Most testicular cancers can be found at an early stage. In some men, early testicular cancers cause symptoms that prompt them to call their doctor. Most of the time a lump on the testicle is the first sign. But some testicular cancers don't cause symptoms until they have reached an advanced stage.
Sometimes testicular cancer is found during testing for other problems. For instance, fertility tests sometimes find testicular cancer.
Most doctors agree that an exam of a man's testicles should be part of his general physical exam. The American Cancer Society (ACS) recommends a testicular exam as part of a routine cancer-related check-up.
Regular self-exams of the testicles have not been studied enough to show that the practice lowers the death rate from this cancer. Because of this, the ACS does not does not have a recommendation about regular testicular self-exams for all men. But some doctors think otherwise, and may advise their patients to do self-exams every month. If you have certain risk factors that increase your chance of getting testicular cancer, you should talk about it with your doctor.
Signs and symptoms of testicular cancer
In most cases of testicular cancer, the man has a lump on a testicle or notices that the testicle is swollen or larger. Most of the time there is no pain. Men with testicular cancer may also notice a feeling of heaviness or aching in the lower belly or scrotum.
In rare cases, men with germ cell cancer notice their breasts are sore or have gotten bigger. This happens because some germ cell tumors give off high levels of a hormone called human chorionic gonadotropin (HCG), which causes the breasts to grow. Blood tests can measure HCG levels. These tests are important in finding, staging, and follow-up of some testicular cancers.
Some stromal tumors can make hormones. If the tumor makes male hormones (androgens), it can cause the growth of facial and body hair at a very early age in boys. The extra androgens are not likely to cause any symptoms in men. Some stromal tumors make female hormones (estrogens) and not male hormones. The female hormones can cause a man to grow breasts and/or lose his sex drive.
Signs of advanced testicular cancer
Even when the cancer has spread to other organs, few men have any symptoms. Lower back pain is a symptom of later-stage testicular cancer. Signs that the cancer has spread to the lungs can include:
- Shortness of breath
- Chest pain
- Cough
- Spitting up blood
A number of problems other than cancer, such as an injury to the testicle, infection, or inflammation, can cause symptoms like those of testicular cancer. If you have any of the signs or symptoms above, see a doctor right away. Remember, the sooner cancer is found the sooner you can start treatment. And the earlier you get treatment, the better it is likely to work. For more details, see our document Do I Have Testicular Cancer?
Medical history and physical exam
If you have signs or symptoms that suggest testicular cancer, your doctor will want to take a complete medical history to check for risk factors and symptoms. Then the doctor will do a physical exam. During the exam, the doctor will feel the testicles for any swelling, tenderness, or lumps. The doctor will also feel your belly for swollen lymph nodes which could be a sign that the cancer has spread.
Ultrasound
This test uses sound waves to make pictures of internal organs. The computer shows the picture on a screen. An ultrasound can help doctors tell whether a lump (or mass) is solid or filled with fluid. If the lump is solid, then it is more likely to be cancer.
This is a very easy test to have done, and it uses no x-rays. You just lie on a table while a flat wand is moved over the skin of the scrotum. Usually, your skin is coated with gel first.
Blood tests
Certain blood tests can help diagnose testicular cancer. Many cancers make proteins (called tumor markers) that can be found in the blood. The levels of these tumor markers might be used to tell the doctor how much cancer is present, how well treatment is working, and whether the cancer has come back.
Surgery to diagnose testicular cancer
If the doctor sees a solid tumor on ultrasound, it is likely to be cancer, so surgery will most likely be done to remove it as soon as possible. Whenever they can, surgeons try to remove the entire tumor, the testicle, and the spermatic cord. The spermatic cord carries sperm, blood, and lymph. It can act as a pathway for cancer cells to spread. For this reason, the cord is tied off early in the operation. Doctors usually do this operation through a cut (incision) in the groin. This is the same operation that is done for cancer in the testicle.
All of the tissue removed will be sent to the lab. A doctor with special training (called a pathologist) will look at it under a microscope. If cancer cells are present, the pathologist sends back a report describing the type and extent cancer.
In rare cases, the doctor may take a tissue sample (biopsy) before removing the testicle. This is done when doctors are not sure if the tumor is cancer. In surgery the doctor makes a cut in the groin, takes the testicle out of the scrotum, and looks at it without cutting the spermatic cord. If an area of concern is seen, part of that area is removed and sent to be looked at by the pathologist right away. If it is cancer, the doctor removes the testicle and spermatic cord. If the tissue is not cancer, the testicle can often be returned to the scrotum.
If testicular cancer is found, doctors use imaging tests to see how advanced it is.
Imaging tests
Chest x-ray: This is a plain x-ray of your chest to see whether the cancer has spread to your lungs or to lymph nodes around the chest. If the x-ray is normal, you probably don't have cancer in your lungs. But most doctors feel a CT scan can better show whether the cancer has spread to the chest.
CT scan (computed tomography): A CT scan is helpful in finding out whether the cancer has spread to your lungs, liver, or other organs. The scan uses x-rays to make detailed pictures of your body. Instead of taking just one picture, a CT scanner takes many as it rotates around you. A computer then combines these into a picture of a slice of your body.
Before the scan, you may be asked to drink a liquid that contains a dye to help outline tissue in your body. Or the dye may be put into a vein. The dye may make you feel warm and flushed. A few people are allergic and get hives. Rarely, there can be more serious problems, like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a problem with a dye used for x-rays or if you are allergic to shellfish. Medicine can be given to prevent and treat these reactions.
CT scans take longer than regular x-rays. You need to lie still on a table. The part of your body being checked is placed inside the scanner. The test is painless, but you may find it hard to hold still for minutes at a time.
CT scans are sometimes used to guide a biopsy needle mass that might be cancer. You stay on the CT scanning table while the doctor moves needle through the skin toward the. .A thin needle (or a larger needle) removes a sample of tissue to be looked at under a microscope. This is not used to biopsy a testicular lump, but may be used to check for cancer spread.
MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI pictures show a lot of detail. They are very helpful when looking at the brain and spinal cord.
MRI scans can be a little more uncomfortable than CT scans because they take longer, often up to an hour. Also, you must lie still inside a tube, which can upset some people. The machine makes a thumping noise as the magnet switches on and off. Some places have earplugs or headphones with music to block this out. Special, more open MRI machines can help with this if needed. You may also get a dye like you would for a CT scan, but this is done less often.
PET scan (positron emission tomography): For a PET scan, a type of radioactive sugar is put into a vein. The sugar collects in cancer tissue, and a scanner can spot these areas. This test is useful for finding cancer that has spread beyond the testicles. It is also helpful in telling whether swollen lymph nodes contain scar tissue or cancer. Often the PET scan is combined with a CT scan. This helps the doctor decide whether changes on the CT are cancer or something else. PET scans are often more useful for seminoma than for the non-seminoma type of testicular cancer, and so are less often used in patients with non-seminoma.
Feedback
