How Is Testicular Cancer Diagnosed?

If you have the symptoms of testicular cancer, your doctor will begin your diagnosis with a medical history and a physical examination.

• Medical history and physical examination - Your doctor will take a complete medical history. From this general information, your doctor will begin to fill in the details, focusing on the symptoms that have brought you to seek medical care. You will be asked about your risk factors for testicular cancer, such as an undescended testicle at birth and whether you or a family member has had testicular cancer in the past; what symptoms you have noticed; and any other health problems or concerns. In addition to the medical history, a physical examination will be performed. This typically includes measuring blood pressure and temperature. The physician will also examine your testicles.

• Blood tests - Scientific research has shown that for some types of cancer, tumor markers in the blood can provide important diagnostic information. Tumor markers are substances whose levels in the blood are often increased in the presence of cancer. For testicular cancer, blood will be drawn to determine the level of these substances:

• Beta-human chorionic gonadotropin (ß-hCG) is normally produced by the placenta during pregnancy. The hormone is also present in low levels in nonpregnant women and men.

• Alpha-fetoprotein (AFP) is normally produced by a growing embryo and fetus and, like ß-hCG, is also present in nonpregnant adults. Lactate dehydrogenase (LDH) is an enzyme that is present in many plants and animals.

The levels of these markers will be checked again after biopsy.  If they remain elevated, this may indicate that some cancer remains. However, tumor markers are not elevated in all types of testicular cancer.

• Ultrasound - Ultrasound can provide further information about a mass in the testicle. Your doctor will combine this information with the results from a biopsy to make the diagnosis. Also called ultrasonography, ultrasound is a procedure in which low-frequency sound waves are used to produce an image of organs and structures inside the body. A device called a transducer is moved over the surface of the area to be examined, emitting sound waves that are then transformed into a computerized image on a monitor. The procedure does not require any cuts or incisions to be made and is completely painless.

• Biopsy - A biopsy is a procedure in which tissue is collected and examined to determine the presence of cancer cells. If testicular cancer is suspected, a biopsy consists of the complete removal of the affected testicle. This procedure is called radical inguinal orchiectomy. It is done under general anesthetic, so the patient is not awake during the operation. The testicle is removed through an incision made in the groin and is then studied in a laboratory for signs of cancer.

The removal of one testicle usually does not affect a man’s sexual performance or fertility. However, in many men with testicular cancer, sexual or fertility problems may be present along with the signs and symptoms of the cancer. These problems may resolve after treatment of the cancer.

In many cases, a biopsy serves as both diagnosis and treatment of testicular cancer. If it is determined that all of the cancer has been removed, then further treatment may not be necessary.