Diagnosing the Cancer

When you go to the doctor, there will be a process to see if there is a cancer, and if so, how to treat it.

To begin, your physician will get a thorough family and medical history. Then, a series of procedures will begin:

Ultrasound – this is a minimally invasive way to see the tumor that uses sound waves to generate pictures.

• Generally, ultrasound is the first step if testicular cancer is suspected
• This procedure takes less than half an hour, during which you lie on your back while your doctor applies a gel to the testicles and uses a probe to examine each one
• This test often distinguishes between solid and fluid-filled masses.  If solid, the chances of testicular cancer are high, and the physician will often choose to perform a surgery, called orchiectomy, to remove the testis

Blood tests – the doctor will order tests to look for certain things that signal whether there is a tumor present. These are called “tumor markers.”  Doctors can track these markers after surgery to make sure the tumor is completely gone.

Removing the testicle – in many kinds of cancer, doctors may take a sample of the lump to see if cancer is there. This is called a biopsy. In testicular cancer, this is rarely done.  The reason for this is because taking a biopsy through the scrotum may spread cancerous cells to other areas of the body through blood vessels and the lymph system, a fluid collecting system.

• The surgery to remove the testis with cancer is known as a radical inguinal orchiectomy
• During surgery, the doctor will remove the affected testicle. The doctor will also remove the spermatic cord which contains the blood supply, lymphatic system, and the sperm duct
• A pathologist then examines the tumor to determine which type of testicular cancer the patient has, and if they need further treatment

Staging the Cancer

Once the cancer is found, doctors go through a process to see if the cancer is spread. This process is called staging.

Staging the cancer is an important part of determining if more chemotherapy or surgery is needed. We determine the stage of the cancer by presence of the disease in the lymph nodes (part of the fluid collecting system) or other organs. Imaging and blood tests are the primary means to stage a disease. The following are certain types of imaging options:

• Computerized tomography (CT) scan – this form of imaging takes many x-rays of your body to look for any enlarged lymph nodes in the chest, abdomen, and pelvis. 
• Magnetic Resonance Imaging (MRI) – this form of imaging can be used when CT cannot be done.  It gives a higher resolution of imaging than CT; however, it requires the patient to lie in a tube without moving for up to an hour.  Many patients find this claustrophobic.
• Positron Emission Tomography (PET) scan and Bone Scan – these imaging techniques can be used to look for spread of cancer to other areas of the body and to the bone, respectively.

Depending on the results of the imaging and blood tests, the cancer may be in one of three stages:

• Stage 1: The cancer is limited to the testicles
• Stage 2: The cancer has spread to the lymph nodes in the abdomen.
• Stage 3: The cancer has spread to other organs such as the lungs, liver, and bones.

For more information:

Go to the Testicular Cancer health topic.