Testicular Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is testicular cancer found?

Most testicular cancers can be found at an early stage. In some men, early testicular cancers cause symptoms that prompt them to see their doctor. Most of the time a lump on the testicle is the first sign, or the testicle might be swollen or larger than normal. But some testicular cancers don’t cause symptoms until they reach an advanced stage.

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.

It is not clear if doing regular self-exams of the testicles 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 may advise their patients to do self-exams every month, especially if they have certain risk factors that increase their chance of getting testicular cancer.

If you choose to examine your testicles routinely, you probably will become familiar with what is normal and what is different. Always report any changes to your doctor without delay. For more information, see our document Do I Have Testicular Cancer?

Signs and symptoms of testicular cancer

Many symptoms of testicular cancer are more likely to be caused by something else. But if a tumor is the cause, the sooner it is found, the sooner you can start treatment and the more effective it is likely to be.

Lump or swelling in the testicle

Most often, the first symptom of testicular cancer is a lump on the testicle, or a testicle becomes swollen or larger. (It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other.) Some testicular tumors might cause pain, but most of the time they do not. Some men with testicular cancer might also have a feeling of heaviness or aching in the lower belly or scrotum.

Breast growth or soreness

Rarely, some tumors can make hormones that can make the breasts grow or become sore.

Early signs of puberty in boys

Some tumors can make androgens (male sex hormones). This might not cause any symptoms in men, but in boys it can cause signs of early puberty, such as a deepening of the voice and the growth of facial and body hair.

Symptoms of advanced testicular cancer

Even when the cancer has spread to other organs, many men might not have symptoms right away. Some possible symptoms of testicular cancer spread can include:

  • Lower back pain
  • Shortness of breath
  • Chest pain
  • Cough, sometimes with blood
  • Belly pain
  • Headache

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. 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 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

This is often the first test done if the doctor thinks you might have testicular cancer. The test uses sound waves to make pictures of internal organs. The computer shows the picture on a screen. 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 is moved over the skin of the scrotum. Usually, the skin on your scrotum 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 also be used to 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 lump because it might risk spreading the cancer and because the doctor can often get a good idea of whether it is cancer based on the ultrasound and blood tumor marker tests.

Instead, if the doctor sees a solid tumor on ultrasound, surgery will most likely be done to remove it as soon as possible. Surgeons try to remove the entire tumor, the testicle, and the spermatic cord. The spermatic cord, which includes part of the vas deferens, can act as a pathway for cancer cells to spread. For this reason, the cord is tied off early in the operation. Doctors usually operate through a cut (incision) just above the pubic area.

All of the tissue removed will be sent to the lab and looked at for cancer cells.

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 a suspicious area is seen, part of that area is removed and looked at for cancer cells 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 will use imaging tests on other parts of the body to see how advanced it is.

Imaging tests

Imaging tests create pictures of the inside of your body. Ultrasound of the testicles, described above, is a type of imaging test. Other imaging tests might be done after cancer is found to learn how far it has spread, to help show if treatment is working, or to check for signs of cancer coming back after treatment.

Chest x-ray: This is a plain x-ray of your chest to see if 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 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): MRI scans use radio waves and strong magnets instead of x-rays to make 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 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 a dye as you would for a CT scan, but this is done less often.

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.

Bone scan: 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.

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: 01/02/2014
Last Revised: 02/11/2014