You will usually begin by seeing your doctor, who will examine your testicles and scrotum for a lump or swelling. Some people may find this embarrassing, but doctors are used to doing these examinations. It will only take a few minutes.

If the doctor feels a lump that might be cancer, you will have an ultrasound. If the lump looks like a tumour on the ultrasound, you will have a blood test and are likely to be referred to a specialist called a urologist. The urologist may recommend removal of the testicle to confirm the diagnosis.

Ultrasound

An ultrasound is a painless scan that uses soundwaves to create a picture of your body. This is a very accurate way to tell the difference between fluid-filled cysts and solid tumours. It can show if a tumour is present and how large it is.

The person performing the ultrasound will spread a gel over your scrotum and then move a small device called a transducer over the area. This sends out soundwaves that echo when they meet something dense, like an organ or a tumour. A computer creates a picture from these echoes. The scan takes about five to ten minutes.

Blood tests

Blood tests can check your general health and how well your kidneys and other organs are working. The results of these tests will also help you and your doctors make decisions about your treatment.

Tumour markers

Some blood tests look for proteins produced by cancer cells. These proteins are called tumour markers. If your blood test results show an increase in the levels of certain tumour markers, you may have testicular cancer.

Raised levels of tumour markers are more common in mixed tumours and non-seminoma cancers. It is possible to have raised tumour markers due to other factors, such as liver disease or blood disease. Some people with testicular cancer don’t have raised tumour marker levels in their blood.

There are three common tumour markers measured in tests for testicular cancer:

• alpha-fetoprotein (AFP) – raised in some non-seminoma cancers
• beta human chorionic gonadotropin (beta-hCG) – raised in some non-seminoma and seminoma cancers
• lactate dehydrogenase (LDH) – raised in some non-seminoma and seminoma cancers.

Doctors will use your tumour marker levels to assess the risk of the cancer coming back after surgery, and this helps them plan your treatment. If the diagnosis of testicular cancer is confirmed after surgery, you will have regular blood tests to monitor tumour marker levels throughout treatment and as part of follow-up appointments.

Tumour marker levels will drop if your treatment is successful, but they will rise if the cancer is active. If this happens, you may need more treatment.

Surgery to remove the testicle

The only way to be sure of the diagnosis is to surgically remove the affected testicle and examine it in a laboratory. The surgery to remove a testicle is called an orchidectomy or orchiectomy. In most cases, the surgeon needs to remove only one testicle. It is rare for both testicles to be affected by cancer at the same time.

For other types of cancer, a doctor can usually make a diagnosis by removing and examining some tissue from the tumour, which is called a biopsy. Doctors don’t usually biopsy the testicle because there is a small risk that making a cut through the scrotum can cause cancer cells to spread.

Having an orchidectomy

The urologist will make a cut (incision) in the groin above the pubic bone. The whole testicle is pulled up and out of the scrotum through this cut, as well as the spermatic cord because it contains blood and lymph vessels that may act as a pathway for the cancer to spread to other areas of the body.

The operation takes about 30 minutes. After the orchidectomy, you can usually go home the same day, but you may need to stay in hospital overnight.

Having a prosthesis

You may decide to replace the removed testicle with an artificial one called a prosthesis. The prosthesis is a silicone implant similar in size and shape to the removed testicle. There are different brands, and some feel firmer than others.

Whether or not to have a prosthesis is a personal decision. If you choose to have one, you can have the operation at the same time as the orchidectomy or at another time. Your urologist can give you more information about your options.

Further tests

If the removal of your testicle and initial tests show that you have cancer, you may have further tests to see whether the cancer has spread to other parts of the body, such as lymph nodes or other organs. These tests may also be used during or after treatment to check how well the treatment has worked. They can include:

• CT scan – You may have a computerised tomography (CT) scan of your chest, abdomen and pelvis. Sometimes this is done before the orchidectomy. A CT scan uses x-rays to take pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture. 
• MRI scan – In some circumstances, such as if you have an allergy to the dye normally used for a CT scan, you may instead have a magnetic
  resonance imaging (MRI) scan. An MRI scan uses a powerful magnet and radio waves to create detailed pictures of areas inside the body.
• PET–CT scan – You may also be given a positron emission tomography (PET) scan combined with a CT scan. You will be injected with a small amount of a glucose (sugar) solution containing some radioactive material, which helps cancer cells show up more brightly on the scan.

Staging and prognosis

Tests for testicular cancer help to show whether the cancer has spread (its stage). There are several staging systems for testicular cancer, but the most commonly used is the TNM (tumour–nodes–metastasis) system.

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. To assess your prognosis, your doctor will consider your test results, the type of testicular cancer you have, the stage of cancer and other factors such as your age, fitness and medical history.