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  • How is testicular cancer diagnosed?

    Contents

    Tests

    You will usually begin by seeing your general practitioner (GP), who will examine your testicles and scrotum for a lump or swelling. You may find the consultation embarrassing, particularly if you have never had a doctor perform this type of examination before, but doctors are used to it and it only takes a few minutes.

    If the GP feels a lump, you will have an ultrasound and a blood test. If the results show any sign of testicular cancer,you will be referred to a urologist who specialises in the urinary and male reproductive systems. If further tests show there is a tumour,you may need to have your testicle removed.

    Ultrasound

    An ultrasound is a painless scan that uses soundwaves to create a picture of your body. It is a very accurate way to diagnose testicular cancer. It is used to show if cancer is present and how large it is. A gel is spread over your scrotum and a small device called a transducer is pressed into the area. This sends out soundwaves that echo when they meet something dense like an organ or a tumour. A computer creates a picture of these echoes. A scan is painless and takes about 15–20 minutes.

    Blood tests

    Blood tests will be taken to check your general health and how well your organs (such as your kidneys) are working. The results of these tests will also help you and your doctors make decisions about your treatment. 

    Tumour markers

    Some types of testicular cancer produce chemicals – also known as hormones or proteins – that are released into the blood. These chemicals can be used as tumour markers which show that cancer may be present.

    If your blood test results show an increase in the levels of tumour markers you may have testicular cancer. Raised levels are more common in mixed tumours and non-seminoma cancers. However it is possible to have raised tumour markers due to other factors such as liver disease or blood disease. Some men with testicular cancer don't have raised tumour marker levels in their blood. Doctors use the results of your tumour marker levels to plan treatment.

    The three most common tumour markers are:

    • alpha-fetoprotein (AFP) – raised in non-seminoma cancers
    • beta human chorionic gonadotrophin (beta-hCG) – raised in some seminoma and non-seminoma cancers
    • lactate dehydrogenase (LDH) – raised in non-seminoma and seminoma cancers, and used to help determine the extent of the cancer.

    If the diagnosis of testicular cancer is confirmed after surgery, you will have regular blood tests to monitor tumour marker levels throughout treatment and as part of follow up appointments.

    Tumour marker levels will decrease if your treatment is successful but will increase if the cancer is active. If this happens you may need more treatment. 

    CT scan

    You may have a computerised tomography (CT) scan to see if the cancer has spread to other parts of the body, such as lymph nodes or other organs.

    A CT scan is a type of x-ray that takes detailed, three-dimesional pictures of the inside of the body. To make the scan pictures clearer and easier to read, you may have to fast (not eat or drink) for a period of time before your appointment.

    Before the scan, you may be given an injection of a dye into a vein to make the pictures clearer. The injection can make you feel hot all over for a few minutes. You may be asked to drink a liquid instead of having an injection.

    Chest x-ray

    In some cases you may have a chest x-ray to check if the cancer has spread to the lungs or the lymph nodes in the chest.

    Further tests

    You may have some other tests, such as MRI or PET scans if the doctor is not sure of the full extent of the cancer, or if your tumour markers are elevated. These scans may also be used during or after treatment.

    MRI scan

    A magnetic resonance imaging scan (MRI) uses a powerful magnet and radio waves to create detailed pictures of areas inside your body. Sometimes dye will be injected into a vein before the scan to make the pictures clearer.

    You will lie on a table that slides into a metal cylinder that is open at both ends. The machine makes a series of bangs and clicks and can be quite noisy. The scan is painless but some people feel anxious in the narrow cylinder.  

    PET scan

    Before a positron emission tomography scan (PET) you will be injected with a small amount of glucose (sugar) solution containing some radioactive material. You will be asked to rest for 30–60 minutes while the solution spreads throughout your body. You will then be scanned for high levels of radioactive glucose. Cancer cells show up brighter on the scan because they absorb more of the glucose solution than normal cells. 

    Removing the testicle

    None of the tests described above can definitively diagnose testicular cancer. The only way this can be done is by surgically removing and examining the affected testicle. This is called an orchidectomy.

    For other types of cancer a doctor can usually make a diagnosis by removing and examining some tissue from the tumour. This is called a biopsy. However doctors don’t usually biopsy the testicle because there is a small risk that making a cut through the scrotum can cause cancer cells to spread.

    Which health professionals will I see?

    After seeing your GP and getting a diagnosis from the urologist you may be cared for by a range of health professionals who are responsible for different aspects of your treatment. The health professionals you see will depend on the treatment you have. The multidisciplinary team (MDT) may include some of the professionals from the list below.

    urologist

    a surgeon who specialises in treating diseases of the urinary system and the male reproductive system

    medical oncologist

    prescribes and coordinates the course of chemotherapy

    radiation oncologist

    prescribes and coordinates the course of radiotherapy

    nurses

    administer drugs - including chemotherapy - and provide care, information and support throughout your treatment

    cancer care coordinator/clinical nurse consultant

    coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment

    anaesthetist 

    administers anaesthetic before surgery and monitors you during the operation

    dietitian

    recommends an eating plan to follow during treatment and recovery

    social worker, physiotherapist, clinical psychologist and occupational therapist

    link you to support services and help you with any emotional, physical or practical problems

    This website page was last reviewed and updated January 2017.

    Information last reviewed September 2016 by: A/Prof Declan Murphy, Urologist, Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Joseph McKendrick, Medical Oncologist, Eastern Oncology, Eastern Health and Monash University, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia, WA; Ben Peacock, Consumer; and Deb Roffe, Cancer Council Nurse, Cancer Council SA.

     

     

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