Testicular Cancer Diagnosis & Staging

November 22, 2024

This page was reviewed under our medical and editorial policy by Alexander Chehrazi-Raffle, M.D., assistant professor, Department of Medical Oncology & Therapeutics Research, City of Hope® Cancer Center Duarte

Most times, a lump in the testicle is the first symptom of testicular cancer. A lump may be detected during a physical exam or testicular self-exam. Swelling or testicular pain are other common signs. If the patient knows how to check for testicular cancer, it can be found during the early stages, leading to effective treatment of the disease.

Tests to Diagnose Testicular Cancer

An accurate diagnosis is crucial for implementing the best testicular cancer treatment plan. The care team may use various methods to test for testicular cancer, including those listed below.

Physical exam and health history review: During this examination, the care team will check for lumps, pain or swelling.

Ultrasound of the testicles: In this procedure, high-energy sound waves make echoes as they bounce off internal tissues or organs. The echoes produce a picture of body tissues called a sonogram, which is then used to create images of the testicles and detect tumors. Performing an ultrasound on the testicles is often the first step in diagnosing testicular cancer.

Cheharzi-Raffle-Zhumkhawala Clinic imaging tests | City of Hope

 

Blood tests: Blood tests to identify tumor markers may be used to diagnose testicular cancer. Tumor markers are proteins or other substances in the blood that may be altered when cancer is present. For testicular cancer, the primary markers are alpha-fetoprotein and human chorionic gonadotropin.

Biopsies: Doctors may perform a biopsy to remove a small tissue sample from a tumor to test it for cancer. Many times, however, a surgeon will remove the entire tumor during a radical inguinal orchiectomy.

Testicular Cancer Screening

Men who find a lump in a testicle should seek medical attention right away. However, testicular cancer may not show signs until it’s reached an advanced stage. Therefore, it is important for men to know what symptoms of testicular cancer look and feel like so they know when to seek treatment. Typically, testicular exams should be part of a man’s general physical or routine checkup.

Patients who have certain testicular cancer risk factors, such as an undescended testicle, previous germ cell tumors or a family history, should notify their doctor and consider monthly self-exams.

Testicular Cancer Stages

Following diagnosis, the care team will assign a cancer stage, which describes disease progression. To do this, the care team will use indicators such as the tumor’s size, whether the disease has spread beyond the testicle and what blood test results indicate. Using this data, they will assign information from the American Joint Committee on Cancer’s TNM staging guidelines using the four categories listed below.

T (tumor): Based on tumor size and whether it has spread outside the original cancer site

N (node): Based on whether testicular cancer cells have been detected in any lymph nodes, and if so, how many and big they are

M (metastasis): Based on whether the cancer has spread (metastasized) to any distant locations

S (serum): Based on whether any tumor markers have been detected in the patient’s lab tests

After assigning the TNM details to the patient’s cancer, the care team will assign a stage from 1 to 3. Unlike some other cancer types, there is no stage 4 testicular cancer.

Stage 0 or Germ Cell Neoplasia in Situ

During this stage, the cancer cells are confined to the small tubes within the testicle, known as seminiferous tubules, and tumor marker numbers are normal.

Stage 1

During this stage, the cancer cells have spread outside of the seminiferous tubules, but not to lymph nodes or distant sites. Stage 1 testicular cancer is further categorized using the substages listed below.

  • Stage 1 A: The tumor is confined to the testicle, and tumor marker numbers are normal.
  • Stage 1B: The tumor has spread beyond the testicle to nearby tissue, but cancer cells are not detected in lymph nodes or distant sites, and tumor marker numbers are normal.
  • Stage 1S: The tumor may have spread beyond the testicle, but not to lymph nodes or distant sites. One or more tumor marker numbers are above normal limits.

Stage 2

During this stage, cancer cells have reached at least one lymph node and may have also spread outside the testicle. Stage 2 testicular cancer is further categorized using the substages listed below

  • Stage 2A: Cancer cells have spread to at least one lymph node (but less than five of them), and the lymph nodes are 2 centimeters (cm) or smaller. Tumor marker number may be normal, or one marker may be elevated.
  • Stage 2B: Cancer has spread to at least one lymph node between 2 cm and 5 cm in size, or the tumor has grown beyond the lymph node or more than five lymph nodes are found to have cancer cells within them. Tumor marker numbers may be normal, or one marker may be elevated.
  • Stage 2C: Cancer has spread to at least one lymph node bigger than 5 cm, but not to distant locations. Tumor marker numbers may be normal, or one marker may be elevated.

Stage 3

During this stage, the cancer cells have spread to distant sites in the body. Stage 3 testicular cancer is further categorized using the substages below.

  • Stage 3A: Cancer cells have spread to the lungs or to distant lymph nodes. Tumor marker numbers may be normal, or one marker may be elevated.
  • Stage 3B: Cancer cells have spread to lymph nodes or the lungs, and tumor marker numbers are higher than normal.
  • Stage 3C: Cancer cells have spread beyond the lymph nodes and lungs to other distant sites, but tumor marker numbers may be normal. Alternatively, cancer cells are found in the lymph nodes or lungs, with very high tumor marker levels.