Diagnosing testicular cancer

Friday 1 August, 2014

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On this page: Ultrasound | Blood tests | Removing the testicle | CT Scan | Chest x-ray | Further tests | Staging | Prognosis | Which health professionals will I see? | Key points  


You will usually begin by seeing your general practitioner (GP), who will examine your testicles and scrotum for lumps or swelling. You may find the consultation embarrassing, particularly if you have never had a doctor perform this type of examination before, but doctors are used to it and it only takes a few minutes.

If the GP feels a lump, you will probably be referred to a urologist, who specialises in the urinary and male reproductive systems. In most cases, the urologist will arrange some tests, such as an ultrasound and blood test. If the tests show there is a tumour, you may need to have your testicle removed. 

Ultrasound

An ultrasound scan uses soundwaves to create a picture of an area of your body. A gel will be spread over your scrotum to conduct the soundwaves and a small device called a transducer is pressed into the area. This sends out soundwaves, which echo when they encounter something dense like a tumour. The ultrasound images are then projected onto a computer screen.

An ultrasound is painless, and takes about 15 minutes.

Blood tests

Blood tests will be taken to check your general health and how well your organs (such as your kidneys) are working. The results of these tests will also help you and your doctors make decisions about your treatment.

Tumour markers

Some types of testicular cancer produce chemicals – also known as hormones or proteins – that are released into the blood. These chemicals can be used as tumour markers, which show that cancer may be present.

If your blood test results show an increase in the levels of tumour markers, you may have testicular cancer. Raised levels are more common in mixed tumours and non-seminoma cancers. However, it is possible to have raised tumour markers due to other factors, such as liver diseases or blood diseases.

The three most common tumour markers are:

  1. alpha-fetoprotein: raised in non-seminoma cancers
  2. beta human chorionic gonadotrophin (beta-hGC): raised in some seminoma and non-seminoma cancers
  3. lactate dehydrogenase (LDH): raised in non-seminoma and seminoma cancers and used to help determine the extent of the cancer and how it is responding to treatment.

You will have regular blood tests to monitor levels of tumour markers in your blood throughout your treatment and afterwards when you have check-ups. Tumour marker levels will decrease if your treatment is successful but will increase if the cancer is active.

Some men who have testicular cancer do not have raised tumour marker levels in their blood.

Removing the testicle

None of the tests described above can definitely diagnose testicular cancer. The only way this can be done is by surgically removing and examining the affected testicle.

For other types of cancer, a doctor can usually make a diagnosis by removing and examining some tissue from the tumour. This is called a biopsy.

However, doctors don’t usually biopsy the testicle because there is a small risk that a cut through the scrotum can make any cancer cells more likely to spread. Instead, the urologist will usually remove the whole testicle and spermatic cord through a cut in the lower abdomen. This is called an orchidectomy or inguinal orchidectomy.

Tissue that is removed during the orchidectomy is sent to a specialist called a pathologist, who examines the cells under a microscope and provides information about the cancer. Most men only have one testicle removed, but if both of your testicles are affected, your doctor may remove them both (bilateral orchidectomy). It is rare for both testicles to be affected.

If the cancer has not spread, an orchidectomy may be the only treatment you need. However, after the operation, you will need to have regular check-ups to ensure there is no recurrence of the disease. This is called surveillance (see surveillance policy).

What happens during an orchidectomyWhat happens during an orchidectomy

You will be given a general anaesthetic before the orchidectomy.

The surgeon will make a cut above the pubic bone in the groin. The testicle is then pulled up and out of the scrotum by the spermatic cord through the surgical incision. The spermatic cord is also removed because it contains blood and lymph vessels that may act as a pathway for the testicular cancer to spread to other areas of the body.

The operation usually takes about an hour; however you may have to stay a day or more in hospital to recover.

You will have a few stitches above the pubic bone in your groin.

Recovery after surgery

After the orchidectomy, you may stay in hospital for 1–2 days. However, many men are able to return home the same day.

When you return home, you should be able to return to work when you feel ready and drive after 2–4 weeks. You should wait about six weeks to do strenuous activities, such as heavy lifting.

Your surgeon will probably recommend that you wear scrotal support or athletic-type underwear to increase your comfort and protect your scrotum while you recover. This can also reduce swelling. Scrotal supports can be purchased at most pharmacies. This is just like underwear and is not noticeable under regular clothing.

