Newly Diagnosed?
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Diagnosis
When diagnosing testicular cancer, the doctor will perform a physical exam to feel the testicles for any abnormalities. Next, the doctor will examine the abdomen to look for enlarged lymph nodes. The doctor also will perform blood tests to look for certain naturally occurring substances in the blood that, when found in abnormally high concentrations, may indicate the presence of a testicular tumor. These tumor markers include beta-human chorionic gonadotropin (beta-hCG), alpha-fetoprotein, and lactate dehydrogenase. In some cases, however, testicular cancer may be present without raised blood marker levels.
The doctor may perform an ultrasound (a painless procedure that uses sound waves to create images of internal organs) to evaluate any lumps or irregularities. Other imaging tests, such as x-ray and computed tomography (CT), may help in diagnosing testicular cancer. Additional tests may be performed if necessary.
If a tumor is discovered, surgery to remove the affected testicle will be required to confirm the diagnosis and determine the exact type of tumor found. The procedure, called radical orchiectomy, is almost always performed in the early stages of testicular cancer. For many patients with early-stage testicular cancer, radical orchiectomy combined with lifelong follow-up may be the only treatment required.
Types of Testicular Cancer
The two main types of testicular tumors are seminomas and nonseminomas. Approximately half of all testicular tumors are seminomas, which occur when the germ cells -- the cells that produce sperm -- become cancerous at a very early stage in their development.
Nonseminomas are another type of germ cell tumor. These tumors tend to grow and spread more quickly than seminomas. There are many different kinds of nonseminomas, including:
- Embryonal carcinomas, which arise in more mature germ cells
- Teratomas, which occur when germ cells differentiate into various tissue types -- such as cartilage, nerve, or muscle -- inside the testes (a process that does not usually occur until after a mature sperm cell combines with a woman's egg)
- Yolk sac tumors, in which the yolk that is normally present in the embryo becomes cancerous
- Choriocarcinomas, a particularly aggressive but very rare type of tumor that shares some characteristics with the placenta (the blood-filtering tissue that forms in a woman's uterus)
Nonseminomas may contain more than one of these tumor types, and some even contain all of them.
Staging
Once a diagnosis has been made, the doctor will use information collected from physical exams, laboratory tests, and diagnostic imaging tests to determine the stage (extent) of the tumor. The most widely used staging system for testicular cancer is the TNM Staging System, developed by the American Joint Committee of Cancer. This staging system combines information about the size and location of the tumor and other relevant clinical information to assign a Roman numeral stage to the cancer. Other letters and numbers may be added to reflect further details about the tumor, with higher numbers and letters indicating more-advanced disease. Pinpointing the precise stage of a patient's testicular cancer helps the doctor select the most appropriate treatment.
The TNM Staging System collects information about the size of the primary tumor (T), whether the cancer has affected the lymph nodes (N) in the pelvis or abdomen, and whether the cancer has metastasized (M) to another part of the body. Testicular cancer staging also includes a category that describes the patient's blood serum (S) marker levels.
The primary tumor (T) may be classified as:
- T0 -- There is no evidence of cancer.
- Tis (testicular cancer in situ) -- Cancer cells have been found, but are confined to the testicle.
- T1 -- The tumor has spread to the membrane surrounding the testicle.
- T2 -- Cancer may have spread into the lymph or blood vessels at the vesicle.
- T3 -- The tumor has grown to the spermatic cord, which also may indicate lymph node involvement.
- T4 -- The tumor has grown into the skin surrounding the testicles (scrotum).
Regional lymph nodes (N) categories include:
- N0 -- There are no cancer cells in the lymph nodes.
- N1 -- Lymph nodes are smaller than 2 cm in diameter.
- N2 -- At least one of the lymph nodes is bigger than 2 cm, but smaller than 5 cm in diameter.
- N3 -- At least one of the lymph nodes is bigger than 5 cm.
Metastasis (M) categories include:
- M0 -- Cancer cells have not spread to other organs.
- M1 -- Cancer has spread to other organs.
- M1a -- Cancer has spread to the lungs or to lymph nodes beyond the abdomen or pelvis.
- M1b -- Cancer has spread to other, more distant organs, such as the liver or brain.
Serum (S), or blood, marker levels categories include:
- S0 -- Serum marker levels are normal.
- S1 -- Markers are slightly higher than normal.
- S2 -- There is a moderate increase in marker levels.
- S3 -- Marker levels are very high.
Information about tumor size, lymph node involvement, spread of cancer cells, and serum marker levels are taken into account in staging testicular cancer.
Stage I testicular cancer refers to tumors that are confined to the testicle, with no spread of cancer cells to the nearby lymph nodes or other organs. Stage IA reflects the absence of cancer cells in the blood vessels of the testicle; stage IB reflects their presence. Stage IS indicates an increase in serum marker levels in patients with a testicular tumor after radical orchiectomy.
In stage II, cancer cells have spread to the lymph nodes in the abdomen or pelvis. Stages IIA, IIB, and IIC indicate increasing size of the lymph nodes.
Stages III, IIIA, IIIB, and IIIC refer to cancer that has spread to the lymph nodes in the chest, the lungs, or more distant organs such as the liver or brain. The cancer also may be classified as stage III if there are high blood marker levels.
