Testicular cancer - Diagnosing testicular cancer

See your GP if you notice a lump or abnormality on or in your testicles.

Most testicular lumps are not cancerous, but it is important you have the abnormality checked as treatment for testicular cancer is much more effective when started earlier.

Physical examination

As well as asking you about your symptoms and consulting your medical history, your GP will usually need to carry out a physical examination of your testicles.

Your GP may hold a small light or torch against the lump in your testicle to see whether light passes through it. Cancerous lumps tend to be solid, which means light is unable to pass through.

Tests for testicular cancer

If your GP suspects the lump in your testicle may be cancerous, you will be referred for further testing at a hospital. Some of the tests you may have are outlined below.

Scrotal ultrasound

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).

During a scrotal ultrasound, 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.

Blood tests

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.

Biopsy

The only way to definitively confirm a case of testicular cancer is to have a biopsy of the tumour taken. The cells from the tumour can be examined in a laboratory to determine whether it 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 will 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.

Other tests

If your specialist feels it is necessary, you may require further tests to check whether testicular cancer has spread. When cancer of the testicle spreads, it most commonly affects the lymph nodes and lungs.

Therefore, you may require a chest X-ray to check for signs of a tumour. You may also require a scan of your entire body, such as a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check for signs of the cancer spreading.

Stages of testicular cancer

Once these tests have been completed, it is usually possible to determine the stage of your cancer.

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

Want to know more?

Cancer Research UK – Testicular cancer stages
Macmillan – Staging for testicular cancer

Benign: Benign refers to a condition that should not become life threatening. In relation to tumours, benign means not cancerous.
Biopsy: A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Incision: An incision is a cut made in the body with a surgical instrument during an operation.
Lungs: Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Lymph nodes: Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Testicle: Testicles are the two oval-shaped reproductive organs that make up part of the male genitals. They produce sperm and sex hormones.
X-ray: An X-ray is a painless way of producing pictures of inside the body using radiation.