Diagnosis & staging
These are tests that may be used to diagnose this type of cancer.
- Complete medical history.
- Physical examination.
- Laboratory tests focus on blood particularly. In addition to other blood tests, the three main tumour markers are:
- HCG (Human chorionic gonadotropin)
- AFP (Alpha feto protein)
- Both HCG and AFP detect substances secreted by the cancer which act as "tumour markers". They can also tell whether or not patient is responding to treatment.
- LDH (Lactate dehydrogenase) may be useful sometimes, but is not as specific for testis cancer as HCG and AFP.
- Ultrasound scanning of the scrotum.
- The biopsy of the testicle is not done until the actual surgery for removal of the testicle.
- Once a diagnosis of testicular cancer is confirmed, then the doctors need to check and see if the cancer has spread. These are some of the tests that may be done:
- Chest X-ray.
- CT scan of pelvis, abdomen and chest (usually done after removal of the affected testicle).
- If the scans are not definite, or are unclear, the doctor might want to take some lymph nodes (lymphadenectomy) from the retroperitoneum in a second surgical procedure.
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests
Types and Stages
- Germ cell tumours – these are divided into two groups:
- This is the most common type (75% of cases) and is usually confined to the testicle.
- The cure rate for seminomas is close to 100%.
- Seminomas are slower-growing than non-seminomas.
- They are very sensitive to radiation and/or chemotherapy.
- Seminomas are more common in the 25 to 45 age group.
- Tumours that are found to contain both seminoma and nonseminoma cells are treated as nonseminomas.
- All germ cell cancers which are not pure seminomas are called nonseminomas. They are also known as a "mixed germ cell tumour".
- These tumours can spread through the bloodstream.
- They usually occur in men in their mid-twenties.
- Nonseminomas are less sensitive to radiation but are very sensitive to chemotherapy.
- Nonseminomas are composed of various cell types:
- Embryonal-cell tumour (aggressive tumour).
- Yolk sac carcinoma - very rare in adult men. Usually found in children under 15, which accounts for 90% of those cases.
- Choriocarcinomas (rare but very malignant).
- Teratocarcinoma - mixture of embryonal cell carcinoma and teratoma.
- Some others may be mixed-cell types.
- Non germ cell tumours
- These tumours are rare in adults, but occur more frequently in children.
- Non germ cell tumours are usually treated surgically.
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
T describes the site and size of the main tumour (primary)
N describes involvement of lymph nodes
M relates to whether the cancer has spread (presence or absence of distant metastases)
Tumour is confined to the testis.
Involvement of the lymph nodes in the retroperitoneal area (back portion of the abdomen)
- Enlarged nodes less than 5 cm in size.
- Enlarged nodes, greater than 5 cm (2 inches)
Extension beyond retroperitoneal lymph nodes