery to remove the testicle may be recommended. Your removed testicle will be analyzed in a laboratory to determine if the lump is cancerous and, if so, what type of cancer.

Determining the type of cancer

Your extracted testicle will be analyzed to determine the type of testicular cancer. The type of testicular cancer you have determines your treatment and your prognosis. In general, there are two types of testicular cancer:

  • Seminoma. Seminoma tumors occur in all age groups, but if an older man develops testicular cancer, it is more likely to be seminoma. Seminomas, in general, aren't as aggressive as nonseminomas and are particularly sensitive to radiation therapy.
  • Nonseminoma. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.

Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma.

Staging the cancer

Once your doctor confirms your diagnosis, the next step is to determine the extent (stage) of the cancer. To determine whether cancer has spread outside of your testicle, you may undergo:

  • Computerized tomography (CT). CT scans take a series of X-ray images of your abdomen. Your doctor uses CT scans to look for signs of cancer in your abdominal lymph nodes.
  • Blood tests. Blood tests to look for elevated tumor markers can help your doctor understand whether cancer likely remains in your body after your testicle is removed.

After these tests, your testicular cancer is assigned a stage. The stage helps determine what treatments are best for you. The stages of testicular cancer are:

  • Stage I. Cancer is limited to the testicle.
  • Stage II. Cancer has spread to the lymph nodes in the abdomen.
  • Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.
Oct. 15, 2011