Testicular Cancer

Diagnosis

Diagnosis of testicular cancer can be made through the following techniques:

• Physical examination and medical history: The patients are asked about the symptoms they are experiencing, including the initiation, duration, severity, and progression of those symptoms. The groin area and the scrotum are examined to determine any lump or swelling that could potentially indicate testicular cancer. Although most cases of testicular cancer occur in one testicle, both testicles may be evaluated for comparison. As testicular cancer involves a genetic component, the patients may be asked about their family history. The patient is also screened for cryptorchidism, as these patients have an increased risk for testicular cancer.
• Blood tests: Certain blood tests assist in diagnosing testicular cancer. Levels of several proteins, such as human chorionic gonadotropin and alpha-fetoprotein, are increased in patients with testicular cancer. These cancer markers also help detect the types of testicular cancer. Patients with testicular tumors also have elevated levels of lactate dehydrogenase.
• Ultrasound: If the blood tests and physical evaluation suggest any issue in the testicle, the patient is recommended to undergo an ultrasound. It is considered a preferred imaging modality due to its high sensitivity, ease of access, relatively lesser cost, and wider patient acceptance. Advanced ultrasound techniques can also potentially diagnose cancer types based on morphological characteristics, as different tumors have different management strategies.
• Surgery: Biopsy is the only method to confirm the presence of cancer. This method involves removing the samples from the abnormal tissue and evaluating them for the presence of cancerous cells. However, the technique is rarely used to diagnose testicular cancer due to the risk of spreading cancer. Based on the ultrasound imaging and blood tests, if the cancer specialist strongly suspects that the lump is cancerous, the patient is recommended to undergo surgery to remove the affected testicles and send them to the laboratory for evaluation of cancer.
• CT scan: CT scan is a non-invasive, painless procedure that provides detailed images of the testicles and other body parts through different angles. Testicular cancer has a high potential to spread to the retroperitoneal lymph nodes. Computed tomography is the imaging modality of choice for evaluating these lymph nodes for testicular cancer metastasis. Further, a CT scan is also employed for determining the response to testicular cancer treatment. It also assists in determining testicular cancer recurrence.
• MRI: MRI can be used along with the ultrasound when the ultrasound does not have a clear view or if there is any uncertainty about the tumor locations. It is also performed for the initial lymph node staging. It is an accepted modality due to the non-involvement of ionizing radiations.
• PET scan: F18-FDG PET/CT scan has slightly higher or almost similar sensitivity for testicular cancer staging than a CT scan. Sometimes, the PET/CT scan may either downgrade or upgrade the initial staging assigned with a CT scan: Seminomas have the highest concentration of FDG compared to non-seminoma. Mixed tumors have the minimum FDG concentration.
• Chest x-ray: Chest x-ray is recommended in patients suspected of testicular cancer metastasizing to the lungs.
• Bone scan: Patients are advised to undergo a bone scan if there is a suspicion that testicular cancer has spread to the bones.