How is testicular cancer diagnosed?

If your healthcare provider thinks you might have testicular cancer, you will need certain exams and tests to be sure. The process starts with your healthcare provider asking you questions. You'll be asked about your health history, your symptoms, risk factors, and family history of disease.

A physical exam will be done. It will include checking your testicles for swelling, sore areas, or lumps. If there is a lump, your healthcare provider will note its size and location. Your provider may also look carefully at your belly (abdomen), groin, and other parts of your body. This is to look for signs that cancer may have spread. 

What tests might I need?

You may have one or more of these tests:

Ultrasound

An ultrasound is often the first test done if you have a lump on or near your testicle. This test uses sound waves to make images of the inside of your body. It can show if the lump is filled with fluid or is a solid mass. Solid lumps are more likely to be cancer.

Blood tests

Blood levels of certain proteins tend to change if you have testicular cancer. These proteins are called tumor markers. The main tumor markers for testicular cancer are alpha-fetoprotein and human chorionic gonadotropin. Another marker is an enzyme called lactate dehydrogenase.

Your healthcare providers may be able to tell what kind of testicular cancer you have based on these marker levels. These blood tests will be repeated after surgery to done to remove the testicle. They might be repeated during treatment to see how well treatment is working. They can also be checked after treatment to watch for signs that the cancer might be back.

Other blood tests will be done to get an idea of your overall health. They can also show how well organs like your kidney and liver are working.

CT scan

You may have a CT scan of your abdomen and pelvis to check for a tumor. A CT scan is an imaging test that combines a series of X-rays to create a more detailed picture. A contrast material may be used to improve the image. It might be injected into a vein. Or it may be a pill or liquid that you swallow.

Surgery to remove the testicle

If a lump is found and the healthcare provider thinks it's cancer, a surgeon will most likely try to remove it. Most often this is done by removing the entire testicle and spermatic cord. This surgery is called a radical inguinal orchiectomy. The testicle and cord are taken out through a cut (incision) above your pubic area. This surgery is not done through the scrotum. This is because if you have cancer, the surgery could spread the cancer cells to your scrotum or your other testicle. If you have only one testicle or will have both testicles removed, you may have the choice to collect sperm samples for sperm banking before surgery.

The removed testicle and spermatic cord are sent to a lab for testing. There, a healthcare provider called a pathologist will look at the removed tissues under the microscope to check for cancer cells.

Getting your test results

Your healthcare provider will contact you with the results of your tests. Ask how you can expect to find out your results. Will it be a phone call or do you need to make an appointment?

You will likely need more tests if cancer is found. Make sure you understand your test results and what your next steps should be.