Diagnosing testicular cancer

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 your health professional will be able to determine whether or not your lump is cancerous (malignant) or non-cancerous (benign).

A scrotal ultrasound may be performed at UCLH, even if you have already had one elsewhere. During the scan, your specialist will be able to determine the position and size of the abnormality in your testicle. It will also give a clear indication of whether the lump is solid or filled with fluid. A lump filled with fluid is known as a cyst and is usually harmless. A more solid lump may be a sign the swelling is cancerous.

For most cases the only way to safely take a biopsy is to remove the affected testicle completely. This is because specialists often think 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 your lump is cancerous. Losing a testicle should not affect your sex life or 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 you will need an orchidectomy.

Read about treating testicular cancer for more information about the procedure.

To help confirm your diagnosis, you may need a series of blood tests 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 an indication you have the condition.

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 you have testicular cancer even if your blood test results come back normal.

We are able to determine the stage of your cancer after an orchidectomy procedure (removal of the testicle).

There are two ways the staging of testicular cancer can be categorised. The first is known as the TNM 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)

Testicular cancer is also staged numerically. There are four 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