Testicular Cancer Screening and Diagnosis

We’re fighting with you, and we start with an accurate diagnosis for testicular cancer.

Testicular cancer is a rare disease that can start in the testes – the sex glands that produce sperm and the male hormone testosterone. Certain cells may grow uncontrollably and eventually form a lump. Out of 100,000 men, only about six men each year will be diagnosed with the disease. Even in the advanced stages, most testicular cancers can often be cured.

There are two main types of testicular cancer:

  • Seminomas: These tumors are relatively slow-growing, and they are more sensitive to radiation than nonseminomas.
  • Nonseminomas: These tumors grow and spread faster than seminomas.

Risk factors for testicular cancer

Testicular cancer mainly affects teenage boys and men who are between the ages of 15-40. It is more common in Caucasian men and other men who have an:

  • Undescended testicle 
  • Abnormal testicle size or development
  • Family history of testicular cancer
  • Klinefelter’s syndrome (sex chromosome disorder)
  • Previous cancer in one testicle

Signs and symptoms of testicular cancer

Testicular cancer can have symptoms that are similar to some diseases that are non-cancerous. For that reason, it’s important to visit a doctor when you have questions about your symptoms. When it’s caught and treated early, testicular cancer has a high cure rate.

The most common symptoms for testicular cancer include:

  • Pain in the testicle or scrotum
  • Painless lump or swelling in the testicle or scrotum
  • Shrinking of the testicle
  • Heavy sensation in the testicle
  • Sudden build-up of fluid in the scrotum
  • Dull pain in the groin or lower abdomen
  • Tenderness of the breasts

Screening for testicular cancer

If you have some of the risk factors for testicular cancer, some doctors may recommend a routine self-examination. This is the only screening method available for testicular cancer. After a warm shower or bath, gently move the testicle between the thumb and fingers. If you feel any lumps, contact your doctor as soon as possible. The doctor can take the steps to diagnose if the lump is non-cancerous or cancerous.

Diagnosing testicular cancer

When testicular cancer is diagnosed in its early stages, treatment may require less surgery, less chemotherapy, and less radiation. That equals, less side effects. The diagnosis process starts by talking with your doctor about your medical history.

Exam: The doctor will ask about close relatives who have had testicular cancer. Tell the doctor about any pain you’ve had. During the exam, your doctor will feel the testicles for tenderness and locate the lump. Also, an examination of your abdomen, lymph nodes, and other areas will be done to locate any symptoms that may indicate the cancer has spread.

Ultrasound: This noninvasive and painless procedure uses sound waves to create images of the testicles, scrotum, and the surrounding tissues. As you lay on your back, a clear gel will be applied to your scrotum. Then a probe will be moved over the scrotum to create the images, calculate the size of the lump, and determine if the lump in the testicle is fluid-filled or solid.

Some lumps may be caused by noncancerous conditions.

Blood tests: A blood test can check for tumor markers in your blood. Tumor markers are certain proteins called alpha-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin. A high level of these proteins in the blood suggests that testicular cancer may be present. Also, the proteins may indicate which type of testicular cancer is present. However, some cancers may be too small to raise the levels of the tumor markers.

Biopsies: These are rarely done for testicular cancer because the procedure may cause the cancer to spread. However, in some unusual cases, a biopsy may be done in the operating room. Your doctor will make an incision and remove the testicle. The testicle will be examined, and a small sample of tissue may be cut from the suspicious area; then it will be immediately examined under a microscope by a pathologist. If cancer is not found, the testicle may be returned to the scrotum. When cancer is found, the testicle and the blood vessel that leads to the testicle (the spermatic cord) will be permanently removed. This procedure is called a radical inguinal orchiectomy. Removing the testicle does not affect the ability to have an erection, and removing one testicle usually does not prevent fathering children.

Computed tomography (CT) scan: When a biopsy shows that testicular cancer is present, a CT scan will be done to determine if cancer cells have spread to the lymph nodes, lungs, liver, or other parts of the body. To create a personalized treatment plan, it is important to know exactly where the cancer cells have moved.

Chest X-ray: In some cases, testicular cancer can travel to the lungs, so an X-ray may be given.

Magnetic resonance imaging (MRI) scan: If your doctor suspects that testicular cancer has spread to the spinal cord or brain, an MRI scan may be done.

Positron emission tomography (PET) scan: After chemotherapy, a PET scan may be used to find any small areas of cancer in the body. The PET scan will be able to determine if those areas are actually cancer cells or scar tissue.

Bone scan: If one of your symptoms has been bone pain, your doctor may recommend having a bone scan to see if cancer has spread to the bone.

Stages of testicular cancer

Your doctor will want to find exactly where testicular cancer may have moved and how much of it is in your body. This process is called staging. The stage is determined by the physical exam, biopsy, imaging, and other tests.

A pathologist will look at the cells taken during the biopsy to identify the stage of cancer. Then the urologist and tumor board will determine additional treatment options.

These are the main stages of testicular cancer. 

  • Stage 0: Cancer is only in the small tubes, called seminiferous tubules, inside the testicles. Generally, the five-year survival rate is about 100 percent.
  • Stage 1: Cancer is only inside the testicles. Generally, the five-year survival rate is about 99 percent.
  • Stage 2: Cancer has spread to one or more lymph nodes near the testicles. Generally, the five-year survival rate is about 96 percent.
  • Stage 3: Cancer has spread to distant parts of the body. Generally, the five-year survival rate is about 73 percent.
  • Note: Testicular cancer does not have a Stage 4.
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