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How is testicular cancer diagnosed

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At the GP

If you find an abnormal swelling in your testicle it is advisable to see your GP for further advice or examination. If he is unsure of the exact cause of the testicular swelling he will usually recommend an ultrasound scan of your scrotum and abdomen and refer you to a urologist for assessment. The ultrasound scan and referral will usually be made on an urgent basis meaning that you will be seen by a urologist possibly within a few days and no more than a few weeks. It does not necessarily mean that testicular cancer is present. 

Referral (to a specialist)

Once you have had your ultrasound scan you will be reviewed by a urologist who will be able to interpret the results. If there is any doubt as to the diagnosis a further more detailed ultrasound scan may be requested. Sometimes if there is a strong suspicion that testicular cancer is present but no definitive proof, a decision may be made to surgically remove the affected testicle.  This decision will not be taken lightly but will be in your best interest. No one will want to wait around and see what happens. Surgery to remove the testicle (orchidectomy) will usually be the only time that a definite cancer diagnosis can be verified or ruled out.

Further tests

If testicular cancer is identified or suspected, your doctor will want you to have some further tests to see if there has been any potential spread of the cancer to other parts of the body. These tests may include some or all of the following:

 

Blood tests

Some testicular cancers produce chemicals, which are released into the bloodstream. The three main chemicals, called tumour markers, are alpha-fetoprotein (AFP), beta human chorionic gonadotrophin (BHCG) and Lactase dehydrogenase (LDH). They are sometimes found to be abnormal in the presence of particular types of testicular cancer. For instance AFP can be raised in the presence of a particular type of testicular cancer called non seminoma. They can also be used to measure the effect of your treatment and may be repeated after orchidectomy (see below) at 48-96 hours if they were abnormal before your operation. Blood tests to measure your kidney and liver function will also usually be requested.

Occasionally if the specific blood tests for testicular cancer are very raised or abnormal or there is obvious evidence that testicular cancer is present or has spread to other areas in your body, a referral may be made to an oncologist to see if chemotherapy should be given prior to any surgery. This is called neo-adjuvant treatment.

Chest X-ray – This can identify any cancer which may have already spread to the lungs.

Pregnancy test!

Yes believe it or not this is sometimes used to detect testicular cancer. A pregnancy test works by identifying BHCG.

Scans: 

Computerised Tomography (CT) 

A CT scan is performed to check for any signs that the cancer has spread to your lungs or to the lymph glands in your abdomen.  The CT scan takes a series of x-rays, which are fed into a computer to build up a three-dimensional picture of the inside of the body. The scan takes from 10 to 30 minutes. You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand. You will probably be able to go home as soon as the scan is over. The scan is painless, but it will mean lying still for 10-20 minutes. Any scans you may need will be requested on a very urgent basis and will usually be performed within a few weeks of request.

Positron Emission Tomography (PET)

A Positron Emission Tomography scan (PET scan) PET scan can be used to find whether testicular cancer has spread beyond the testes, or to examine any lumps that remain after treatment to see whether they are scar tissue, or whether cancer cells are still present. They are not always necessary, but you can discuss with your doctor whether one would be useful in your case.

A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is then taken. Areas of cancer are usually more active than surrounding tissue and show up on the scan. It is not usually used on a routine basis but may be performed after initial treatment.

Surgery (orchidectomy)

Orchidectomy is the removal of a testicle and is usually performed very quickly after a suspected diagnosis of testicular cancer. It is a simple procedure which may take about half an hour or so to perform and will usually be performed as a day case procedure under general anesthetic. During this surgery a small incision is made into your groin region on the affected side and the testicle is removed from above. Your scrotum will not be cut. Prior to your surgery your doctor may ask you if you wish to have a prosthetic (artificial) testicle in place of the removed testicle. However some men may develop minor problems in the long term (see below). You may be offered the possibility of sperm storage before surgery (see information sheet on sperm banking).

Falsely or not?

Your doctor may discuss the insertion of a false (prosthetic) ball to take the place of your old one. These are silicone implants that can be inflated with salt water. They come in various sizes and can make you feel whole again.  They can give a very good cosmetic result and be of great psychological value but some men may experience problems with them at a later date. Some of these possible problems include:

·         Scar tissue can form around the implant inside the scrotum. This can sometimes cause a thick fibrous growth of tissue to form which may in turn cause discomfort or give rise to worry that a second cancer has appeared.

