Where testicular cancer is suspected ultrasound is often the first test done if the doctor thinks you might have testicular cancer. It uses sound waves to produce images of the inside of your body. It can be used to see if a change in the testis is a benign condition (like a hydrocele or varicocele) or a solid tumor that could be a cancer. If the lump is solid, it’s more likely to be a cancer. In this case, the doctor might recommend other tests or even surgery to remove the testicle.
Some blood tests can help diagnose testicular tumors. Many testicular cancers make high levels of certain proteins called tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). When these tumor markers are in the blood, it suggests that there's a testicular tumor.
Rises in levels of AFP or HCG can also help doctors tell which type of testicular cancer it might be.
- Non-seminomas often raise AFP and/or HCG levels.
- Pure seminomas occasionally raise HCG levels but never AFP levels.
This means any increase in AFP is a sign that the tumor has a non-seminoma component. (Tumors can be mixed and have areas of seminoma and non-seminoma.) Sertoli and Leydig cell tumors don't make these substances. It's important to note that some cancers are too small to elevate tumor markers levels.
A testicular tumor might also increase the levels of an enzyme called lactate dehydrogenase(LDH). A high LDH level often (but not always) indicates widespread disease. But, LDH levels can also be increased with some non-cancerous conditions.
In very rare cases, when a diagnosis of testicular cancer is uncertain, the doctor may biopsy the testicle before removing it.
Tumor marker tests sometimes are also used for other reasons, such as to help estimate how much cancer is present (see Testicular Cancer Stages) to see how well treatment is working, or to look for signs the cancer might have come back.
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