Diagnosis & Staging

Newly Diagnosed? We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial more

Diagnosis

Young men can perform a testicular self-examination monthly. This is the best way to find a testicular tumor early, and the earlier a tumor is found, the easier it is to treat. If a lump or other change in the shape or feel of a testicle is found, call a doctor right away for an appointment.

First, the doctor will perform a physical exam in which he or she feels the testicles for any abnormalities. Next the doctor will examine the abdomen, looking for affected and enlarged lymph nodes. Other important tests that a doctor will order are blood tests looking for certain "markers" in the blood called beta-hCG, alpha-fetoprotein, and lactate dehydrogenase. In some cases, though, testicular cancer can occur without raising blood marker levels. The doctor may order an ultrasound (a painless procedure that uses sound waves to create images of internal organs) to evaluate any lumps or irregularities. If a tumor is found, biopsy is rarely done. The proper procedure is removal of the testicle to confirm that cancer is present and determine the exact type.

The doctor may order various other imagining tests -- such as x-ray, CT (computed tomography) scan, MRI (magnetic resonance imaging), and PET (positron emission tomography) scan -- in order to diagnose testicular cancer.

Staging

Once a diagnosis of testicular cancer has been made, tests will need to be performed to determine how far the cancer has spread. This process is called staging. These tests are important because they help physicians choose the most effective type of treatment. Because testicular cancer has so many different types and subtypes, each with different treatments and potential outcomes, the staging process can be complicated.

A simplified process, using Roman numerals, has been created to denote the various stages of testicular cancer. The stages start at 0, which represents the least serious amount of spread, and go to III, which covers the most serious metastasis.

Stage 0, also known as Carcinoma in Situ (CIS)

The abnormal cells are contained within the testicle and have not spread, a condition which is referred to as carcinoma in situ.

Stage I

Stage I testicular cancers are divided into two subtypes, each determined after the surgical removal of the affected testicle in a procedure known as a radical inguinal orchiectomy:

• Stage IA, in which the tumor marker levels in the blood are normal but the cancer may have spread to the membrane surrounding the testicle.

• Stage IB, in which the cancer has spread from the testicle to the lymph system or the blood, the membrane around the testicle, or the scrotum.

Stage II

Stage II testicular cancers are divided into two main subtypes, each determined after a radical inguinal orchiectomy:

• Nonbulky Stage II (IIA), in which the cancer is in the testicle, spermatic cord, or scrotum and has moved into up to five abdominal lymph nodes in the abdomen, all no larger than two centimeters.

• Bulky Stage II (IIB, IIC), in which the cancer is in the testicle, spermatic cord, or scrotum and has spread to up to five abdominal lymph nodes, at least one of which is larger than two centimeters.

Stage III

Stage III testicular cancer, in which the cancer cells have moved to distant lymph nodes and/or organs, is subdivided into two main subtypes, each determined after a radical inguinal orchiectomy:

• Nonbulky Stage III, in which the spread of the cancer is limited to lymph nodes and the lungs, and in which no single tumor is larger than two centimeters.

• Bulky Stage III, in which the cancer has spread to multiple locations within the body, including lymph node tumors that are larger than two centimeters, and/or to organs other than the lungs.

The American Joint Committee of Cancer has created its own comprehensive system, which is known as the TNM (Tumor, Node, Metastasis) Staging System.