These are tests that may be used to diagnose this type of cancer.

• Complete medical history.
• Physical examination.
• Laboratory tests that 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.
• Biopsy of the testicle is not done until the actual surgery for removal of the testicle.
• If a diagnosis of testicular cancer is confirmed, the doctors will check 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 pelvic area in a second surgical procedure.
  

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types (histology)

• Germ cell tumours – these are divided into two groups:
• Seminomas
• 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.
• Nonseminomas
• All germ cell cancers that 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:
• Teratomas.
• Embryonal-cell tumour (aggressive tumour).
• Yolk sac carcinoma - very rare in adults. 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.

Stages

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)

Stage I
Tumour is confined to the testis.

Stage II
Involvement of the lymph nodes in the retroperitoneal area (back portion of the abdomen)

• Non-bulky
  
• Enlarged nodes less than 5 cm in size
  
• Bulky
  
• Enlarged nodes, greater than 5 cm (2 inches)
  

 

• Cure rate for patients with early stage seminoma and nonseminoma is almost 100%.
• Depending on the type of treatment you receive, fertility may be a concern, and sperm banking may be desired.
• Information on BC sperm banks is available from the Vancouver Centre Library.

Surgery

• Surgery is usually the first treatment for all testicular cancers.
• Radical inguinal orchiectomy is the removal of the testis plus spermatic cord, through a small cut made just above the pubic area. The surgeon ties off the spermatic cord before removal to prevent cancer cells from spreading.
• The complete testis is sent to a pathologist for biopsy.
• Removal of abdominal lymph nodes may be recommended depending on the type and stage of the cancer. This type of surgery is called retroperitoneal lymph node dissection, and it requires a larger incision in the abdomen.

Ongoing Surveillance (Follow-up) after Surgery

• Following the orchiectomy and staging of the tumour, many patients with early disease (Stage I) need no further treatment.
• All patients should be monitored for at least five years for potential recurrence of the cancer.
• Initial assessment at a cancer centre is strongly recommended; then ongoing surveillance is the standard.
• Follow-up visits will occur with a specialist several times per year for the first five years. Follow-up for the next five years should be done once a year and can be done by the family doctor.
• Follow-up visits will include clinical examination, blood tests and imaging tests such as CT scans, or chest x-rays.

Chemotherapy

• Early stage patients who are not able to comply with a surveillance program may be offered chemotherapy.
• Patients with more advanced stage seminomas and nonseminomas are offered chemotherapy.
• Chemotherapy is also offered to patients with more advanced stage nonseminomas.
• Chemotherapy may temporarily or permanently decrease the sperm count. If future fertility is a concern, patients might want to consider sperm banking. 

Radiation

• Radiation therapy is no longer recommended as a routine therapy for early stage seminoma.
• Radiation may be used for patients who are not able to undergo chemotherapy or ongoing surveillance.
• Radiation therapy is a standard therapy for patients with Stage II A seminomas, and is a treatment option for patients with Stage II B seminomas
• Radiation may also be used for recurrences of this cancer.

Follow-up after Treatment

• You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• For cancer of the testis, ongoing surveillance for 5 to 10 years is suggested, as detailed above.
  
• Life after Cancer focuses on the issues that cancer survivors might face.