How is testicular cancer diagnosed?

If you have symptoms, a doctor may use several tests to see if you have testicular cancer.  

Physical examination and medical history

A doctor will check the testicles and around your belly to look lumps and other signs of cancer. They will also ask you about your medical history. 

Imaging tests

An ultrasound is often used to check for tumours in the testicle.  

Depending on the type of testicular cancer suspected and if the doctor thinks it may have spread, you may also have X-rays, a computed tomography (CT) scan or magnetic resonance imaging (MRI). 

Blood tests

Your doctor will likely order blood tests. This is a way to look for tumour markers in the bloodstream, which can indicate cancer.  

There are 3 types of tumour makers relevant to testicular cancer: 

• alpha-fetoprotein (AFP) levels may be raised in some non-seminoma cancers 
• beta human chorionic gonadotropin (beta-hCG) levels may be raised in some non-seminoma and seminoma cancers 
• lactate dehydrogenase (LDH) levels may be raised in some non-seminoma and seminoma cancers. 

Biopsy

A biopsy is when the doctor takes a sample of tissue (biopsy) from the testicle, to look at under a microscope for signs of abnormal cells. Biopsies are usually not done for suspected testicular cancer, because the cut through the scrotum can increase the chances of the cancer spreading, if cancer is present. Results from blood tests and ultrasound are usually sufficient to make a diagnosis of testicular cancer. 

Staging

The stage of testicular cancer describes its size and whether it has spread beyond its original area of the body. 

Knowing the type and stage helps the doctors to decide on the most appropriate treatment. 

Testicular cancer is usually staged using the TNM system: 

• T (tumour) describes whether the cancer is only in the testicle (T1) or has spread into nearby blood vessels or tissue (T2, T3, T4) 
• N (nodes) describes whether the cancer is not in any lymph nodes (N0) or has spread to nearby lymph nodes (N1, N2) 
• M (metastasis) describes whether cancer has not spread to distant parts of the body (M0) or whether cancer has spread to distant lymph nodes, organs or bones (M1). 

The stages of testicular cancer are: 

Stage I: The tumour may or may not have grown outside the testicle and into nearby structures. The cancer has not spread to nearby lymph nodes or distant parts of the body. 

Stage II: The tumour may or may not have grown outside the testicle and into nearby structures. The cancer has spread to at least 1 nearby lymph node but not to distant parts of the body. Tumour marker levels are within normal limits. 

Stage III: The tumour may or may not have grown outside the testicle and into nearby structures. The cancer has spread to nearby or distant lymphs node and to distant parts of the body such as the lungs. Tumour marker levels may be higher than normal. 

Your doctor may also use tumour marker results to help determine the cancer stage.^[4]