How is testicular cancer diagnosed?
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 to learn more about your 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 uses sound waves to make pictures of internal organs. This is often the first test done if the doctor thinks you might have a problem with your testicle. An ultrasound can help doctors tell if a lump (or mass) is solid or filled with fluid. If the lump is solid, it is more likely to be cancer.
This is a very easy test to have, and it uses no x-rays. You just lie on a table while a flat wand (called a transducer) is moved over the skin of the scrotum. Usually, the skin is coated with gel first.
Many testicular cancers make proteins (called tumor markers) that can be found in the blood. These include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
The levels of these tumor markers might also help tell which type of testicular cancer it might be, how much cancer is present, how well treatment is working, and whether the cancer has come back.
Surgery to diagnose testicular cancer
Most types of cancer are diagnosed by removing a small piece of the tumor and looking at it under a microscope for cancer cells. This is known as a biopsy. But a biopsy is rarely done for a testicular tumor because the doctor can often get a good idea of whether it is cancer based on the ultrasound and blood tumor marker tests. There is also concern that putting a needle into the tumor through the skin of the scrotum could spread cancer if it is present.
Instead, if the doctor sees a solid tumor on ultrasound, surgery will most likely be done to remove it (and the testicle) as soon as possible. This is the same operation that is used to treat the cancer, and is discussed more in “Surgery for testicular cancer.”
The tissue removed is sent to the lab and looked at for cancer cells.
In rare cases, the doctor may start the surgery, but take a tissue sample (biopsy) before removing the testicle. If cancer is found, the doctor finishes the surgery to remove the testicle. If cancer isn’t found, the testicle is left in place and the patient sewn up again.
If a patient has known testicular cancer or high levels of tumor markers, doctors will use imaging tests to look for areas of cancer spread.
Imaging tests create pictures of the inside of your body. They are also used to help show if treatment is working and to check for signs of cancer coming back after treatment.
A plain x-ray of your chest may be done to see if the cancer has spread to your lungs or to lymph nodes in the chest. If the x-ray result is normal, you probably don’t have cancer in your lungs. But more often a CT scan is done instead to see if the cancer has spread to the chest.
CT scan (computed tomography)
A CT scan is helpful in finding out if 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 might be asked to drink a liquid that contains a dye to help outline structures 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 have any allergies.
The CT scanner is like a large donut, with a narrow table that slides in and out of the middle opening. You will need to lie still on the table while the scan is being done. The test is painless, but you might find it hard to hold still for minutes at a time.
CT scans are sometimes used to guide a biopsy needle into a mass that might be cancer. You stay on the CT scanning table while the doctor moves the needle through the skin toward the mass. The needle removes a sample of tissue to be looked at under a microscope. This is not used to biopsy a lump in a testicle, but it may be used to check for cancer spread.
MRI (magnetic resonance imaging) scan
MRI scans use radio waves and strong magnets instead of x-rays to make pictures. For testicular cancer, MRI scans are used to see if the cancer has spread to the brain and spinal cord in patients with symptoms.
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 on a table that slides inside a narrow tube, which can upset some people. There are special, more open MRI machines that can help with this if needed. The machine makes buzzing and clicking noises, so some places have earplugs or headphones with music to block this out. You might also get an IV contrast dye to make it easier to see cancers.
PET (positron emission tomography) scan
For a PET scan, a type of radioactive sugar is put into your vein. The sugar collects in cancer tissue, and a scanner can spot these areas. This test is 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.
This test can help show if cancer has spread to the bones. It might be done if a person is having symptoms like bone pain and other test results aren’t clear. If you had a PET scan you won’t need a bone scan.
For this test, a small amount of a radioactive substance is put into your vein. The substance settles in areas of bone changes. You then lie on a table while a special scanner creates a picture of your skeleton.
Last Medical Review: 01/20/2015
Last Revised: 02/23/2015