Testicular Cancer

Diagnosis

Experienced urologists at Mayo Clinic conduct a physical exam and gather a medical history before ordering lab and blood tests that help determine the cause of a patient's symptoms. Mayo urologists use serum marker tests, such as alpha fetoprotein and beta-hCG, to diagnose the progression of testicular cancer.

Imaging Studies

The patient may undergo imaging studies such as ultrasound and computed tomography scans.

In ultrasound, high-frequency sound waves form images of the testicles that help identify cancerous tissue. A technician places a wandlike device (transducer) on the surface of the skin while monitoring the image on the screen.

Computed tomography (CT) scans generate two-dimensional images of the body that may reveal whether cancer has invaded other tissues or organs beyond the initial tumor site. Generally seminoma tumors may spread to nearby lymph nodes and nonseminoma tumors may spread to lymph nodes and the lungs. New technology at Mayo Clinic also allows for three-dimensional reconstruction of the CT images.

Inguinal Orchiectomy

Patients may need to undergo a radical inguinal orchiectomy, a procedure necessary for both diagnosis and treatment of testicular cancer. During this procedure a surgeon will remove the testicle through an incision in the groin. Pathologists then examine the tissue under a microscope to determine whether the tissue is benign or malignant. If the tissue reveals cancer, the pathologist will also determine the type of cancer cells present. Each form of testicular cancer grows and spreads differently and requires a separate approach to treatment.

Staging Testicular Cancer

After establishing the diagnosis and type of testicular cancer, Mayo physicians determine the stage of the cancer. Imaging studies and other test results will help the physician to classify the cancer as stage I, stage II or stage III.

Stage I — At this stage, testicular cancer appears to exist only in the testicle. Close observation is generally recommended to detect any recurrence early because the ability to cure the disease after it has spread is related to the amount of metastatic disease that is present. Only about 25 percent of stage I patients will develop a recurrence, usually within two years of diagnosis.

Stage II — Testicular cancer has spread to the lymph nodes in the space behind the abdomen (retroperitoneum), but the recovery rate remains high.

Stage III — Testicular cancer has spread beyond the lymph nodes to other regions of the body, such as the lungs or liver. In this stage, the recovery rate drops to about 75 percent. With the development of effective chemotherapy, patients with metastatic testicular cancer are often classified into good, intermediate, and poor prognosis groups based on the extent of the disease, the elevation of serum tumor markers, and the likelihood of cure with chemotherapy and surgery.