• Diagnosis of Testicular Cancer

    Your doctor will ask about your symptoms, and medical and family history. The testicles and surrounding areas will be carefully examined. Your doctor may recommend different tests in order to identify tumors and confirm a diagnosis.

    Suspicion of Testicular Cancer

    If you are having symptoms or your doctor detects abnormalities, you may need further testing. Tests can help confirm a cancer diagnosis or another condition, such as epididymitis or orchitis. Tests may include:
    • Blood tests—Certain substances are released into the blood when a cancerous tumor develops. These markers, such as alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG), may be elevated in the presence of cancer.
    • Imaging tests—Changes in the testicle(s) and nearby structures, including the presence of tumors, can be found with these tests. They can also assess tumor size and location. Imaging tests may include:

    Diagnosis of Testicular Cancer

    During a radical inguinal orchiectomy, a testicle is removed and the tissue is examined under a microscope. In most cases, testicles with suspicious masses seen on ultrasound are completely removed via the groin rather than through the scrotum. This helps minimize the potential for the spread of cancer cells if they are present. This is the only way to confirm a diagnosis. Once the testicle is removed and examined, the stage of cancer can be determined.

    Staging of Testicular Cancer

    If testicular cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Nearly all testicular cancers are germ cell tumors called seminomas and nonseminomas. There are several types of nonseminomas, all of which tend to be more aggressive than most types of seminomas.
    Staging is used to determine characteristics of the tumor that will help develop the prognosis and treatment plan. Factors that play a role in staging include how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
    Staging Tests
    Tests that may help determine testicular cancer include:
    • Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
    • Imaging tests—To help determine if cancer has spread to nearby lymph nodes or structures. They may also help to determine if there are any metastatic growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
    Stages of Testicular Cancer
    The following structures may be affected by testicular cancer:
    • An inner and outer layer of tissue that surrounds the testicle.
    • Epididymis—A network of tiny tubules that are attached to the back and top of the testicle.
    • Spermatic cord—A cord-like structure of connective tissue that runs from the abdomen to the testicle. It contains the vas deferens, nerves, and blood vessels.
    Testicular cancer is staged from 0-III (after a radical inguinal orchiectomy):
    • Stage 0—Testicular intraepithelial neoplasia—Abnormal cells are found in the tiny tubules where sperm cells are made. The have the potential to become cancer cells and spread into nearby structures.
    • Stage IA—Cancer is found in the testicle and epididymis and MAY be in the inner layer of tissue that surrounds the testicle.
    • Stage IB—Cancer is found in the testicle and epididymis AND has spread to either of the following:
      • Blood or lymph vessels in the testicle.
      • The outer layer of tissue that surrounds the testicle.
      • The spermatic cord or scrotum (and maybe to the blood or lymph vessels in the testicle)
      Stage IS—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND either one of the following:
      • Blood tests are slightly elevated for all tumor markers.
      • Blood tests that indicate higher than normal for one or more tumor markers.
    • Stage IIA—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND has spread to up to 5 abdominal lymph nodes that are 2 centimeters (cm) or less in size. Blood tests are normal or slightly elevated for all tumor markers.
    • Stage IIB—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND and either of the following:
      • Up to 5 abominal lymph nodes with at least one that is 2-5 cm in size.
      • More than 5 abdominal lymph nodes that are 5 cm or less in size.
      • Blood tests are normal or slightly elevated for all tumor markers.
    • Stage IIC—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND in at least one abdominal lymph node that is more than 5 cm in size. Blood tests are normal or slightly elevated for all tumor markers.
    • Stage IIIA—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND one or more abdominal lymph nodes AND lymph nodes in other parts of the body OR the lungs. Blood tests are normal or slightly elevated for all tumor markers.
    • Stage IIIB—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND one or more abdominal lymph nodes, lymph nodes in other parts of the body, or the lungs. Blood tests are moderately elevated for one or more tumor markers.
    • Stage IIIC—Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND one or more abdominal lymph nodes, lymph nodes in other parts of the body, or the lungs. Blood tests are highly elevated for one or more tumor markers.
    • Stage III—May be determined by any of the other stage III criteria OR any of the following:
      • Cancer is found in the any of the structures associated with the testicle, spermatic cord, or scrotum AND may have spread to one or more abdominal lymph nodes AND is NOT in lymph nodes in other parts of the body or the lungs, BUT has spread to other parts of the body. Blood tests indicate normal to higher than normal for any tumor markers.

    References

    How is testicular cancer diagnosed? American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated February 12, 2016. Accessed September 22, 2017.

    How is testicular cancer diagnosed? Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/testicular-cancer/diagnosis. Accessed September 22, 2017.

    Stages of testicular cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#link/%5F26. Updated July 7, 2016. Accessed September 22, 2017.

    Testicular cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer. Updated May 31, 2017. Accessed September 22, 2017.

    Testicular cancer. Merck Manual Professional Version. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/testicular-cancer. Updated November 2013. Accessed September 22, 2017.

    9/6/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer: Yacoub JH, Aytekin O, Allen BC, et al. ACR Appropriateness Criteria for staging of testicular malignancy. Available at: https://acsearch.acr.org/docs/69375/Narrative.

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