Diagnosis of testicular cancer

Testicular cancer is a disease that happens in the testicles of a man’s reproductive system. The testes or testicles are responsible for the production of sperm and hormones that control the development of male secondary sex characteristics – mainly testosterone.

In approximately 90% of men, testicular cancer is discovered by the man who finds a lump on one side of the scrotal sac. They may notice that one side is larger or swollen but usually not painful or uncomfortable. Some men feel a heaviness or aching in the lower abdomen or scrotum.

There isn’t one type of cell that causes cancer in the testicles of men so the signs and symptoms prior to diagnosis can also be different. For instance, men with germ cell cancer will notice that their breast are sore or have grown. Those who have Leydig cell or Sertoli cell will have a lump in the testicle but these cells can produce either androgens or estrogens (male or female hormones). In men the estrogens will cause breast growth or loss of sex drive but the androgens don’t cause other symptoms. The release of these hormones give a clue to the diagnosis of the cell type and therefore the treatment options.

Some men who have small tumors or cancer cells find they have the disease after testing for infertility or testing for other medical symptoms. And there are a number of non-cancerous conditions that can produce symptoms similar to testicular cancer, such as testicular injury or inflammation.

The first step the practitioner will take in diagnosis is a thorough medical history and physical examination. Not only will the doctor examine the scrotal sac but also the abdomen for signs of an enlarged lymph node.

They may use an ultrasound to look more closely at the lump that was found in the testicles. The goal is to determine if the tumor is solid or filled with fluid. The ultrasound is non-invasive, uses sound waves and is considered very safe. It is the same diagnostic test used to see developing babies. During the test the man lies on a table and the transducer is passed over the scrotal sac and abdomen to help the physician determine if the tumor is benign or malignant, size the tumor and get an accurate placement.

There are some blood tests that may be recommended to help diagnose a testicular tumor. Because many of these types of tumors secrete hormones measuring the hormone levels of alpha-fetoprotein and human chorionic gonadotropin is considered an accurate way of measuring the presence of tumors. Practitioners may also look for LDH, an enzyme. The presence of one, both or all three help the oncologist to definitively diagnose the type of cell present.

If the oncologist sees a solid tumor in the scrotum they will recommend an immediate removal. During the surgery the surgeon will tie off the spermatic cord that has blood and lymph vessels before removing the testicle so tumor cells aren’t able to migrate to the body during the procedure. The operation is best performed through an incision in the groin area.

Once the tumor is removed it will be sent to the lab where a pathologist will evaluate the tissue under a microscope. They will determine the type of cells, confirmed by the blood tests, and this information will be used to help determine the remainder of treatment that may be recommended.

Men who have had the testicle and tumor removed will also have a chest x-ray and either CT scan or MRI performed to evaluate the presence of other tumor cells or metastisis in the body.

RESOURCES

American Cancer Society: Testicular Cancer

American Cancer Society: Testicular Cancer: early detection, diagnosis and staging

Cancer.net: Testicular Cancer

American Family PHysician: Diagnosis and Treatment of Testicular Cancer

MayoClinic: Testicular Cancer

MD Anderson Cancer Center: Q&A Testicular Cancer Diagnosis and Treatment

NHS Choices: Testicular Cancer Diagnosis

Memorial Sloan Kettering Cancer Center: Diagnosis and Staging Testicular Cancer