DIAGNOSIS

Signs and symptoms

A hard lump in either testis is the usual sign of testicular cancer. In about 10 to 20% of men the lump may be painful.

Other symptoms may include:

• Swelling and tenderness of the testis or scrotum;
• A dull ache or ‘heaviness’ in the lower abdomen or groin.

In a few men, constant backache, cough or breathlessness, enlarged or tender breasts may also mean that the cancer has spread and you should see your doctor straight away. However, there may be many other reasons other than cancer for these symptoms.

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Should I see a doctor?

If you notice a hard lump within your testes, or any other possible sign, you should see a doctor straight away. If a diagnosis is made and treatment started early, there is a high rate of cure for these cancers.

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How it is diagnosed

If the local doctor thinks that testicular cancer may be present, a referral to a specialist (urologist) is likely. A urologist deals specifically with problems in the genital and urinary tracts of both men and women. 

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Examination of the male

Diagnosis of testicular cancer will include:
 
A medical history taken by the doctor, including any previous problems with the testes and any history of testicular cancer in the family.  Specific questions about undescended testes may be asked by the doctor.  The failure of the testes to lower into the scrotum before birth is a problem normally fixed with surgery in the first few years of life.  However, even when this operation is successful, a history of undescended testes is known to increase the chance of developing testicular cancer.
 
 A full physical examination including:

• Examination of the testis that is possibly affected;
• Examination of the other testis to make sure there is no evidence of a second tumour;
• Examination of the chest and abdomen to make sure that the cancer has not spread to other parts of the body.

An ultrasound of the testes is usually done to confirm that the identified lump is solid and is actually within the testis.  Many lumps are found to be fluid-filled cysts within the scrotum.  These are often far less dangerous.  An ultrasound uses sound waves to make a picture of the testis.  This procedure is painless, safe and relatively quick.

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Other tests

Other tests may be done to check if the lump is cancerous and has spread to other parts of the body.  These may include:

• Blood tests
  Blood tests look for chemical markers produced by tumours that are released into the bloodstream, such as beta-human chorionic gonadotrophin (beta-hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).  Very high levels of these chemical markers are a sign that the cancer is widespread and needs more aggressive treatment.  A slight rise in these levels is common, even when the cancer is contained within the testes.
  
  After treatment, levels of tumour markers are also a useful way of measuring how successfully the cancer has been treated. If the treatment has been successful, the levels of the tumour markers should fall back into the normal range.
• A chest X-ray
  A chest x-ray of the lungs may be done if the testicular tumour is thought to be cancerous, to make sure that there has not been any spread of the tumour to the lungs.
• A CT scan
  A computerised tomography (CT) scan of the abdomen and pelvis will often be done to make sure that there is no spread of the cancer to the organs in the abdomen, particularly the lymph glands. A CT scan is a form of X-ray medical imaging process that gives detailed cross-sectional images of organs in the body to help find abnormal changes within them.

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