How Testicular Cancer is Diagnosed

Screening for Testicular Cancer

There are other types of cancer for which screening is routinely implemented. These include types such as breast, colon, prostate, and lung. One could ask if there should be screening for testicular cancer rather than just wait for the individual to notice a lump or other symptoms. The reason screening is not pursued nor recommended is multifactorial. For one thing, most testicular cancers are discovered at an early stage even without screening.

For another thing, even when testicular cancer has spread, it is still highly curable. Screening could be accomplished by three different approaches: periodic testicular exam (either by a clinician or a self-exam), periodic blood tests looking for certain tumor markers specific to testicular cancer and/or periodic scrotal ultrasounds. None of these have been proven to be beneficial at decreasing mortality (deaths) from testicular cancer1, which is already very low as it is, less than 5% of cases.

Developing a Suspicion

The diagnosis of testicular cancer is done in a stepwise fashion. First of all, there needs to be a suspicion of testicular cancer. This most commonly occurs when someone notices a painless lump on one of the testis (singular of testes, basically synonymous with testicle) or scrotal swelling. Other signs and symptoms may also be present.

Clinical Evaluation

Clinical exam by an experienced, qualified clinician (physician, physician assistant or nurse practitioner) is the next step in evaluation.

A testicular exam will be performed by palpating (feeling) each testis between the thumb and opposing digits. Care will be taken to determine if the lump or swelling is due to a benign cause such as a hydrocele or varicocele, amongst other things. If suspicion is reasonably high, ultrasound is the next step in diagnosis.


Ultrasound of the scrotum is the gold standard for reasonably establishing the diagnosis of testicular cancer following clinical exam. Ultrasound devices use high-frequency sound waves which are then received and interpreted to create images of the underlying anatomic structures. There are no known adverse effects from a scrotal ultrasound and no radiation is used. If a mass is visualized on the testis suspicious for testicular cancer, surgery is the next step.


Radical orchiectomy is the surgical removal of the testis with the suspected cancer. It is usually performed by a qualified urologist. A needle biopsy is not typically performed beforehand because evidence suggests that this may affect lymphatic drainage and cause the cancer to spread in different patterns. After surgery, all the tissues removed, are sent to pathology for review and diagnosis.

Pathologic Evaluation

A pathologist is a specialized physician trained in evaluating tissue for pathologic entities, including cancer.

The tissue/cells are evaluated under the microscope with special stains. This is where the diagnosis of testicular cancer is officially made and other etiologies ruled out. The exact testicular cancer subtype is discovered at this point in time. This process typically takes around three days depending on the institution.

Assessing for Spread of the Cancer

Before any surgery for cancer, it is important to complete the staging through diagnostic imaging and blood tests for chemistry profile, complete blood count, and  tumor markers. A CT scan is performed of the abdomen and pelvis to specifically assess if cancer is in the lymph nodes. Imaging is typically also performed of the chest. This may just be a simple x-ray or may be a CT scan, especially if there are any pulmonary symptoms such as coughing or shortness of breath.

This concludes the diagnostic process of testicular cancer. Depending on stage and other factors, further treatment may include chemotherapy or radiation.


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