Men find most testicular cancers themselves, although a doctor usually examines the testicles during routine physical exams. When testicular cancer is found early, the treatment can often be less aggressive and may cause fewer side effects.
Certain blood tests are sometimes helpful in diagnosing testicular tumors. Many testicular cancers secrete high levels of certain proteins such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). Tumors also may boost the levels of enzymes such as lactate dehydrogenase (LDH). These proteins are important because their presence in the blood suggests that a testicular tumor is present. However, they can also be found in conditions other than cancer.
Nonseminomas often raise AFP and hCG levels; seminomas sometimes raise hCG levels but never AFP levels. A high LDH level often indicates widespread disease.
However, sertoli’s cell tumors or leydig’s cell tumors do not produce these substances. Because these protein levels are not usually high if the tumor is small, blood tests can also estimate the size of the cancer and evaluate the response to therapy to ensure a tumor has not recurred.
Ultrasound of the scrotum can reveal the presence and size of a mass in the testicle or rule out other conditions, such as swelling due to infection. An ultrasound can help doctors determine whether a mass is solid or fluid filled, to distinguish some types of benign and malignant tumors from one another. If the mass is solid, it is probably cancer.
If a tumor is suspected, the doctor will suggest surgery to remove the testicle. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called inguinal orchiectomy. The surgeon tries to remove the entire tumor together with the testicle and spermatic cord. The spermatic cord contains blood and lymph vessels that may provide a pathway that allows testicular cancer to spread to the rest of the body. To minimize the risk that cancer cells will spread, these vessels are tied off early in the operation. This is best done by performing the operation through an incision in the groin (inguinal) area.
In rare cases (for example, when a man has only one testicle or when cancer is not certain), the surgeon performs an inguinal biopsy before removing the testicle; in this case, only a sample of tissue from the testicle is removed through an incision in the groin. During this operation, the surgeon makes an incision in the groin, withdraws the testicle from the scrotum, and examines it without cutting the spermatic cord. If the mass is not cancerous, the testicle can often be returned to the scrotum. The testicle is removed only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue, because if there is cancer, this could potentially increase the risk of recurrence in the scrotum.)