Testicular cancer : Diagnosis

See a GP as soon as possible if you notice a swelling, lump or any other change in 1 of your testicles.

Most lumps within the scrotum are not cancerous, but it's important to get checked as soon as possible.

Treatment for testicular cancer is much more effective when started early.


Physical examination

As well as asking you about your symptoms and looking at your medical history, a GP will usually need to examine your testicles.

They may hold a small light or torch against your scrotum to see whether light passes through it.

Testicular lumps tend to be solid, which means light is unable to pass through them.

A collection of fluid in the scrotum will allow light to pass through it.

Tests for testicular cancer

If you have a non-painful swelling or lump, or a change in the shape or texture of 1 of your testicles, and a GP thinks it may be cancerous, you'll be referred for further testing within 2 weeks.

Some of the tests you may have are described below.

Scrotal ultrasound

A scrotal ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle.

It's 1 of the main ways of finding out whether or not a lump is cancerous (malignant) or non-cancerous (benign).

During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle.

It'll also give a clear indication of whether the lump is in the testicle or separate within the scrotum, and whether it's solid or filled with fluid.

A fluid-filled lump or collection around the testis is usually harmless. A more solid lump may be a sign the swelling is cancerous.

Blood tests

To help confirm a diagnosis, you may need a series of blood tests to detect certain hormones in your blood, known as markers.

Testicular cancer often produces these markers, so it may indicate you have the condition if they're in your blood.

Markers in your blood that'll be tested for include:

  • alpha feto-protein (AFP)
  • human chorionic gonadotrophin (HCG)

A third blood test is also often carried out as it may indicate how active a cancer is.

It's called lactate dehydrogenase (LDH), but it's not a specific marker for testicular cancer.

Not all people with testicular cancer produce markers. There may still be a chance you have testicular cancer even if your blood test results come back normal.

Histology

The only way to definitively confirm testicular cancer is to examine part of the lump under a microscope. These tests and reports are called histology.

Unlike many cancers where a small piece of the cancer can be removed (a biopsy), in most cases the only way to examine a testicular lump is by removing the affected testicle completely.

This is because the combination of the ultrasound and blood marker tests is usually sufficient to make a firm diagnosis.

Also, a biopsy may injure the testicle and spread cancer into the scrotum, which is not usually affected.

Your specialist will only recommend removing your testicle if they're relatively certain the lump is cancerous.

Losing a testicle will not affect your sex life or ability to have children.

The removal of a testicle is called an orchidectomy. It's the main type of treatment for testicular cancer, so if you have testicular cancer, it's likely you'll need to have an orchidectomy.

Other tests

In almost all cases, you'll need further tests to check whether testicular cancer has spread.

When cancer of the testicle spreads, it most commonly affects the lymph nodes in the back of the abdomen or the lungs.

You may need to have a chest X-ray to check for signs of a tumour.

You'll also need a scan of your entire body. This is usually a CT scan to check for signs of the cancer spreading.

In some cases, a different type of scan known as an MRI scan may be used.

Stages of testicular cancer

After all tests have been completed, it's usually possible to determine the stage of your cancer.

There are 2 ways that testicular cancer can be staged.

The first is based on a 3-stage system. The stages are based on how far the cancer has spread, as well as the levels of chemicals associated with cancer (markers) that are in your bloods.

Stage 1 testicular cancer is when the cancer is contained within your testicle.

Stage 2 testicular cancer is when the cancer has spread into nearby lymph nodes (small glands that fight infection) in your pelvis or tummy.

Stage 3 cancer is split into 3 sub-stages.

Stage 3A testicular cancer is when the cancer has spread into distant lymph nodes, such as the nodes near your collarbone or to your lungs. Your marker levels are normal or only slightly raised.

Stage 3B testicular cancer can take 2 forms:

  • the cancer has spread to nearby lymph nodes and you have higher marker levels, or
  • the cancer has spread to distant lymph nodes or your lungs and you have higher marker levels

With stage 3C testicular cancer, the cancer spread is the same as stage 3B, but you have very high marker levels or the cancer has now spread into another 1 of your body organs, such as the liver or the brain.

The second system is known as the TNM staging system, which is not used widely in the UK:

  • T indicates the size of the tumour
  • N indicates whether the cancer has spread to nearby lymph nodes
  • M indicates whether the cancer has spread to other parts of the body (metastasis)

Cancer Research UK has more information about testicular cancer stages.

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