Diagnosis

See your GP as soon as possible if you notice a lump or other abnormality in your scrotum that you think may be on one of your testicles.

Most scrotal lumps aren't cancerous, but if you have a lump that you think may be in one of your testicles it's important you have it checked as soon as possible. Treatment for testicular cancer is much more effective when startedearly.

Physical examination

As well as asking you about your symptoms and looking at your medical history, your GP will usually need to examine your testicles.

They may hold a small light or torch against your scrotum to see whether light passes through it. Testicular lumps tend to be solid, which means light is unable to pass through them. A collection of fluid in the scrotum will allow light to pass through it.

Tests for testicular cancer

If you have a non-painful lump, or a change in shape or texture of one of your testicles, and yourGP thinks it may be cancerous, you'll be referred for further testing within two weeks.

Some of the tests you may have are described below.

Scrotal ultrasound

A scrotal Ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle. It's one of the main ways of finding out whether or not a lump is cancerous (malignant) or non-cancerous (benign).

During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle.

It will also give a clear indication of whether the lump is in the testicle or separate within the scrotum, and whether it's solid or filled with fluid. A fluid-filled lump or collection around the testisis usually harmless. A more solid lump may be a sign the swelling is cancerous.

Blood tests

To help confirm a diagnosis, you may need a series of blood tests to detect certain hormones in your blood, known as "markers".

Testicular cancer often produces these markers, so if they're in your blood itmay indicate you have the condition.

Markers in your blood that will be tested for include:

• AFP (alpha feta protein)
• HCG (human chorionic gonadotrophin)

A third blood test is also often carried out as it may indicate how active a cancer is. It's calledLDH (lactate dehydrogenate), but it isn't a specific marker fortesticular cancer.

Not all people with testicular cancer produce markers. There may still be a chance you have testicular cancer even if your blood test results come back normal.

Histology

The only way to definitively confirm testicular cancer is to examine part of the lump under a microscope. These tests and reports are called histology.

Unlike many cancers where a small piece of the cancer can be removed (a biopsy ), in most cases the only way to examine a testicular lump is by removing theaffected testicle completely.

This is because the combination of the ultrasound and blood marker tests is usually sufficient to makea firm diagnosis. Also, a biopsy may injure the testicle and spread cancer into the scrotum which isn't usually affected.

Your specialist will only recommend removing your testicle if they're relatively certain the lump is cancerous. Losing a testicle won't affect your sex life or ability to have children.

The removal of a testicle is called an orchidectomy . It's the main type of treatment for testicular cancer, so if you have testicular cancer it's likely you'll need to have an orchidectomy.

Other tests

In almost all cases, you'll need further tests to check whether testicular cancer has spread. When cancer of the testicle spreads, it most commonly affects the lymph nodes in the back of the abdomen or the lungs.

Therefore, you may require a chest X-ray to check forsigns of a tumour. You'll also need a scan of your entire body. This is usually a CT scan (computerised X-ray) to check for signs of the cancer spreading. In some cases, a different type of scan, known as a magnetic resonance imaging (MRI) scan may be used.

Stages of testicular cancer

After all tests have been completed, it's usually possible to determine the stage ofyour cancer.

There are two ways that testicular cancer can be staged. The first is known as the TNM staging system:

• T indicates the size of the tumour
• N indicates whether the cancer has spread to nearby lymph nodes
• M indicates whether the cancer has spread to other parts of the body (metastasis)

Testicular cancer is also staged numerically. The four main stages are:

• Stage 1 the cancer is contained within your testicle and epididymis (the tube at the back of the testicle)
• Stage 2 the cancer has spread from the testicles into the lymph nodes (small glands that help fight infection) at the back of the abdomen
• Stage 3 the cancer has spread to the lymph nodes in the middle of the chest or in the neck
• Stage 4 the cancer has spread to the lungs or, rarely, to other tissues ororgans, such as the liver, bones or brain

Cancer Research UK has more information about testicular cancer stages .

Benign

Benign refers to a condition that should not become life threatening. In relation to tumours, benign means not cancerous.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Incision

An incision is a cut made in the body with a surgical instrument during an operation.

Lungs

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Lymphnodes

Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.

Testicle

Testicles are the two oval-shaped reproductive organsthat make up part of the male genitals. They produce sperm and sex hormones.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.