Testicular Cancer


To help find the cause of testicular cancer symptoms, the doctor evaluates a man's general health. The doctor also performs a physical exam and may order laboratory and diagnostic tests. If a tumor is suspected, the doctor will probably suggest a biopsy, which involves surgery to remove the testicle.

  • Blood tests measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactase dehydrogenase (LDH) may detect a testicular cancer tumor that is too small to be detected during physical exams or imaging tests.

  • Ultrasound is a diagnostic test, commonly used in testicular cancer diagnosis, in which high-frequency sound waves are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection.

  • Biopsy- Microscopic examination of testicular tissue by a pathologist is the only sure way to know whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue, because if the problem is testicular cancer, this procedure could cause the disease to spread.)

If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. Determining the stage (extent) of the disease helps the doctor to plan appropriate treatment.

The process used to find out if cancer has spread within the testicles or to other parts of the body is called cancer staging. The information gathered from the testicular cancer staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help make the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • Lymphangiography: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels and x-rays are taken to see if there are any blockages. This test helps find out whether the testicular cancer has spread to the lymph nodes.

  • Abdominal lymph node dissection: A procedure to examine lymph nodes in the abdomen. Lymph nodes are removed and a pathologist checks them for cancer cells. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.

  • Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.)

  • Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types or cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used in staging testicular cancer:

    • Alpha-fetoprotein (AFP)

    • Beta-human chorionic gonadotropin (ß-hCG)

    • Lactate dehydrogenase (LDH)

Tumor marker levels are measured again, after radical inguinal orchiectomy and biopsy, in order to determine the stage of the testicular cancer. This helps to show if all of the cancer has been removed or if more treatment is needed. Tumor marker levels are also measured during follow-up as a way of checking if the cancer has come back.

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