Testicular Cancer

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Diagnosis

Diagnosis of testicular cancer involves a patient history, physical examination, and diagnostic tests. A patient history is taken to evaluate risk factors. During physical examination the physician feels (palpates) the testicles and the abdomen to detect a lump, swelling, or enlarged lymph nodes. Diagnostic tests include ultrasound, CT scan, and blood tests.

Testicular Self-Examination
Physicians routinely examine the testicles during a physical. But monthly testicular self-examinations (TSE) are recommended after puberty, especially for men at increased risk for testicular cancer. Finding testicular tumors early increases the chance for curing the disease.

The best time to perform the exam is during or after a warm bath or shower, when the skin of the scrotum is relaxed. Examine each testicle gently with both hands. The index and middle fingers should be placed underneath the testicle, and the thumbs placed on the top. Roll the testicle gently between the thumbs and fingers.

One testicle may feel larger than the other. This is normal. You will also feel a cord-like structure on the top and back of the testicle that stores and transports the sperm. This is the epididymis and should not be confused with an abnormal lump.

If you find an abnormal lump on the front or the side of the testicle, make an appointment to see your physician immediately. If the lump is caused by an infection, the physician can prescribe treatment. If the lump is not an infection, the physician will perform tests to determine if it is a tumor.

Differential Diagnosis

To diagnose testicular cancer physicians must rule out the following conditions:

• Accumulation of fluid in the testicle (hydrocele)
• Cancer of the lymphatic system (lymphoma)
• Cyst on the surface of the testicle that contains sperm (spermatocele)
• Enlarged veins in the testicle (varicocele)
• Inflammation of the surface of the testicle (epididymitis)
• Twisting of the testicle (testicular torsion)

Ultrasound uses sound waves to produce an image of the testicle on a computer screen. This test determines if a mass is a benign condition (e.g., hydrocele) or a solid tumor. A solid tumor in the testicle is usually cancerous.

When a solid tumor is detected by ultrasound, computed tomography (CT scan) of the pelvis, abdomen, and chest is performed to determine if the cancer has spread to lymph nodes or other organs. CT scan uses x-rays and, in some cases, a contrast agent (dye) to produce a detailed image on a computer screen.

Blood Tests
Certain types of testicular cancer raise the level of substances (so-called tumor markers) in the blood. For example, nonseminomas raise the level of proteins (e.g., alpha-feta protein [AFP]); seminomas and nonseminomas raise the level of hormones (e.g., human chorionic gonadotropin [HCG]); and advanced seminomas and nonseminomas usually raise the level of enzymes (e.g., lactate dehydrogenase [LDH]). Blood tests that measure the levels of these substances are used to diagnose testicular cancer and, in some cases, to determine the extent of the disease.

Biopsy is performed when other diagnostic tests are inconclusive. In this procedure, the surgeon makes an incision in the groin (inguinal incision), removes the testicle from the scrotum without cutting the spermatic cord, and may remove suspicious tissue for microscopic examination.

More often the testicle is removed when the mass is shown to be within the testicle due to the very high incidence of malignancy. If no cancer is found, the testicle is returned to the scrotum. If cancer is detected, the testicle and spermatic cord are removed (called orchiectomy) and the stage of the disease is determined.

Testicular Cancer Resources

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