How is testicular cancer diagnosed?
Testicular cancer is usually diagnosed after the man notices a lump or other change in a testicle. When an abnormality is suspected, an ultrasound is usually ordered, which is a painless medical test that helps the doctor to see whether there are abnormalities in the testicle. If the ultrasound shows evidence of cancer, then surgery is performed to remove the testicle and it is examined under a microscope to see whether cancer is present and, if so, what type of cancer. Testicular cancer is only diagnosed after the testicle is removed and examined. Biopsies, which involve the removal of a small amount of tissue using a needle or other medical tool, are NOT performed on testicles because penetrating the testicle can make it more difficult to treat a cancer if one is discovered.
Tests to help diagnose testicular cancer can include:
- Ultrasound: This is a procedure that uses high-energy sound waves to form pictures of body tissues.
- A physical exam and history: A physical exam and medical history can help the doctor look for problems that might be related to testicular cancer.
- A serum tumor marker test: This procedure examines a blood sample to measure the amounts of certain substances linked to specific types of cancers. These substances are called tumor markers. The tumor markers that are often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG or beta-HCG) and lactate dehydrongenase (LDH).
- Inguinal orchiectomy and biopsy: This procedure involves the removal of the entire testicle through an incision in the groin. A tissue sample from the testicle is then checked for cancer cells.
- CT scans and X-rays: A CT scan is a medical test that uses X-rays to form pictures of the inside of the body. When a cancer is diagnosed or suspected, a CT scan (also referred to as a CAT scan) is performed to see whether cancer can be seen elsewhere in the body. In testicular cancer, a CT scan is performed of the abdomen and pelvis. Images of the chest are taken using either a CT scan or a regular X-ray.
What are the stages of testicular cancer?
Stage 0: Abnormal cells have developed but are still confined within the tubules where sperm cells start to develop.
Stage I: This stage consists of the stages IA, IB and IS.
- In Stage IA, the cancer is confined to the testicle and the epididymis, and all tumor marker levels are normal. The cancer has not spread to the outer layer of the double membrane that surrounds the testicle and has not grown into the blood or lymph vessels.
- In Stage IB, at least one of the following applies: The cancer invades into the blood vessels or lymphatics within the testicle; the cancer has spread to the outer layer of the membrane around the testicle; and/or the cancer invades into the spermatic cord or the scrotum. In stage IB, all tumor marker levels are normal.
- In Stage IS, the cancer is anywhere within the testicle, spermatic cord, or scrotum and one or more of the tumor markers is elevated.
Stage II : This stage consists of Stage IIA, Stage IIB and Stage IIC and refers to patients whose cancer has spread to the lymph nodes in the back of the abdomen (this part of the body is referred to as the retroperitoneum) but not to anywhere else. If patients with cancer in their lymph nodes have moderately or highly elevated tumor markers, then they are stage III rather than stage II.
- In Stage IIA, the cancer has spread to a maximum of five lymph nodes in the abdomen. None of the lymph nodes is larger than 2 centimeters in size. Tumor markers must be either normal or only mildly elevated.
- In stage IIB, the cancer has spread to more than 5 nodes, none of which is larger than 5 centimeters, or the cancer has spread to 5 or fewer nodes and there is a lymph node mass measuring between 2 and 5 centimeters. Tumor markers must be either normal or mildly elevated.
- In Stage IIC, the cancer has spread to at least one lymph node in the abdomen that is larger than 5 cm diameter. Tumor markers must be either normal or only mildly elevated.
Stage III: This stage is divided into Stage IIIA, Stage IIIB and Stage IIIC and is determined after an inguinal orchiectomy (removal of a testicle through an incision in the groin) is performed.
- In Stage IIIA, the cancer has spread to lymph nodes beyond the abdomen (such as lymph nodes in the chest) and/or to the lungs. Tumor markers must be normal or only mildly elevated.
- In stage IIIB, the cancer has spread to lymph nodes in the abdomen or elsewhere (such as lymph nodes in the chest) and/or to the lungs and the tumor markers are moderately elevated.
- In stage IIIC, either the cancer has spread to an organ other than the lungs (such as the liver, the bones, or the brain) or the tumor markers are highly elevated and the cancer has spread to at least one lymph node or organ.