Often the diagnosis of testicular cancer is either made or suspected by your primary care physician or a urologist, if you get referred to a urologist. In general, you undergo an evaluation because there is a suspicion that you may have testicular cancer, and this usually involves some sort of pathology related to the testicular.
You may have a mass there. That's the most common presenting symptom, but in general you usually get referred to a urologist. The evaluation will then involve an examination and documentation of your history, family history, medical history. We will ask questions like, "Have you ever had a history of an undescended testicle? Do you have any family members with testicular cancer?"
We'll then perform an examination to examine the testicles, to see if there are any firm masses. We also want to rule out other possible etiologies, things that could be representative of benign conditions. So we generally perform an examination, but we're looking for a firm area within the testicle that would be indicative of a possible cancer.
In some cases, when the diagnosis is uncertain, then we may actually get imaging tests such as a scrotal ultrasound to look for masses within the testicle. We will also obtain a series of lab tests, and these are called tumor markers. There are three specific tumor markers we check for with testicular cancer, one called LDH or lactate dehydrogenase, one called beta hCG, human chorionic gonadotropin. This is the same hormone that we test for, for pregnancy tests.
Then, another hormone called AFP, or alpha fetal protein. These are all called testicular tumor markers. When they're elevated it can signify the presence of testicular cancers and we can also look at these tumor markers to help determine the various possible types of testicular cancer that may be involved. But essentially, everybody with suspicious testicular cancer will get tumor markers, possibly imaging tests, and if we want to further evaluate for staging of testicular cancer... If we know someone has the cancer and we want to see how extensive it is, then we will often get imaging of the abdominal area or the chest, or various other parts of the body to see if there is any spread of cancer.
The ultimate diagnosis of testicular cancer has to be based on a tissue diagnosis, and that means we have to have some tissue to evaluate to see if there is truly cancer in the testicle. The way we obtain that tissue is by removing the testicle. We do a procedure called a radical inguinal orchiectomy, whereby the testis is removed. It gets sent to a pathologist for them to examine it and evaluate what type of cancer it is and also what we call the staging of the cancer itself.