•    A prosthetic testicle will not change in size due to temperature like a normal one.

·         Rupture of the implant can rarely occur due to vigorous activities such as contact sport, cycling or physical contact including sex.

·         Sometimes the implant may move out of its original position.

·         Surgery can cause small spots of calcium in the testicle to appear usually some years following surgery. Although they are harmless they can sometimes be confused with the type of calcium deposits (microlithiasis), seen in testicular cancer.

If you are unsure whether you want an implant or not, the procedure can always be carried out at a later date.

Tips

 If you are diagnosed or suspected of having testicular cancer you will usually be given the details of a urology specialist nurse or “ Key worker” who will act as your point of contact during and after your treatment as well as provide you with relevant information and advice. Make sure you have these details as the specialist nurse will usually have access to other medical professionals who may be involved in your care and may be able to liaise with them if you are having problems. They may also be involved in planning your future care or treatment.

Once a diagnosis of testicular cancer is suspected things will begin to move very fast for you, surgery will be booked and scans arranged usually within a two-week period. Plan ahead. Try and involve all of your family. Let them know what is happening so that they can help with any arrangements that need to be made while you are having treatment ( childcare, work etc.)

While you are being treated and afterwards, you will need to take some time off work. Keep any correspondence/ letters and contact details of the health professionals you meet or procedures that you undergo as proof of your treatment in case your employer wants evidence. It may also be a good idea to talk to your human resources department and inform them of your current situation and the fact that you are likely to need some time off. Think about working from home if possible. Although the hospital where you have been treated can issue you with a sick certificate to cover your stay they will not provide you with a long term sick certificate. You will have to get one from your G.P.

The websites below have a great deal of information with regard to work related issues and are well worth a visit if you think you may get problems. If you are self employed and have to stop working due to your illness you should be entitled to incapacity benefit providing you have been paying National Insurance contributions previously. You may also be entitled to other benefits or rebates if you are going to be out of action for some time.

 After Surgery

·         You will have a small dressing covering the incision site on your groin. This can usually be removed at about 24 hours after the operation. The stitches (sutures) you will have in your wound will be dissolvable but can take up to 3-months to fully dissolve.

·         You can have a bath or shower, normally after 24 hours, but it is important not to rub soap on the wound area. Dry the wound area by gently patting it with a clean towel / gauze pad afterwards.

• Your groin and scrotal area can feel bruised and swollen after the operation. It is advisable to wear close fitting underwear, such as briefs or ‘Y’ fronts or a scrotal support rather than boxer shorts while you recover. This will help the bruising settle. Take any painkillers you have been prescribed on a regular basis, (not just when you get pain) for the first 48 hours or until you feel comfortable. Always read the instructions to ensure you administer them correctly. Often simple Paracetamol combined with an anti-inflammatory medication (such as Ibuprofen) are effective at reducing discomfort.

• Although this is a minor operation, it is important to take things easy for the first week. You should be able to return to work within a few weeks. However if you are being reviewed in an outpatient clinic or referred to an oncologist for further treatment; it may be a good idea to await these arrangements before returning to work as you may need to take further time off.

• Occasionally a collection of blood may form under the surgical wound (haematoma) or your wound may become infected. If you think that this is the case it is sometimes useful to phone the unit that performed your operation or contact your GP. 

•  It is important to avoid heavy lifting and or strenuous exercise for the first few weeks. Only start driving when you are able to do an emergency stop without hesitation.

• You may begin your normal sexual activity again two weeks after your operation, as long as you feel comfortable. Having an orchidectomy should not affect your ability to have an erection, but the psychological stress associated with a potential diagnosis of a cancer may affect your performance.

• You should be given a follow up appointment within a few weeks of your operation for the tissue results of your operation, blood and scan results. At this time any further recommended treatment will usually be discussed. 

MacMillan cancer support:

Click here to visit their website or phone: 0800 808 1234

Citizens Advice Bureau:

Click here to visit their website  or phone 0207 833 2181

Government benefit enquiry line:

Click here to visit their website or phone 0800 882 200