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202 North Avenue #305
Grand Junction, CO 81501

Everything you need to know about testicular cancer; awareness, education, support, treatment, resources, signs & symptoms, self exam, and more. 

Diagnosing TC

The process of how testicular cancer is diagnosed.

How is Testicular Cancer diagnosed? 

History and physical exam: The first step is for the doctor to take a complete medical history and check for risk factors and symptoms.  During a physical exam, the physician will feel the testicles to detect any sign of swelling or tenderness and the size and location of any lump.  The doctor will also examine the abdomen to feel for enlarged lymph nodes, which are a sign that the cancer has spread to the retroperitoneal lymph nodes.

Ultrasounds: If a mass or nodule is present the doctor will probably want to see an ultrasound image of the testicle to help decide if it is likely to be cancer.  Ultrasounds use sound waves to create "echoes" of internal organs.  The pattern of echoes reflected can distinguish a hydrocele and other benign masses. If the tumor is solid, then it is most likely cancer. Click here for Benign Causes of Testicular Abnormalities

Blood Tests: Certain blood tests are often helpful in diagnosing testicular tumors.  Some testicle cancers secrete high levels or certain proteins such as alpha-feto protein (AFP), human chorionic gonadotropin (HCG) or placental alkaline phosophotase (PLAP).  The tumors may also increase the levels of enzymes such as lactate dehydrogenase (LDH).  Nonseminomas often raise AFP levels, while seminomas do not.  LDH, HCG and PLAP levels are increased in some seminomas and nonseminoma germ cell tumors.  These substances are not produced by Leydig or Sertoli cell tumors. Blood tests can measure the levels of these substances in the fluid part of the blood (serum). 

These proteins are not usually elevated in the plasma if the tumor is small.  Therefore these tests are also useful in estimating how much cancer is present, predicting a patient's prognosis and evaluating the response to therapy to make sure the tumor has not returned. 

Surgery: If a suspicious growth is found, a surgeon will need to remove the diseased testicle known as orchiectomy and send it to laboratory.  A pathologist will look at this tissue under a microscope.  If cancer cells are present, the pathologist will send back a report detailing the type and extent of the cancer. 

Then the cancer will be "staged" by your doctor.  Staging is the process of finding out how far the cancer has spread, and this process is very important because your treatment options and prognosis depend on the "stage" of your cancer.   

Examinations and Tests for Staging Testicular Cancer

Computed Tomography Scan (CT Scan): this test uses a rotating x-ray beam to create a series of pictures of the body from many angles.  A computer processes the information provided by the scan and produces a detailed cross-sectional image of the selected part of the body.  To highlight details on a CT Scan, a dye may be injected into a vein.  The CT Scan is especially valuable in identifying the spread of tumors to the lymph nodes. 

Lymphangiography: In this procedure a special dye is injected into a lymph vessel and is carried into the lymph nodes.  Enlarged lymph nodes could be a sign of spreading cancer r that your body is fighting an infection.  During lymphangiography, a special viewing monitor displays x-ray images or the lymph node system which doctors can study to detect signs that the cancer has metastasized.  CT Scans have replaces lymphangiography in staging most cases of testicular cancer

Magnetic Resonance Imaging (MRI): This technique uses magnetic fields and radio waves instead of x-rays to create images of certain areas of the body.  These images can show enlarged lymph nodes and abnormal nodules of certain organs that may indicate spread of cancer from the testicles.  MRI is not often done for testicular cancer staging, as CT Scan provides the same results at a lower cost.

Other Tests: Chest x-rays, bone scans and other tests may be performed if metastasis is suspected.  Also blood tests for proteins AFP, HCG and LDH will be performed.

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.

  • In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.
  • In stage IB, cancer:
    • is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or
    • has spread to the outer layer of the membrane surrounding the testicle; or
    • is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle.
    All tumor marker levels are normal.
  • In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
    • all tumor marker levels are slightly above normal; or
    • one or more tumor marker levels are moderately above normal or high.

Stage II

Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.

  • In stage IIA, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.
    All tumor marker levels are normal or slightly above normal.
  • In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
    • has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
    • has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
    All tumor marker levels are normal or slightly above normal.
  • In stage IIC, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • has spread to a lymph node in the abdomen that is larger than 5 centimeters.
    All tumor marker levels are normal or slightly above normal.

Stage III

Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.

  • In stage IIIA, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen; and
    • has spread to distant lymph nodes or to the lungs.
    Tumor marker levels may range from normal to slightly above normal.
  • In stage IIIB, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
    The level of one or more tumor markers is moderately above normal.
  • In stage IIIC, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
    The level of one or more tumor markers is high.

    or

    Cancer:

    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen; and
    • has not spread to distant lymph nodes or the lung but has spread to other parts of the body.
    Tumor marker levels may range from normal to high.

If you have any possible signs & symptoms of testicular cancer, seek medical attention immediately.

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