Diagnosis & staging
Diagnosis
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 and Stages
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)
Stage III
Extension beyond retroperitoneal lymph nodes