Testicular cancer is an uncommon cancer that affects about one out of every 250 men at some point during their lives. When it comes to testicular cancer diagnosis and treatment, the prognosis is excellent if it is detected early and treatment is started immediately.
How is testicular cancer diagnosed?
The first step is usually an examination of your testicles and scrotum by your general practitioner (GP), who will be looking for abnormalities such as lumps or swelling. You may find the consultation embarrassing, especially if you have never had a doctor perform this type of examination before, but it over in just a few minutes.
If your doctor detects a lump, you will have an ultrasound and a blood test (see below). If the results of these tests indicate testicular cancer, you will be referred to a urologist, who specializes in the urinary and male reproductive systems. If further tests show a tumor, you may need to have your testicle removed.
Ultrasound: An ultrasound is a painless scan that uses sound waves to create a picture of your body. It is a very accurate way to diagnose testicular cancer and is capable of showing if cancer is present and how large it is. To perform the scan, a gel is spread over your scrotum and a small device called a transducer is pressed on the area. This sends out sound waves that echo when they meet something dense, like a tumor. A computer creates a picture from these echoes. The entire procedure takes about 15 to 20 minutes.
Blood tests: Blood tests are taken to check your general health and how well your organs (such as your kidneys) are functioning. Results of blood tests are used to help you and your physician make decisions about treatment.
Tumor markers: Some types of testicular cancer produce hormones or proteins that are released into the bloodstream. The three most common tumor markers are:
- Alpha-fetoprotein (AFP), elevated in non-seminoma cancers
- Beta human chorionic gonadotropin (Beta-hCG), elevated in some seminoma and non-seminoma cancers
- Lactate dehydrogenase (LDH), elevated in non-seminoma and seminoma cancers, and used to help determine the extent of the cancer
If your blood test results show increased levels of tumor markers, you may have testicular cancer. Elevated tumor marker levels are more common in men with mixed tumors and non-seminoma cancers. However, it is possible to have raised tumor markers due to other conditions, such as blood disease or liver disease. At the same time, some men with testicular cancer don’t have raised tumor marker levels. Doctors can use the results of tumor marker levels to plan treatment.
If a diagnosis of testicular cancer is confirmed after you undergo surgery, you will have regular blood tests to monitor tumor marker levels throughout treatment and as a part of follow-up appointments. Your tumor marker levels will decrease if treatment is successful but increase if the cancer is active. If this occurs, you may need more treatment.
None of the abovementioned tests can definitively diagnose testicular cancer. The only way this can be done is by surgically removing and examining the affected testicle, which is a procedure known as an orchidectomy. An orchidectomy is also the main treatment for testicular cancer when it has not spread.
How is testicular cancer treated?
The only way to categorically diagnose testicular cancer is by surgically removing and examining the affected testicle. This procedure, called orchidectomy, is also the main treatment for testicular cancer that has not spread beyond the testicle.
What about a biopsy, you may ask. True, for other types of cancer, doctors can usually make a diagnosis by taking a tissue biopsy and examining it under a microscope. However, biopsy of the testicles is typically not done because there is a small risk that the incision through the scrotum may cause cancer cells to spread.
That is why urologist who strongly suspect testicular cancer after they complete their examination and testing will usually remove the entire testicle and spermatic cord (channel for blood and lymph vessels, which may act as a pathway for the cancer to spread) through an incision in the lower abdomen. This procedure, known as an orthidectomy, usually takes about 60 minutes and requires only a few stitches that will dissolve after several weeks.
Tissue that is removed during the orchidectomy is examined by a pathologist who can provide information about the type of cancer, whether it has spread, and how far. Removal of the testicle and the results of other tests will help to determine whether the cancer has spread (the stage). There are several staging systems for testicular cancer. A simplified one is provided here:
- Stage I: cancer is found in one testicle only
- Stage II or higher: cancer has spread outside the testicle to the lymph nodes in the abdomen, pelvis, or other areas of the body
Most men have only one testicle removed. It is rare for both testicles to be affected by cancer at the same time. However, cancer may appear in the remaining testicle at a later time. If the cancer has not spread, an orchidectomy may be the only treatment necessary. However, after surgery, you should undergo regular check-ups to ensure there is no recurrence of the disease. Occasionally, men with testicular cancer may need to undergo further surgery to remove the lymph nodes at the back of the abdomen.