Tests for Testicular Cancer

An ultrasound is often the first test done if the doctor thinks you might have testicular cancer. It uses sound waves to produce images of the inside of your body. It can be used to see if a change is a certain benign condition (like a hydrocele or varicocele) or a solid tumor that could be cancer. If the lump is solid, it’s more likely to be cancer. In this case, the doctor might recommend other tests or even surgery to remove the testicle.

Your chest may be x-rayed to see if cancer has spread to your lungs.

CT scans can be used to help determine the stage (extent) of the cancer by showing if it has spread to the lymph nodes, lungs, liver, or other organs.

MRI scans are very good for looking at the abdomen, pelvis, and brain in patients with testicular cancer. CT scans (see above) are used more often than MRI scans for viewing the abdomen and pelvis. However, MRI scans may be used as an alternative to CT scans for imaging the abdomen and pelvis in patients who prefer to avoid CT scans, particularly for those undergoing surveillance for stage I seminoma. This depends on whether an MRI scanner and a radiologist with expertise in interpreting MRI scans are available.

MRI scans are generally preferred to CT scans for examining the brain or the spine. MRI scans of the brain are only done if the doctor suspects that the cancer has spread there.

A PET scan can help spot small collections of cancer cells in the body. It’s sometimes useful after chemotherapy to see if enlarged lymph nodes contain cancer or just scar tissue. PET scans are often more useful for seminomas than for non-seminomas. Many centers have special machines that can do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed images of the CT scan.

When alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) are in the blood, it may suggest that there’s a testicular tumor.

Rises in levels of AFP or hCG can also help doctors tell which type of testicular cancer it might be.

• Non-seminomas often raise AFP and/or hCG levels.
• Pure seminomas occasionally raise hCG levels but never AFP levels.

This means any increase in AFP is a sign that the tumor has a non-seminoma component. Tumors can be mixed and have areas of seminoma and non-seminoma.  It’s important to note that some cancers are too small to elevate tumor marker levels.

A testicular tumor might also increase the levels of an enzyme called lactate dehydrogenase (LDH). A high LDH level often (but not always) indicates widespread disease. However, LDH levels can also be increased with many noncancerous conditions.

Less often, doctors may test for a tumor marker called placental alkaline phosphatase (PLAP).

AFP, beta-hCG, and LDH levels will be tested regularly before and during the active treatment period to monitor the cancer. These tumor markers will also be tested at regular times during follow-up care after treatment is completed.