Introduction: Who Should Seek Diagnostics and When

Any man who notices changes in his testicles should schedule a visit with a healthcare provider without delay. The most common warning sign of testis cancer is a painless lump or swelling in one of the testicles^[1]. Other symptoms that should prompt immediate medical attention include a feeling of heaviness in the scrotum, a dull ache in the lower belly or groin area, sudden fluid buildup in the scrotum, or any discomfort or pain in a testicle or the scrotum itself^[2]. Some men may also notice enlargement or tenderness of breast tissue, which can sometimes occur with testicular cancer^[1].

Testis cancer is most common in men aged 15 to 45 years, though it can occur at any age^[1]. Men in this age range should be particularly attentive to any changes in their testicles. It’s important to understand that delays in seeking medical care can allow cancer cells more time to spread beyond the testicle, which may make treatment more complex^[2]. While these symptoms can occur with other conditions that aren’t cancer, only a healthcare provider can determine the cause through proper testing.

Men with certain risk factors should be especially vigilant about monitoring their testicular health. These risk factors include having had an undescended testicle (a condition where one or both testicles didn’t move into the scrotum before birth), a family history of testicular cancer in a father or brother, a personal history of testicular cancer in the other testicle, or being white^[4]. If you have any of these risk factors and notice any changes, seeking diagnostic testing promptly is particularly important.

Diagnostic Methods for Identifying Testicular Cancer

When you visit a healthcare provider with concerns about testicular cancer, they will begin with a thorough evaluation that combines several diagnostic approaches. The goal is to determine whether cancer is present, identify what type of cancer it is, and understand how far it may have spread.

Physical Examination

The first step in diagnosing testicular cancer is a physical exam, during which your doctor will carefully examine both testicles, the scrotum, and the surrounding area^[4]. The doctor will check for lumps, swelling, pain, or any other unusual findings. They will also take a complete health history, asking about your symptoms, how long you’ve had them, any risk factors you may have, and your general health^[4]. This exam is straightforward and painless, but it provides important initial information that guides further testing.

Ultrasound Examination

If the physical exam reveals anything unusual, the next step is typically an ultrasound of the testicles. This is often the most important imaging test for diagnosing testicular cancer^[12]. During an ultrasound, you lie on your back with your legs spread while a healthcare provider applies a clear gel to the scrotum. A hand-held device called a probe is moved over the scrotum, using high-energy sound waves to create detailed pictures of the testicles and surrounding structures^[12].

An ultrasound is completely painless and doesn’t use radiation. It helps doctors see whether any lumps are inside or outside the testicle. This distinction matters because lumps inside the testicle are much more likely to be cancer^[12]. The ultrasound can also help distinguish between solid masses, which might be cancer, and fluid-filled cysts, which are usually not cancerous^[5]. The detailed images produced by ultrasound give your care team crucial information about what’s happening inside your body.

Blood Tests for Tumor Markers

Blood tests play a critical role in diagnosing testicular cancer. These tests look for specific substances called tumor markers, which are proteins that some testicular cancer cells release into the bloodstream^[12]. The three main tumor markers for testicular cancer are alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH)^[4].

Having elevated levels of these markers doesn’t automatically mean you have cancer, and not all testicular cancers produce these markers. However, when tumor marker levels are higher than normal, they provide valuable clues about what’s happening in your body^[12]. These blood tests are simple—a healthcare provider draws a small sample of blood from your arm, which is then sent to a laboratory for analysis. The results help doctors understand whether cancer might be present and, if so, what type it might be.

Surgery for Diagnosis

If your physical exam, ultrasound, and blood tests strongly suggest testicular cancer, the next step is typically surgery to remove the affected testicle. This procedure is called a radical inguinal orchiectomy^[12]. While this might sound frightening, it serves two important purposes: it provides a definitive diagnosis and it treats the cancer at the same time.

