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  • Diagnosis of Testicular Cancer

    Most often with testicular cancer, you will find a painless mass in your scrotum. At other times, either the mass will be discovered during a routine health check-up or it will be painful. Painful masses are likely to be infections ( epididymitis or orchitis) and may be treated first with antibiotics, but all masses or swellings in the scrotum or testis should be examined by your physician.
    Your doctor will ask about your symptoms and medical history and perform a physical exam, including a careful exam of your testes.

    Diagnostic Tests for Testicular Cancer

    Your doctor may do some of the following tests:
    Blood Tests —A sample of your blood is taken and the levels of certain tumor markers are measured. Tumor markers are chemicals that sometimes appear in the blood if cancer is present in the body.
    Testicular cancer produces two markers: alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG). These chemicals not only help diagnose the disease, they are also used to monitor the success of treatment.
    Another substance in the blood, the liver enzyme LDH, is usually elevated in advanced cases of cancer. It may be measured to help diagnosis and to monitor the success of treatments.
    Ultrasonography —Ultrasound is the key test in diagnosing testicular cancer. It uses sound waves to find tumors. If it shows a mass that is solid, the testicle will most likely be removed.
    Excisional Biopsy —This is the removal of an entire testicle for laboratory examination to check for cancer. Most testes with suspicious masses seen on ultrasound are completely removed. In order to minimize the potential for spread of cancer cells as a result of the surgery itself, the surgical approach to this procedure is through the groin rather than across the scrotum.
    Chest X-ray —This is a series of standard x-ray images of your chest. If cancer is confirmed by biopsy, it may have spread to the lymph nodes in the chest. The chest x-ray is done to check for this spread.
    CAT Scan —This test provides detailed computerized x-ray images of any part of your body and can be used to help determine if the cancer has spread. The CT scan is usually taken of the abdomen and pelvis.
    MRI—This test uses magnetic waves to take pictures anywhere in your body. The images are used to determine the stage of cancer or to see if it has spread.

    Staging of Testicular Cancer

    If cancer is found, the treatment and chance for cure depend on the tumor type, location, size, stage of the cancer, and your general health. For most stages of disease the cure rate is currently over 90%.
    Ninety-five percent of testicular cancers are of a type called germ cell tumors. There are two major types of germ cell tumors: seminomas and nonseminomas. There are several types of nonseminomas, all of which tend to be more aggressive than most seminomas. They are distinguished with microscopic examination as well as by blood tests for tumor markers. Some tumors may have more than one cell type. Nonseminomas are less easily cured than seminomas.
    Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected. Staging of testicular cancer considers both the growth of the tumor and the involvement of the lymph nodes. The following stages are used to classify testicular cancer:
    Tumor Stage:
    Tis ( in situ )—The cancer is very localized and has not spread to other areas.
    T1 —The tumor is limited to the testis and epididymis, without having spread to nearby blood vessels.
    T2 —The tumor is limited to the testis and epididymis and has spread to the blood vessels or into the thin skin surrounding the inside of the scrotum (called the tunica vaginalis).
    T3 —The tumor has spread to the spermatic cord.
    T4 —The tumor has spread into the wall of the scrotum.
    Nodal Stage:
    N1 —lymph node with 2 centimeters (cm) or less of cancer
    N2 —lymph node with 2-5 cm of cancer
    N3 —lymph node with more than 5 cm of cancer


    Columbia Presbyterian Medical Center website. Available at: http://cpmcnet.columbia.edu/ . Accessed January 31, 2006.

    Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

    2/1/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: American College of Radiology. ACR Appropriateness Criteria. 2012; Jun 16. Available at http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/StagingTesticularMalignancy.pdf. Updated June, 2012. Accessed February 2, 2013.

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