Because of the way the muscles in the groin are cut, you may experience some discomfort sitting down after surgery. This can last for some time, but will ease as the muscles heal.

Surgery side effects

You may experience some of the following side effects.

Pain

Your doctor can give you medication to control any pain you have after the operation. Be sure to tell the doctor or nurses if the pain is severe.

Bruising

You may have some bruising around the wound and scrotum. Blood may collect inside the scrotum (intrascrotal haematomas). If this develops, the swelling may make it feel like the testicle hasn’t been removed.

The supportive scrotal support underwear helps reduce the risk of intrascrotal haematomas. Both the bruising and the haematoma will disappear over time.

Erection difficulties

The removal of one testicle doesn’t affect your ability to have an erection. If both testicles are removed, your testosterone levels will drop, so you may be given hormones to increase your sex drive and ability to get erections. For more information, see sexuality and intimacy.

Effect on fertility

Losing one testicle shouldn’t affect your ability to have children (fertility), providing the remaining testicle is healthy. This is because the other testicle makes up for the missing one by making more testosterone and sperm.

If both testicles are removed, men are no longer able to produce sperm, making them unable to conceive (infertile).

It is important to discuss this risk with your doctor to determine if you want to bank some sperm for later use. See more information about fertility.

Emotional effects

Losing a testicle may cause some men to feel embarrassed, depressed or suffer from low self-esteem. It may help to talk about how you are feeling with someone you trust, such as a partner or counsellor. See information about support services.

Body image issues

Some men choose to replace the removed testicle with an artificial testicle, called a prosthesis. See below for more information. 

"I had a testicle removed nine years ago and felt okay about it. After nine years of remission, I lost my second testicle to testicular cancer. I've decided to have two new ones put in, for aesthetic reasons." – Bill
Having a prosthesis

You may be given the option of replacing the removed testicle with an artificial testicle, called a prosthesis. This is a silicone implant intended to have the weight and feel of a normal testicle.

Whether or not you have a prosthesis (or two prostheses) is a personal decision. Most men don’t have a prosthesis.

However, you may decide to do so if you’re concerned or anxious about the appearance of having one or no testicles. If you choose to have a prosthesis, you can have the operation at the same time as the orchidectomy or separately. Your urologist can give you more detailed information about your options and the procedure.

CT scan

If the removal of your testicle and other tests show you have cancer, you may have a computerised tomography (CT) scan to see whether the cancer has spread to other parts of the body. Sometimes this is done before the orchidectomy.

The CT scan is a type of x-ray procedure. It takes pictures of the inside of your body, which can help determine if the cancer has spread to your lymph nodes, lungs, liver or other organs.

Before the scan, a dye may be injected into one of your veins. This dye will help create clearer pictures. For a few minutes, this injection may make you feel hot all over. You may also have a strange taste in your mouth from the dye.

The contrast solution used in CT scans may occasionally cause an allergic reaction. If you have any allergies, let the person performing the scan know in advance. 

You will lie on a table and pass through the CT scanner, which is large and round. This machine takes pictures of your body and displays them on a screen.

Preparing for the scan and having it takes about 30–40 minutes. Most men are able to go home as soon as their scan is done. 

Chest x-ray

If the CT scan doesn’t provide enough information, an x-ray of the chest is taken to check if the cancer has spread to the lungs or the lymph nodes in the chest. 

Further tests

You may have some other tests, such as MRI or PET scans, if the doctor is not sure of the full extent of the cancer, or if your tumour markers are elevated. These scans may also be used during or after treatment.

There are a limited number of facilities that deliver these scans, so they may not be available at your local hospital. Some men have to travel to a treatment centre where a PET or MRI scanner is located.

MRI scan
  • A magnetic resonance imaging scan.
  • Uses a powerful magnet linked to a computer to take detailed pictures of areas inside your body.
  • You will lie on a table that slides into a metal cylinder.
  • The scan is painless, but some people feel anxious in the confined space (claustrophobic). The machine can also be quite noisy.
  • If this makes you feel anxious, your medical team can talk to you about ways to relax or may be able to give you medication to ease your anxiety.
  • The scan takes about an hour.
PET scan
  • A positron emission tomography scan.
  • Highlights areas in the body where there are lots of actively dividing cells, such as cancer cells.
  • You will be injected with a glucose solution containing a small amount of radioactive material, then you will have a full body scan.
  • Actively dividing cells, such as cancer cells, absorb the radioactive material.
  • The radiation will leave your body within a few hours and is generally not harmful, but talk to your doctor beforehand if you are concerned.
  • The scan takes about 2–3 hours. 

