What to Expect During Tests for Testicular Cancer

Testicular cancer is one of the most treatable and survivable forms of cancer: The five-year relative survival rate is 95 percent, according to the National Cancer Institute. Testicular cancer will cause only an estimated 460 deaths in all of 2022.

But all those statistics hang on one crucial factor: You've got to detect it early.

And, yes, testicular self-exams—the ones we've been taught since barely before we knew what our testicles were for—are a good start.

However, your doctor has numerous other options on the table, as well as expertise and years of training. You might encounter several possible exams when you go in to be tested for testicular cancer.

Manual testicular exam

First things first. If you report feeling a lump, hardness or other abnormality on one of your testicles, your doctor will likely begin by examining them with a gloved hand. The doctor will gently roll each of your testicles between thumb and fingers, feeling for hard spots that might indicate cancer. They will also look for swelling and tenderness in your scrotum and testicles.

This initial exam can also help rule out other testicle conditions, such as epididymitis or a hydrocele, that you might not recognize without medical training. These and other conditions can present with odd swelling and other changes in your scrotum, but they aren't cancerous.

In addition to checking your testicles, your doctor will also probably palpate your abdomen to feel your lymph nodes for signs of cancer. Testicular cancer often initially spreads to the lymph nodes.

Ultrasound

The first testicular cancer exam a doctor usually orders is an ultrasound. An ultrasound wand is a handheld device that uses sound waves to take images inside your scrotum. These pictures look something like grainy X-rays and can help determine the nature of any lump, swelling or abnormality.

The images are usually precise enough to tell whether a change in your testicles is a benign condition, such as a hydrocele or a varicocele, or a solid tumor.

Blood tests

If the manual exam or ultrasound discovers a lump on one or both of your testicles, your physician will order a blood test to look for elevated levels of certain proteins known as tumor markers.

There are many types of testicular cancer, but most form in germ cells, where sperm originates. The two main categories of germ cell tumors are seminoma and nonseminoma.

The tumor markers that may be present in your blood if you have testicular cancer include alpha-fetoprotein (AFP), a protein produced by nonseminomas; human chorionic gonadotropin (hCG), a glycoprotein produced by both seminoma and nonseminoma tumors; and lactate dehydrogenase (LDH), a cellular enzyme. A comprehensive overview of tumor markers can be found here.

Depending on which of these tumor markers are present and at what levels, your oncology team can determine which type of cancer you have and how to proceed.

Imaging tests

You may have imaging tests done if you're diagnosed with certain types or certain stages of testicular cancer to see if it has spread to other areas. These could include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) and others.

Conclusions

Testicular cancer isn't very common, but it is very survivable. As of 2018, an estimated 277,000 testicular cancer survivors were living in the United States, according to the National Institutes of Health.

The key to survival is getting diagnosed early. The testing protocols are well-developed and offer clinicians a clear picture of what type of cancer you have, how far it has spread and how best to proceed.

Don't hesitate to see your doctor if you find a lump or other abnormality in your testicles because time is of the essence.