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• How is testicular cancer diagnosed

How is testicular cancer diagnosed

At the GP

Usually you begin by seeing your GP, who will examine you and take your medical details. They may then refer you to a hospital specialist for further tests, expert advice and treatment.

Referral (to a specialist)

The specialist will give you a full physical examination and take your medical history. You may have a special ultrasound test of the scrotum and the testes. This test can often distinguish between cancer and lumps due to other causes. It uses sound waves to build up a picture of the testes and scrotum. The test is painless and occurs on the skin surface. You may also have some blood tests. However, the only way to confirm that the swelling is cancer is for a surgeon to examine the testicle during an operation. During the surgery, the surgeon can usually see whether the lump is a cancer or not. Sometimes a small piece of tissue is removed and immediately examined under a microscope by a pathologist (this is known as a biopsy).

Further tests

If the tests show that you do have testicular cancer, your doctor will want you to have some further tests to see if there has been any spread of the cancer to other parts of the body.

These tests may include some or all of the following:

• Blood tests
• Chest x-ray and CT scan (CAT scan)
• Magnetic resonance imaging (MRI or NMR scan)
• Positron Emission Tomography scan (PET Scan) 

Blood tests

Some testicular cancers produce chemicals, which are released into the bloodstream. The two main chemicals, called tumour markers, are alpha-fetoprotein (AFP) and beta human chorionic gonadotrophin (BHCG). If they are present in the blood, they can be used to measure the effect of treatment on the cancer.

Samples of your blood will be taken regularly throughout your treatment to check your general health and the effect that any treatment may be having on the normal cells in your blood.

Chest x-ray and CT scan (CAT scan)

Usually a chest x-ray or CT scan is done 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.

Magnetic resonance imaging (MRI or NMR scan)

This test uses magnetism to build up cross-sectional pictures of your body. Some people are given an injection of dye into a vein in the arm to improve the image.

During the scan you will be asked to lie very still on a couch inside a long chamber for up to an hour. This can be unpleasant if you don't like enclosed spaces; if so, it may help to mention this to the radiographer. The MRI scanning process is also very noisy, but you will be given earplugs. You can usually take someone with you into the room to keep you company.

The chamber is a very powerful magnet, so before entering the room you should remove any metal belongings. People who have cardiac monitors, pacemakers or metal surgical clips cannot have an MRI scan because of the magnetic fields.

Positron Emission Tomography scan (PET Scan)

PET scans 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.

Once you have had all the tests you need, the doctor will have a good idea of the type of cancer and the stage (whether it is just within the testicle or has spread). It will probably take several days for the results of your tests to be ready, and a follow-up appointment will be made for you.

STAGING OF TESTICULAR CANCER

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. There are several staging systems for testicular cancer. Generally it is divided into four stages, from small and localised (stage one), to spread into surrounding structures or other parts of the body (stage four). Knowing the extent of the cancer and the type of cell involved helps the doctors decide on the most appropriate treatment.

The staging system most commonly used in the UK is described below.