Staging

The removal of the testicle and the results of the other tests will help to determine how far the cancer has spread (the stage). The most common staging system uses numbers – see below.

Your doctor will determine your treatment based on the stage of the cancer and your personal preferences. 

  • Stage 1: Cancer is found only in the testicle. 
  • Stage 2: Cancer has spread to the lymph nodes in the abdomen or pelvis.
  • Stage 3: Cancer has spread beyond the lymph nodes to other areas of the body, such as the lungs, liver or brain.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about common issues that affect men with testicular cancer.

Test results, the type of testicular cancer you have, the stage of the cancer and other factors such as age, fitness and medical history are all important in assessing your prognosis.

Five-year survival rate

Doctors often use numbers (statistics), including five-year survival rate, when considering someone’s prognosis.

Testicular cancer is the most curable solid organ tumour. If the cancer is found while it is still only in the testicle (stage 1), the five-year survival rate for men is 98%. Stages 2 and 3 cancer become more difficult to treat, but in most cases, tumours can be controlled, shrunk or cured with treatment.

However, it’s important to realise that regular follow-up and review is a major factor in the high cure rates of testicular cancer.

"My doctor said to me, ‘If you're going to get a cancer, this is the one to get.' The cure rate is high, side effects are minimal and life afterwards is pretty normal. It's very uncommon to die from testicular cancer." – Mark

Which health professionals will I see?

After seeing your GP and getting a diagnosis from the urologist, you may be cared for by a range of health professionals who are responsible for different aspects of your treatment.

The health professionals you see will depend on the treatment you have. The multidisciplinary team may include some or all of the people listed below:

  • urologist: a surgeon who specialises in treating diseases of the urinary system and the male reproductive system
  • medical oncologist: prescribes and coordinates chemotherapy
  • radiation oncologist: prescribes and coordinates radiotherapy
  • nurses: help administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
  • cancer care coordinator/cancer nurse coordinator: supports patients and families throughout treatment and liaises with other staff to help organise care
  • endocrinologist: specialises in restoring the normal balance of hormones in the body, for men who have had both testicles removed and need testosterone replacement
  • anaesthetist: administers an anaesthetic before an operation so you lose consciousness and don’t feel any pain
  • dietitian: recommends an eating plan for you to follow while you are in treatment and recovery
  • social worker, physiotherapist, clinical psychologist and occupational therapist: link you to support services and help you with any emotional, physical or practical problems

Key points

  • Your doctor will do an external examination to feel your testicles and scrotum to check for lumps and swelling.
  • An ultrasound scan will create a picture of your scrotum and testicles. This is a quick and painless scan.
  • Blood tests will be done to monitor chemicals released into your blood (tumour markers). An increase in tumour markers may indicate that cancer is present.
  • The only way to definitely diagnose testicular cancer is by removing the testicle. This operation is called an orchidectomy or inguinal orchidectomy. For some men, this is the only treatment required.
  • After an orchidectomy, you will have side effects, such as pain and bruising. These will ease over time.
  • If the removal of the testicle shows you have cancer, you will probably have more tests to see whether the cancer has spread. You may have a CT scan, chest x-ray and other scans.
  • The doctor will tell you the stage of the cancer, which describes how far it has spread. Testicular cancer uses a scale from 1–3. More advanced cancers have a higher number (i.e. stage 3).
  • Your doctor may discuss your prognosis with you. Testicular cancer is the most curable solid organ tumour, and 98% of men with stage 1 cancer survive at least five years after treatment.
  • You will see a range of health professionals, such as a urologist and nurses. They will work together as a multidisciplinary team to diagnose and treat you.

Reviewed by: Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, QLD; Gregory Bock, Cancer Nurse Coordinator Urology, WA Cancer and Palliative Care Network, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Howard Gurney, Head of Clinical Research for Medical Oncology, Westmead Hospital, Director of Clinical Trials and Medical Oncology, Macquarie University, NSW; Carmen Heathcote, Cancer Council Queensland Helpline Operator, QLD; Aaron Likely, Consumer; David Moser, Consumer; and Dr Marketa Skala, Radiation Oncologist, W.P. Holman Clinic, TAS..

Updated: 01 Aug, 2014