Diagnosis & staging
Testicles are in a sac of skin called the scrotum, underneath the penis. One testicle is called a testis.
Testicular cancer is also called cancer of the testis.
Testicular cancer is not common. However, it is the most common type of cancer in young men [see note below].
Testicular cancer treatments can affect your fertility (ability to have children in the future). If this is a concern for you, please talk to your oncologist. There may be sperm banking options for you.
Note: Available statistics do not have information about the inclusion of transgender and gender diverse participants. It is unknown how these statistics apply to transgender and gender diverse people. Patients are advised to speak with their primary care provider or specialists about their individual considerations and recommendations.
Sometimes there are no early symptoms of this cancer. Some of these symptoms may also be caused by something else. Talk to your doctor if you have any of these symptoms:
- An enlarged testicle (larger than is normal for you). This is the most common sign.
- A painless lump in your testicle.
- A dull ache in your groin, abdomen or back.
- A feeling of heaviness in your scrotum.
- A build-up of fluid or swelling in your scrotum.
- Shortness of breath. This is not common but might mean the cancer has spread to your lungs.
- Hormonal imbalance that causes breast enlargement. This is rare.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose testicular cancer include:
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Physical exam by a doctor or nurse practitioner.
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Blood test (tests your blood for three tumour markers made by the cancer cells):
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HCG (Human Chorionic Gonadotropin): this tumour marker may be higher in the blood of someone with testicular cancer.
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AFP (Alpha Fetoprotein): this tumour marker may be higher in the blood of someone with a certain type testicular cancer called non-seminoma germ cell tumour.
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LDH (Lactate Dehydrogenase): may be higher in someone with testicular cancer. This is sometimes useful but not as useful as HCG and AFP.
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Ultrasound imaging of scrotum: to see the tumour.
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Biopsy: This is when a sample of tissue is taken. A specialty doctor (pathologist) then looks at the tissue for cancer. A biopsy is only done after a surgeon has removed your testicle.
If tests confirm you have testicular cancer, your doctor may order more tests to check if the cancer has spread to other parts of your body:
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Seminomas: This is the most common type of testicular cancer. 75% (75 out of 100) of testicular cancers are seminomas.
- Nearly 100% of cases are curable.
- Grow slowly.
- Very sensitive to radiation therapy and systemic therapy (chemotherapy).
- Most common in people between 25 and 45 years old.
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Non-seminomas: This is also known as mixed germ cell tumour.
- Most common in people in their mid-twenties.
- Can spread through your bloodstream.
- Very sensitive to systemic therapy but less sensitive to radiation therapy.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell your health care team how your cancer might respond to treatment and the chance that your cancer may come back (recur).
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Stage 1A: Cancer is only in the testicle. Cancer may have spread to the inner layer of the membrane that surrounds the testicle. Tumour marker levels are normal.
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Stage 1B: Tumour marker levels are normal plus one of the following
- Cancer is in the testicle and has spread to the blood vessels or lymph vessels in the testicle.
- Cancer has grown into the outer layer of the membrane that surrounds the testicle.
- Cancer has grown into the spermatic cord. Cancer may have spread to the blood vessels or lymph vessels in the testicle.
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Stage 1S: Cancer is anywhere in the testicle, spermatic cord or scrotum. One or more tumour marker levels are higher than normal.
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Stage 2A: Cancer has spread to one or more lymph nodes in the groin. Lymph nodes are 2 cm or smaller. Tumour marker levels may be slightly higher than normal.
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Stage 2B: Cancer has spread to one or more lymph nodes in the groin. Lymph nodes are between 2 and 5 cm. Tumour marker levels may be slightly higher than normal.
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Stage 2C: Cancer has spread to one or more lymph nodes in the groin. Lymph nodes are larger than 5 cm. Tumour marker levels may be slightly higher than normal.
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Stage 3A: Cancer has spread to lymph nodes outside of the groin or to the lungs. This is also called metastatic testicular cancer. One or more tumour marker levels
may be
slightly higher than normal.
-
Stage 3B is one of the following:
- Cancer has spread to one or more lymph nodes in the groin, and one or more tumour marker levels
may be slightly higher than normal.
- Cancer has spread to one or more lymph nodes outside of the groin or to the lungs. This is also called metastatic testicular cancer. One or more tumour marker levels
are somewhat
higher than normal.
-
Stage 3C is any of the following:
- Cancer has spread to one or more lymph nodes in the groin, and one or more tumour marker levels
are much higher than normal.
- Cancer has spread to lymph nodes outside of the groin or to the lungs. This is also called metastatic testicular cancer. One or more tumour marker levels
are much higher than normal.
- Cancer has spread to a distant part of the body other than lymph nodes or lungs. One or more tumour marker levels
may be higher than normal.
