Ultrasound

Ultrasounds bounce sound waves off of your internal organs in order to create echoes that form a picture. Your doctor will wave an ultrasound device over your testicles, and use it to spot any lumps or abnormal areas. An ultrasound can show whether a lump is solid or filled with fluid, which can help your doctor determine whether the lump is benign or malignant. If the lump is solid, it is more likely to be malignant, and your doctor may order additional tests.

Tumor Markers

Tumor markers are substances found in higher than normal amounts in a person's blood or urine when they have a specific type of cancer. Tumor markers play an important role in the staging of testicular cancer. Your doctor will take a sample of your blood and have it analyzed for the following tumor markers:

• Alpha-fetoprotein (AFP) – AFP is a protein made in the fetus of a developing baby, and AFP levels decrease after birth. Elevated AFP levels may indicate the presence of a nonseminoma.
• Lactate dehydrogenase (LDH) – LDH is an enzyme normally found in low levels in almost all body tissues. Elevated levels of LDH may indicate tissue damage related to more widespread testicular cancer, or may be related to another benign condition.
• Beta human chorionic gonadotropic (b-HCG) – b-HCG is the “pregnancy hormone” and this blood test is commonly used as a pregnancy test. Elevated levels of b-HCG in men may indicate the presence of nonseminoma and possibly a seminoma.

Please see Understanding Tumor Markers: AFP for more information

Tissue Diagnosis

If an ultrasound shows a solid mass or lump, your doctor will most likely remove the entire testicle and spermatic cord through an incision in your groin (radical orchiectomy), and have it sent to a lab to be analyzed under a microscope. Doctors usually remove the entire testicle and spermatic cord because it is very easy for cancer cells to spread to other parts of the body through the spermatic cord. Unfortunately, if the pathology is benign, the testis cannot be reimplanted.

Abdominal Lymph Node Dissection

Also called lymphadenectomy, this procedure is the surgical removal of lymph nodes in the abdomen. A tissue sample from the lymph nodes is then checked for cancer under a microscope. For those with nonseminoma, the removal of the lymph nodes may help stop the spread of the cancer and the cells can be treated with radiation therapy.

Chest X-ray

A chest X-ray uses electromagnetic waves to create pictures of the inside of your body. Your doctor will order a chest X-ray to see if the cancer has spread to your lungs or to the lymph nodes in your chest. If your chest X-ray looks suspicious in any way, your doctor will order additional tests.

Computed tomography (CT) scan

A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan reveals the presence of tumors and whether or not the cancer has spread to other parts of your body.

Magnetic resonance imaging (MRI) scan

Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show “slices” of the body. Doctors commonly use MRIs to check the brain and spinal cord for any signs of metastasis.

Positron emission tomography (PET) scan

For a PET scan, the doctor injects a radioactive substance into the patient's bloodstream. This substance collects in malignant (cancerous) cells in the patient's body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient's body. PET scans are often combined with CT scans and can help identify areas of cancer spread outside the testicles. Doctors usually use PET scans when they think the cancer might have spread but do not know where.