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. They will ask you 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 (alpha feta protein)
• HCG (human chorionic gonadotrophin)
• LDH (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. Your doctor may use the level of the markers to decide which treatment you should have. If your markers are at high levels, you may need more treatment.

Your doctor will test the level of the marker in your blood 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 treatment. Your doctor will test your blood for markers as part of your follow up, even if you have not had raised markers in the past.

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

If the ultrasound cannot show whether the lump is non cancerous (benign) or a cancer, your doctor may ask you to have an MRI scan. This type of scan uses magnetic fields to create a picture of body structures. We have information about having an MRI scan in the section about cancer tests.

If your scans and blood tests show that there may be a cancer, your doctor will ask you to agree to have your testicle removed. This is called orchidectomy (or sometimes orchiectomy).

A pathologist will examine cells from the lump under a microscope to see if they are cancerous. They can also see 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. Removing the affected testicle is the first treatment for testicular cancer and so you would need to have this anyway.

You will have your operation to remove the testicle as soon as possible after your initial tests. You will need to stay in hospital for a few days. You have the operation under general anaesthetic. Your surgeon makes a small cut in the groin and removes the whole testicle. If you like, they can put a false testicle (called a prosthesis or implant) into the scrotum to replace the one that they 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 that removing one testicle does not affect your ability to have an erection or father children. There is more about this in the section about your sex life and testicular cancer.