Medical Tests and Diagnosis
Anamnesis (detailed medical review of past health state): One
of the first steps in establishing a testicular cancer diagnosis is a
detailed and complex medical review of a patient's past health problems
and general health state, family medical history, testicular cancer risk
factors, and symptoms.
Physical Examination: During the physical examination, the doctor
checks the general signs of health and signs of the cancer such as testes
lumps, swollen testes, changes in the breast appearance, abdominal lumps
possibly caused by swollen lymph nodes (a sign that the cancer has spread).
Blood Tests: The blood test performed in patients that might suffer
from testicular cancer is a serum tumor marker test.
This test measures the amount of certain substances, called tumor markers,
which are released into the blood by organs, tissues, or tumor cells.
There are three tumor markers used to detect testicular cancer:
1. Alpha-fetoprotein (AFP) is a protein produced
normally by the fetus, but it cannot be detected in healthy
adult women (unless pregnant) and men. A high amount of AFP
in the blood might suggest the presence of a germ cell tumor
(testicular tumor). Non-seminomas can cause the level of AFP
2. Beta-human chorionic gonadotropin (ß-hCG)
is a hormone normally found in the blood and urine of pregnant
women. This hormone is also produced by several tumor cells
(such as testis, uterus, ovary, liver, stomach, pancreas, or
lungs). Non-seminomas and occasionally the seminimas cause the
level of the hormone to increase.
3. Lactate dehydrogenase (LDH) is an enzyme
found in many body tissues, which is released in the blood when
the tissues suffer damage. Sometimes, a high level of LDH can
indicate that the cancer has spread.
Scrotal Ultrasound: Ultrasound imaging is a medical
technique that uses high-frequency sound waves to create an interior
image of the body on a special computer screen. This image is formed
from the echoes of the sound waves on the surface of the organs. Abnormal
tissue masses and organs reflect sound waves differently. This test
involves a device called a transducer, that is placed on the upper
part of the abdomen, and a computer that translates this sound into
an image. Ultrasound imaging is a safe, noninvasive and quick test
that can detect liver tumors. A scrotal ultrasound allows the doctor
to visualize the abnormal mass, to determine its size and location,
to establish its consistency (if solid or fluid), and to differentiate
the cancer from other medical conditions (such as infections).
Chest X-ray: An x-ray test uses high energy electromagnetic
radiation to penetrate the body and create the inside image
on a film. The chest x-ray is performed in order to establish whether
or not the cancer has spread in the upper part of the abdominal cavity
(such as the liver and abdominal lymph nodes).
Computed tomography (CT): This imaging test is
similar with an x-ray test, and creates a detailed cross-sectional
image of the body.
A CT scan is usually performed in two steps for a better diagnoses
1). First, the targeted area is scanned without a contrast agent.
2). Second, the targeted area is scanned after a contrast agent was
This is an effective test to reveal if the cancer has spread within
Magnetic resonance imaging (MRI)
An MRI is an advanced technique that uses radio waves, strong magnets
and a contrast substance to outline the image of a certain part of
the body. The cancer cells absorb a high amount of the contrast substance
and reveal the shape and pattern of the abnormal tissue mass. This
technique is used to better examine and assess the tumor(s) and establish
the extant of the metastasis (how far the cancer has spread).
Positron Emission Tomography (PET): This technique
uses radioactive glucose to locate the cancer. Cancer cells absorb
a higher amount of this radioactive glucose than normal tissues. This
imaging test can effectively reveal the cancer location, especially
when there are tumors in other parts of the body beside the testes.
Radical inguinal orchiectomy: This is a medical
procedure where the entire testis, together with the spermatic cord,
is removed through an incision in the groin. To reduce the risk for
the cancer to spread during this procedure, the doctor ties off, before
removing the testis, the blood and lymph vessels within the spermatic
cord. The spermatic cord, because of these blood and lymph vessels,
represents an easy pathway for the cancer to spread within the body.
The testis is then examined by a pathologist.
Biopsy: This is another medical procedure used
to removed a sample of tumor tissue, performed when the cancer diagnosis
is uncertain. During this procedure, the doctor performs a small incision
in the groin, withdraws the testicles from the scrotum, and removes
a small sample of the abnormal tissue. After the doctor removes a
sample, the testicle is then reinserted back into the scrotum. This
tissue is then examined by a pathologist, who can establish the cancer
type and stage.
Article by Alina Morrow, MS
Page Covers: What are the tests for testicular cancer? Including
blood tests and MRI, CT scans?