How Do Doctors Test for Testicular Cancer?

Diagnosing testicular cancer requires a thorough history and physical examination along with diagnostic testing.

Diagnosing testicular cancer requires a thorough history and physical examination along with diagnostic testing. A diagnostic test can confirm or eliminate disease presence, monitor the disease progress, or evaluate if the disease has spread to other parts of the body. The physician may consider the following factors when choosing a diagnostic test:

• Type of cancer suspected
• Signs and symptoms
• Age and general health
• Results of earlier medical tests

If there is any lump around the testicles or some other signs, it is essential to consult a doctor. The doctor may perform a physical examination and an ultrasound for primary diagnosis. If they show any abnormality, the physician may perform additional tests to confirm the presence of testicular cancer.

1. Physical examination

During a physical examination, the physician will lookout for signs of

• Swelling
• Tenderness
• Hardening

Additionally, the physician may also check the abdomen, neck, upper chest, groin and armpits for enlarged lymph nodes.

2. Ultrasound

It uses high-energy sound waves that hit against the tissues in the scrotum. The echoes of these sound waves produce a range of images called a sonogram. These images of the testicle guide the doctor to find any tumors in the testicular area. If a tumor is large enough to be seen on an ultrasound, then the sonogram will reveal the size, location and hardness of the tumor. A hard tumor inside the testicle is highly likely to be cancerous.

3. Blood tests/tumor marker

Tumor markers are chemicals produced by cancerous cells and found more commonly in individuals with cancer. The most common tumor markers used to diagnose testicular cancer include

• Alpha fetoprotein (AFP) 
• Human chorionic gonadotropin (hCG)

4. Imaging tests

Imaging can help diagnose testicular cancer by

• Detecting tumors and other abnormalities in the testicle.
• Determining the extent of testicular cancer.
• Evaluating the effectiveness of testicular cancer treatment.

Some of the imaging tests include:

• Computed tomography (CT) scan: A CT scan uses an X-ray machine linked to the computer to create 3D images of the testicles. In testicular cancer, a CT scan is used to evaluate the abdomen, pelvis, chest, lungs, brain or other areas. Brain CT is rarely needed in testicular cancer because there is less likelihood for cancer to spread to the brain.
• Magnetic resonance imaging (MRI) scan: An MRI scan uses a powerful magnet or radio waves to create images of the body in slices. These slices are used to create detailed images of the organs and structure, which helps differentiate between healthy and unhealthy tissues. For testicular cancer, an MRI is generally used to examine the brain or the spine.
• Positron emission tomography (PET) scan: It is a type of nuclear scan that creates 3-D images of the areas with a higher glucose uptake than normal (these are potentially cancerous areas). PET scan is usually not recommended for testicular cancer. Even if the doctor recommends a PET scan, they are usually combined with a CT scan, known as a PET-CT scan.
• X-ray: It uses a low dose of radiation to create images of the organs and structures. A chest X-ray may be recommended to identify if cancer has spread to the lungs.

5. Tumor biopsy

The doctors mostly prefer doing tumor biopsy on the operation table where they can immediately remove the testis if the tumor is cancerous. This is because there is a high risk of tumor spreading if it is manipulated during the biopsy.

6. Orchiectomy

If the physician suspects testicular cancer, they will perform surgery to remove the entire testicle through an incision in the groin. Next, a thin slice of tissues is taken from the testicle to examine under a microscope to identify the cancer type.