Diagnosis of Testicular Cancer

by Michael Jubinville, MPH

Your doctor will ask you about your symptoms, health, and family history. The testicles and nearby structures will be fully checked. Your doctor will look for other causes of the problems you’re having.

Suspicion of Testicular Cancer

You will need more tests if your doctor thinks you have problems or finds something during the exam. Tests can help find cancer or other problems such as epididymitis. These may be:

Blood tests —Certain proteins are released into the blood as cancer grows. These markers may be higher if you have cancer.
Imaging tests —These tests can help look for changes in the testicle(s) and find tumors. These tests are:
- Ultrasound
- Chest x-ray

Diagnosis of Testicular Cancer

During a radical inguinal orchiectomy, a testicle is removed. It's then sent to a lab for testing. In most cases, testicles with masses seen on ultrasound are removed though the groin rather than the scrotum. This helps lower the chances of any cancer spreading. Once it’s been tested, the stage of cancer can be found.

Staging of Testicular Cancer

If cancer is found, results from all your tests will help find out what stage it's in. The stage is based on how the cancer looks in a lab. It will help your doctors come up with ways to treat it. The stage of cancer is based on where it’s found and how far it’s spread.

Staging Tests

Tests that may help with cancer stage are:

Blood tests to look for certain components in the blood, proteins, or other signs of cancer—The tests can also see how your liver and kidneys are working.
Imaging tests to find how much the cancer has spread—It will also look for growths in the lymph nodes or nearby structures. They may also help to find cancer in other parts of the body. Some tests use contrast matter to highlight structures. This makes them easier to see. These may be:
- Abdominal and pelvic CT scan
- MRI scan
- Bone scan
- Positron emission tomography (PET) scan

Stages of Testicular Cancer

These may be involved:

An inner and outer layer surrounds the testicle.
Epididymis—Tiny tubules are attached to the back and top of the testicle.
Spermatic cord—A cord-like structure that runs from the belly to the testicle. It houses the vas deferens, nerves, and blood vessels.

Testicular cancer is staged from 0-3:

Stage 0—Testicular intraepithelial neoplasia —A group of cells that don't look normal are found in the tiny tubules where sperm cells are made. They can grow into cancer cells and spread into nearby structures.
Stage IA —Cancer is found in the testicle and epididymis. It MAY be in the inner layer that surrounds the testicle.
Stage IB —Cancer is found in the testicle and epididymis AND has spread to either one of these:
- Blood or lymph vessels in the testicle
- The outer layer that surrounds the testicle
- The spermatic cord or scrotum (and maybe to the blood or lymph vessels in the testicle)
Stage IS —Cancer is found in the any of the structures linked to the testicle, spermatic cord, or scrotum AND either one of these:
- Blood tests are slightly higher for all markers
- Blood tests that show higher than normal for 1 or more markers
Stage IIA —Cancer is found in the any of the structures linked to the testicle, spermatic cord, or scrotum AND has spread to up to 5 lymph nodes in the belly that are 2 centimeters (cm) or less in size. Blood tests are normal or slightly higher for all markers.
Stage IIB —Cancer is found in the any of the structures linked to the testicle, spermatic cord, or scrotum AND either one of these:
- Up to 5 lymph nodes in the belly with at least one that is 2 to 5 cm in size
- More than 5 lymph nodes in the belly that are 5 cm or less in size
- Blood tests are normal or slightly higher for all markers
Stage IIC —Cancer is found in any of the structures linked to the testicle, spermatic cord, or scrotum AND in at least 1 lymph node in the belly that is more than 5 cm in size. Blood tests are normal or slightly elevated for all markers.
Stage IIIA —Cancer is found in any of the structures linked to the testicle, spermatic cord, or scrotum AND 1 or more lymph nodes in the belly AND lymph nodes in other parts of the body OR the lungs. Blood tests are normal or slightly higher for all markers.
Stage IIIB —Cancer is found in any of the structures linked to the testicle, spermatic cord, or scrotum AND 1 or more lymph nodes in the belly, lymph nodes in other parts of the body, or lymph nodes in the lungs. Blood tests are somewhat higher for one or more markers.
Stage IIIC —Cancer is found in any of the structures linked to the testicle, spermatic cord, or scrotum AND 1 or more lymph nodes in the belly, lymph nodes in other parts of the body, or lymph nodes in the lungs. Blood tests are much higher for 1 or more markers.
Stage III —May be found with any stage III criteria OR any of the these:
- Cancer is found in the any of the structures linked to the testicle, spermatic cord, or scrotum. It may have spread to 1 or more lymph nodes in the belly AND is NOT in lymph nodes in other parts of the body or the lungs BUT has spread to other parts of the body. Blood tests show normal to higher than normal for any markers.

References:

How is testicular cancer diagnosed? Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/testicular-cancer/diagnosis. Accessed October 1, 2020.

Stages of testicular cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/_26. Accessed October 1, 2020.

Testicular cancer. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer. Accessed October 1, 2020.

Tests for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed October 1, 2020.

9/6/2016 DynaMed Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer: Yacoub JH, Aytekin O, Allen BC, et al. ACR Appropriateness Criteria for staging of testicular malignancy. Available at: https://acsearch.acr.org/docs/69375/Narrative.

Last reviewed September 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 12/4/2020

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