Diagnosing Testicular Cancer

Accurate diagnosis and staging to create a personalized treatment plan.

Testicular cancer is a relatively rare — but very treatable — cancer type, accounting for around 1 percent of all cancers that occur in men. While testicular cancer can affect a man or boy at any age, it is most common in men who are 15 to 44 years old. With early diagnosis, testicular cancer can be cured.

Effective testicular cancer treatment starts with a thorough, accurate diagnostic process. Our experts will determine your type of testicular cancer to develop a treatment plan that is unique to your diagnosis and health needs.

Understanding your testicular cancer risk

Testicular cancer starts in the male gland known as a testicle or testis. Certain cells grow uncontrollably, then they crowd and destroy healthy cells around testicle to form a tumor.

To catch this cancer early, men are encouraged to learn about early warning signs, how to do a testicular self-exam and the importance of talking with your health care provider if you find a suspicious lump, swelling, or pain in the area.

Signs of a testicular tumor are:

• A painless lump in the testicle (the most common sign)
• Swelling of the testicle (with or without pain) or a feeling of weight in the scrotum
• Pain or a dull ache in the testicle, scrotum or groin
• Tenderness or changes in the male breast tissue

If you find any lump or firm part of the testicle, you should see a doctor to find out if it is a tumor. Very few men who have testicular cancer felt pain at first.

Factors that may increase your testicular cancer risk:

• Men with a father or brother who had testicular cancer
• Men with a history of testes that don’t drop before birth (also known as undescended testes or cryptorchidism)
• Abnormal cells in the testicle called germ cell neoplasia in situ (GCNIS), most often found during an infertility test

If you fall into any of these categories, we recommend that you perform a monthly testicular self-exam to potentially catch problems early, when treatment is most effective.

Is there a screening test for testicular cancer?

If you have some of the risk factors for testicular cancer, some doctors may recommend a routine self-examination. This is the only screening method available for testicular cancer. After a warm shower or bath, gently move the testicle between the thumb and fingers. If you feel any lumps, contact your doctor as soon as possible. The doctor can take the steps to diagnose if the lump is non-cancerous or cancerous.

How is testicular cancer diagnosed?

On average, men wait for about five months to notifying their health care provider about any signs or symptoms of testicular cancer. During that time, the tumor can spread. That’s why is important to tell your health care provider or urologist as soon as possible if you’re experiencing any symptoms for longer than two weeks.

To determine if you have testicular cancer, a urologist will first determine if your symptoms may signal another condition, like:

• Epididymitis: swelling of the epididymis. Often treated with antibiotics.
• Testicular torsion: twisting of the testicles. Often treated with surgery.
• Inguinal hernia: when part of the intestine pokes through a weak part of the stomach muscles near the groin. Often treated with surgery.
• Hydrocele: when fluid builds up in the scrotum. This often goes away without treatment.

Diagnosis tests

If your urologist suspects your symptoms may be a sign of testicular cancer, they’ll want to test if cancer is growing and examine your scrotum, belly, lymph nodes, and other parts to look for signs of cancer. They will look for lumps, firmness or signs of swelling. Tell them if you have a history of undescended testes.

You may have one or more of these tests to confirm a diagnosis of testicular cancer:

• Testicular ultrasound: This imaging test is used to see inside the scrotum and to check a suspicious lump. Other scans or x-rays may be done if your doctor would like to see inside your chest or abdomen. This is done to see if cancer has spread to lymph nodes, the lungs or liver. MRIs are rarely used but needed in some cases to check the brain and spinal cord.
• Blood test: A blood test is taken to check tumor markers. These are proteins and hormones made by some testicular cancers. AFP, ACG and LDH tumor markers rise with some cancers but many testicular cancers will not produce tumor markers. In other words, just because tumor markers are normal does not mean that you are free of cancer. It’s of great value to ask your doctor about your tumor maker levels and learn what’s normal vs. not normal.
  
  • Serum Tumor Marker Test: Tumor markers (AFP, HCG, and LDH) should be measured before any treatment, such as surgery. If cancer is found, tumor marker tests will be repeated after treatment to track how well you’re doing over time. Some medicines and marijuana can create false positive levels of HCG. Tell your doctor about your medicine and/or marijuana use.
    
    • Pure seminomas can raise HCG levels but never AFP levels.
    • Non-seminomas often raise AFP and/or HCG levels.

How testicular cancer is staged

If your urologist finds cancer through these exams, they will want to learn the exact cancer cell-type and if it has spread. This is called “staging.”

Unlike other cancers, your doctor does not take a tissue sample (biopsy) before surgery. With testicular cancer, cells are looked at after surgery is done to remove the cancerous tissue.

Testicular cancer stages:

• Stage 0: This is also called “Germ Cell Neoplasia In Situ (GCNIS)”. This is not really cancer, but a warning that cancer could grow. GCNIS may be found in the seminal tubules and nowhere else.
• Stage I (IA, IB, IS): Cancer is found only in the testicle. It has not spread to nearby lymph nodes.
• Stage II (IIA, IIB, IIC): Cancer has spread to one or more lymph nodes in the abdomen (belly). It has not spread to other parts of the body.
• Stage III (IIIA, IIIB, IIIC): Cancer has spread beyond the lymph nodes in the abdomen. Cancer may be found far from the testicles, like in distant lymph nodes or the lungs. Tumor marker levels are high.