Visiting your GP
See your GP if you notice a lump or abnormality on or in your testicles. Most testicular lumps are not cancerous, but it is essential that you have the abnormality checked. This is because the treatment for testicular cancer is much more effective when it is started as soon as possible after the condition is diagnosed.
Physical examination
As well as asking you about your symptoms and consulting your medical history, your GP will usually need to carry out a physical examination of your testicles.
Your GP may hold a small light or torch against the lump in your testicle to see whether light passes through it. Cancerous lumps tend to be solid, which means that light is unable to pass through them.
If your GP suspects that the lump in your testicle may be cancerous, you will be referred for further testing at a hospital. Some of the tests that you may have are outlined below.
Scrotal ultrasound
A scrotal ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle. This is one of the main ways that your radiologist (a doctor who specialises in using imaging equipment such as ultrasound scans) will be able to determine whether or not your lump is cancerous.
During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle.
It will also give them a clear indication of whether the lump is solid or whether it is filled with fluid. A lump that is filled with fluid is known as a cyst and is usually harmless. A more solid lump may be a sign that the swelling is cancerous.
Blood tests
To help confirm your diagnosis, you may require a series of blood tests. These tests will be used to detect certain hormones in your blood, which are known as 'markers'. Testicular cancer often produces these markers, so having them in your blood may be a strong indication that you have the condition.
The markers in your blood that will be tested for include:
- AFP (alpha feta protein)
- HCG (human chorionic gonadotrophin)
- LDH (lactate dehydrogenate)
Not all forms of testicular cancer produce these markers. There may still be a chance that you have testicular cancer even if your blood test results come back normal.
Biopsy
The only way to definitively confirm a case of testicular cancer is to have a biopsy of the tumour taken. The cells from the tumour can be examined in a laboratory to determine whether it is cancerous (malignant) or non-cancerous (benign).
A biopsy usually involves taking a small sample of cells from the tumour. For most cases of testicular cancer, the only way to safely take a biopsy is to remove the affected testicle completely. This is because specialists often think that the risk of the cancer spreading is too high for a conventional biopsy to be taken.
Your specialist will only recommend removing your testicle if they are relatively certain that your lump is cancerous. Losing a testicle will not affect your sex life or your ability to have children.
The removal of a testicle is known as an orchidectomy. The main form of treatment for testicular cancer is removing the affected testicle, so if you have testicular cancer it is likely that you will need to have an orchidectomy at some point.
See Cancer of the testicles - treatment for more information about the procedure.
Other tests
If your specialist feels it is necessary, you may require further tests to check whether testicular cancer has spread to any other parts of your body. When cancer of the testicle spreads, it most commonly affects the lungs.
Therefore, you may require a chest X-ray to check for any signs of a tumour. You may also require a scan of your entire body, such as a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check for signs of the cancer spreading.
Staging
Once the above tests have been completed, it is usually possible to determine the stage of your cancer, as well as any resulting implications, both in terms of your treatment and the possibility of achieving a complete cure.
There are two ways that the staging of testicular cancer can be categorised. The first is known as the TMN staging system:
- T indicates the size of the tumour.
- N indicates whether the cancer has spread to nearby lymph nodes.
- M indicates whether the cancer has spread to other parts of the body (metastasis).
While widely used, the TNM system can sometimes be difficult for someone with little or no medical expertise to understand. Therefore, for the sake of clarity, the rest of the article will use the second staging system, where the stages of testicular cancer are described numerically.
See the Macmillan website for more information about TNM staging for testicular cancer.
In the numerical system, there are four main stages:
- Stage 1: the cancer is contained inside your testicles.
- Stage 2: the cancer has spread from the testicles into the lymph nodes in your abdomen and pelvis.
- Stage 3: the cancer has spread into the lymph nodes in your upper chest.
- Stage 4: the cancer has spread into another organ, such as your lungs.
