Testis Cancer

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Diagnosis

The first test usually ordered by your doctor will be a testicular ultrasound. The ultrasound images will confirm that the lump that is felt on physical examination is in the testicle and not in one of the other scrotal structures.

The testicle is surrounded by the epididymis and the vas deferens. These anatomic structures are involved in the maturation process of sperm. Although benign tumors of the epididymis are common, cancerous tumors are extremely rare. Therefore, if a nodule is found in the epididymis, your doctor may recommend that it be followed and not treated.

Once the ultrasound confirms the presence of a lesion in the testicle, your doctor will order a series of laboratory tests:

  • AFP (alpha-fetoprotein)
  • Beta-hCG (human chorionic growth hormone)
  • LDH (lactate dehydrogenase)

The levels of these proteins that are in your blood can help determine the type of testicular cancer as well as the stage of the cancer (to what extent the tumor has spread).

Unfortunately, none of the above laboratory tests or imaging studies can reliably determine whether a testicular lesion is indeed a cancer. Therefore, the next step is to undergo surgery to remove the affected testicle (orchiectomy). This is done through a small incision (3-5 cm) in the groin and can often be performed as outpatient surgery. In order to be assured that the tumor is removed, the entire testicle and spermatic cord (blood vessels and vas deferens) must be removed at the time of the operation. Once the testicle is removed, the pathologist will determine what type of cancer (germ cell vs stromal, Seminoma versus NSGCT) and the extent of spread within the testicle. Prior to surgery, your doctor may also discuss sperm banking with you.

Finally, your doctor will order imaging studies, usually a CT scan (or in some cases, a MRI), of the chest, abdomen and pelvis. These scans are done in order to determine if the cancer has spread to the lymph nodes and/or other organs in the body.

Once all of these tests/procedures have been done and the pathology report has been reviewed, your doctor will be able to have a full discussion with you about the recommended treatment.