During this surgery, the doctor makes a small incision in the groin (not the scrotum) and removes the entire testicle along with the spermatic cord, which is the structure that holds the testicle in place and contains blood vessels and nerves^[5]. Once the testicle is removed, it’s sent to a laboratory where specialists examine the tissue under a microscope to determine whether cancer cells are present and, if so, what type of cancer it is^[4]. This tissue examination, called a biopsy, is the only way to definitively diagnose testicular cancer.

The reason doctors remove the entire testicle rather than just taking a small tissue sample is that cutting into a testicle containing cancer could allow cancer cells to spread into nearby tissues or the bloodstream. By removing the whole testicle through an incision in the groin, doctors minimize this risk. Most men who undergo this procedure are able to maintain normal hormone levels and fertility with the remaining testicle, assuming it’s healthy.

Determining Cancer Type

Once the testicle is removed and examined, laboratory specialists determine the specific type of testicular cancer. About 90% of testicular cancers start in germ cells, which are cells that eventually develop into sperm^[2]. There are two main types of germ cell testicular cancers: seminomas and non-seminomas^[2].

Seminomas are slow-growing cancers that typically affect people in their 40s or 50s. They’re particularly sensitive to radiation treatment. Non-seminomas grow more rapidly and mainly affect people in their late teens, 20s, and early 30s. There are four different types of non-seminoma tumors, each named after the type of germ cell that makes up the tumor: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma^[2]. Some testicular cancers contain both seminoma and non-seminoma cells, and these are treated as non-seminomas.

Knowing which type of testicular cancer you have is essential because it determines your treatment plan. The cancer type, along with information about how far the cancer has spread, helps your healthcare team recommend the best approach to treatment.

Additional Imaging Tests

After testicular cancer is diagnosed, additional imaging tests may be needed to see if the cancer has spread beyond the testicle. These tests might include a CT scan (computed tomography scan) of the abdomen and pelvis to check the lymph nodes, which are small bean-shaped structures that are part of the body’s immune system. A chest CT scan or chest X-ray may be done to check whether cancer has spread to the lungs^[3]. These imaging tests use X-rays and computer technology to create detailed cross-sectional images of the inside of your body. They’re painless, though you’ll need to lie still on a table that moves through a large, doughnut-shaped machine.

Diagnostics for Clinical Trial Qualification

If you’re considering participating in a clinical trial for testicular cancer, you’ll undergo specific diagnostic tests that serve as standard criteria for enrollment. Clinical trials are research studies that test new treatments or approaches to managing cancer. These trials have strict eligibility requirements to ensure that participants are appropriate candidates and to maintain the scientific validity of the study.

Before enrolling in a clinical trial, you’ll typically need confirmation that you have testicular cancer through tissue examination (biopsy) from the removed testicle. This pathological confirmation is essential because clinical trials need to ensure all participants have the specific disease being studied. Your healthcare team will also need to determine the exact stage and type of your cancer through the diagnostic tests described earlier—physical exam, ultrasound, blood tumor markers, and imaging scans^[14].

Staging information is particularly important for clinical trial enrollment. The stage describes how large your cancer is and whether it has spread. Doctors look at several factors to determine the stage, including the size and characteristics of the original tumor, whether cancer cells are found in nearby lymph nodes, and whether cancer has spread to distant parts of the body like the lungs or liver^[14]. They also consider the levels of tumor markers (AFP, beta-hCG, and LDH) in your blood after the testicle has been removed, as these levels help classify the cancer’s stage and guide treatment decisions.

Clinical trials often have specific requirements about tumor marker levels, overall health status, and previous treatments. Some trials only accept patients who haven’t received any treatment yet, while others specifically enroll patients whose cancer has come back after initial treatment. You may need to have blood tests to check your overall health, including kidney function, liver function, and blood cell counts. These tests help ensure that you’re healthy enough to tolerate the treatments being studied in the trial.

Your healthcare provider can help you understand which clinical trials might be appropriate for your situation and what specific diagnostic information is needed for enrollment. The diagnostic tests for clinical trial qualification are generally the same tests used for standard care—they’re simply reviewed with the specific eligibility criteria of the trial in mind.