Testicular cancer tests

Usually you begin by seeing your GP who examines you and takes your medical details. Then your GP refers you to a hospital specialist for tests to see whether you have testicular cancer.

At the hospital, the specialist will examine you again and ask questions about your health and your family's health. You will probably be asked to have some blood tests and an ultrasound scan.

Testicular cancers often produce hormones that can be measured in the blood. Doctors call them 'markers'. There are 3 different markers that testicular cancers can make

• AFP or alpha feta protein
• HCG or human chorionic gonadotrophin
• LDH or lactate dehydrogenase

If you have abnormal levels of any of these markers in your blood, then you could have testicular cancer. But you could have a cancer without raised markers. Not all testicular cancers make these chemicals.

Raised markers are more common in pure teratomas and mixed tumours than in pure seminomas. The level of the markers may be used by your doctor to decide which treatment you should have. If your markers are at high levels, you may need more treatment.

Raised AFP is never found in pure seminoma - if it is, it means there must be at least some non seminoma cancer cells in the tumour.

The level of the marker in your blood will be tested throughout your treatment and your follow up. This is because the marker will go down as your treatment works. Or it could rise again if your cancer comes back after you have finished your treatment. You will still be tested for markers as part of your follow up, even if you have not had raised markers in the past.

You will be given an ultrasound of both testicles and your scrotum. This can show if there is a solid lump, or a fluid filled cyst which is less likely to be a cancer. Ultrasound is a painless examination using sound waves.

If your ultrasound cannot rule out cancer, you will probably be asked to agree to have your testicle removed. This is called orchidectomy (or sometimes orchiectomy).

Unfortunately, this is the only way to know for certain whether you have cancer or not. Cells from the lump must be examined under a microscope to see if they are cancerous and if so, what type of cancer you have.

You may wonder why it is not possible to remove some tissue from the lump (a biopsy) without taking the whole testicle. This is because specialists think there is too high a risk of the cancer spreading with a biopsy.

Specialists will only remove a testicle when they are fairly sure there is a cancer there. Removal of the affected testicle is the first treatment for testicular cancer and so it would probably have to be done anyway.

The operation will be done as soon as possible after your initial tests. You will have to stay in hospital for a few days. The operation is done under general anaesthetic. A small cut is made in the groin and the testicle is removed whole. If you like, a false testicle (prosthesis) made out of silicone can be put into the scrotum to replace the one that has been removed.

After the operation, you will have a few stitches in your groin. The area will be sore for a few days. Do ask for painkillers if you need them.

The testicle that has been removed will be sent to the laboratory for examination under a microscope. The results of these tests could take a few days.

Remember - removing one testicle does not affect your ability to have an erection or father children. There is more about this in the section on your sex life and testicular cancer.