Diagnosis and Staging of testicular cancer
Tests that examine the testicles and blood are used to detect (find) and diagnose testicular cancer.
The following tests and procedures may be used:
-Physical exam and history
-Ultrasound exam
-Serum tumor marker test
-Radical inguinal orchiectomy and biopsy
Medical history and physical exam
An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual
The testicles will be examined to check for lumps, swelling, or pain
A history of the patient's health habits and past illnesses and treatments will also be taken
A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes
The echoes form a picture of body tissues called a sonogram
A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body
Certain substances are linked to specific types of cancer when found in increased levels in the blood
These are called tumor markers
The following 3 tumor markers are used to detect testicular cancer:
-Alpha-fetoprotein (AFP)
-Beta-human chorionic gonadotropin (β-hCG)
-Lactate dehydrogenase (LDH)
Tumor marker levels are measured before radical inguinal orchiectomy and biopsy, to help diagnose testicular cancer.
Radical inguinal orchiectomy and biopsy
The removal of cells or tissues so they can be viewed under a microscope by a pathologist
The pathologist will check the biopsy sample to see if there are cancer cells and find out the Gleason score
The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread
The lower the number, the less likely the tumor is to spread
Radical inguinal orchiectomy and biopsy
It is important to choose a surgeon who has experience with this kind of surgery.)
If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment
After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body
The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging
The information gathered from the staging process determines the stage of the disease
It is important to know the stage in order to plan treatment
The following tests and procedures may be used in the staging process:
Chest X-ray
CT scan
Lymphangiography
Abdominal lymph node dissection
Serum tumor marker test
An x-ray of the organs and bones inside the chest
An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body
A strong magnet linked to a computer is used to make detailed pictures of your lower abdomen
An MRI can show whether cancer has spread to lymph nodes or other areas
Sometimes contrast material is used to make abnormal areas show up more clearly on the picture
A procedure used to x-ray the lymph system
A dye is injected into the lymph vessels in the feet
The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages
This test helps find out whether cancer has spread to the lymph nodes
A surgical procedure in which lymph nodes in the abdomen are removed and a sample of tissue is checked under a microscope for signs of cancer
This procedure is also called lymphadenectomy
For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease
Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy
Abnormal cells are found in the tiny tubules where the sperm cells begin to develop
These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal
Stage 0 is also called carcinoma in situ
Cancer has formed
Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.
Stage IA
Cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle
All tumor marker levels are normal
Stage IB
Cancer is in the testicle and the epididymis has spread to the blood vessels or lymph vessels in the testicle
Or has spread to the outer layer of the membrane surrounding the testicle
Or is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle
All tumor marker levels are normal
Stage IS
Cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either
-All tumor marker levels are slightly above normal; or
-One or more tumor marker levels are moderately above normal or high
Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.
In stage IIA, cancer
-Cancer is anywhere within the testicle, spermatic cord, or scrotum; and
-Has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters
-All tumor marker levels are normal or slightly above normal
Is anywhere within the testicle, spermatic cord, or scrotum; and either:
Has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
Has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters
All tumor marker levels are normal or slightly above normal
Is anywhere within the testicle, spermatic cord, or scrotum; and
Has spread to a lymph node in the abdomen that is larger than 5 centimeters
All tumor marker levels are normal or slightly above normal
Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.
In stage IIIA, cancer:
Is anywhere within the testicle, spermatic cord, or scrotum; and
May have spread to one or more lymph nodes in the abdomen; and
Has spread to distant lymph nodes or to the lungs
Tumor marker levels may range from normal to slightly above normal
Is anywhere within the testicle, spermatic cord, or scrotum; and
May have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs
The level of one or more tumor markers is moderately above normal
Is anywhere within the testicle, spermatic cord, or scrotum; and
May have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs
The level of one or more tumor markers is high
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