Making the Diagnosis
The best way to detect testicular cancer is through a monthly testicular self-examination. Just as breast cancer exams should be performed regularly by women, men should be aware of their testicles - their shape and how they feel. The best time to perform the examination is after a bath or shower, and the best place is in front of a mirror.
To do the monthly exam, gently hold the testicle and feel it with the fingertips of the index finger and thumb, checking for any abnormalities or swelling. Repeat the process with the other testicle. The testicles should feel oval in shape, and smooth and firm. Check for any swelling around the epididymis, a cord-like structure at the top and back of the testicle.
When someone has a suspected testicular tumor, the doctor usually reviews the family medical history and does a full physical exam, including checking the testicles and scrotum and taking blood tests. The blood tests will check for chemical markers which can indicate cancer. This is usually followed by an ultrasound of the scrotum. The ultrasound can show any masses or abnormalities on the testicles.
The next step in diagnosis is a biopsy of the tumor. The biopsy is done by removing the affected testicle (excisional biopsy) and studying the tissue for signs of cancer. Although the entire testicle is taken, it's removed not through the scrotum but through a small incision made in the groin. The entire testicle is taken because this reduces the risk of the cancer spreading.
Chemical markers of the turmour found in the blood can be very helpful in diagnosing testicular cancer as well as for treatment and later follow-up. A pattern of how these markers appear (alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and lactate dehydrogenase (LDH)) can help determine the type of testicular cancer and the type of treatment required.
Once the diagnosis has been made, it's important to determine the cancer's stage, called staging. Staging is done using a chest X-ray and computed tomography (CT) or magnetic resonance imaging (MRI) scans of the abdomen and pelvic area. The chest X-ray will show if the cancer has spread to the lungs, while the CT scans will show if it has spread to the abdominal lymph nodes. Some doctors recommend X-rays be taken with special dyes. An intravenous pyelography shows the urinary system, while a lymphangiography shows the lymph system.
The stages of testicular cancer are:
- stage I – the cancer is only in the testicle
- stage II – the cancer has spread into the lymph nodes in the abdomen
- stage III – the cancer has spread to other parts of the body such as the lungs or liver
- recurrent – cancer has returned after treatment