Diagnosis

An ultrasound scan is extremely accurate at diagnosing testicular cancer. If a man is suspected of having testicular cancer a referral will be made to a hospital specialist called a urologist. If there is a strong suspicion that testicular cancer is present then a decision will be made to surgically remove the affected testicle. This decision will not be taken lightly but will be in a man’s best interest. No one will want to wait around and see what happens. Surgery to remove the testicle (orchidectomy) will usually be the only time that a definite cancer diagnosis can be verified or ruled out.

Other tests will also be carried out to identify any cancer that may have potentially spread beyond the testicle to other parts of the body:

Blood tests 

Some testicular cancers produce chemicals, which are released into the bloodstream. These chemicals, called tumour markers, are alpha-fetoprotein (AFP), beta human chorionic gonadotrophin (BHCG) and lactate dehydrogenase (LDH). They may be abnormal in the presence of particular types of testicular cancer. For instance AFP and HCG can be raised in the presence of a particular type of testicular cancer called non seminoma. They can also be used to measure the effect of treatment such as an orchidectomy, in reducing cancer activity which maybe present and they may be repeated after orchidectomy at 48-96 hours if they were abnormal beforehand. Blood tests to measure kidney and liver function will also usually be requested.

Occasionally if there is obvious evidence that testicular cancer is present and has spread to other areas of the body, a referral may be made to an oncologist (cancer specialist) to see if treatment such as chemotherapy should be given before surgery (orchidectomy).

Chest X-ray

This can identify any cancer which may have already spread to the lungs.

Pregnancy test

BCHG is produced in the blood during pregnancy and in the prescence of certain types of testicular cancer. Large amounts of BHCG can therefore be detected urine. However not all testicular cancers will produce BHCG and this should never be used as a diagnostic test. Some non regulated performance enhancing drugs can also cause a positive result.

Computerised Tomography Scan (CT scan)

A CT scan is performed to check for any potential sign that the cancer has spread to other areas of the body; lungs or lymph glands in the abdomen (see below). The scan takes a series of x-rays, which are fed into a computer to build up a three-dimensional image of the inside of the body and takes from 10 to 30 minutes to perform. A special drink or an injection of a dye into a vein which helps show areas of the body more clearly will usually be given. This may cause a warm sensation for a few minutes. The scan is painless, but involves lying still for 10-20 minutes.

For more information on having a CT scan from NHS Choices please click here 

What are Lymph Nodes?

The human body is covered by a special type of drainage system called the lymphatic system. This system is responsible for transporting excess fluid from the organs and tissues of the body in a fluid called lymph. Lymph fluid will contain various types of cells and substances that are no longer needed. The fluid will be transported through the lymphatic drainage system and pass through small nodules or nodes which are responsible for filtering out the unwanted substances. Cancerous cells which break off from the an organ which has cancer can also travel along this route and become trapped at the lymph nodes where they can then accumulate and infiltrate a different area of the body.

Lymphnodes TC

Surgery (orchidectomy)

Orchidectomy (unilateral) is the surgical removal of one testicle and is usually performed very quickly after a suspected diagnosis of testicular cancer. It is a simple procedure which may take about half an hour to perform and will usually be carried out as a day case procedure under general anaesthetic. During this surgery a small incision is made into the groin region on the affected side and the testicle is removed from above. The scrotum will not be cut. A prosthetic (artificial) testicle can be inserted in place of the cancerous testicle. Men may also be offered the possibility of sperm storage before surgery. 

Falsey or not?

The health care team may discuss the insertion of a false (prosthetic) ball to take the place of the old one. These are silicone implants that can be inflated with salt water. They come in various sizes can give a very good cosmetic result and be of great psychological value, but some men may experience problems with them in the longer term. Once inserted the neck of the scrotum is closed with stitches to prevent the prosthesis from moving back up to the groin.

Some possible problems may include:

  • The overall cosmetic result may vary.
  • Scar tissue forming around the implant inside the scrotum. This can sometimes cause a thick fibrous growth of tissue which may in turn cause discomfort or give rise to worry that a second cancer has appeared.
  • Rupture of the implant can rarely occur due to vigorous activities such as contact sport, cycling or physical contact including sexual intercourse.
  • Sometimes the implant may move out of its original position.
  • Surgery can cause small spots of calcium in the testicle to appear usually some years following surgery. Although they are harmless they can sometimes be confused with the type of calcium deposits (microlithiasis), which may rarely in some instances increase the risk of testicular cancer.
  • A prosthetic testicle will not react to temperature like a normal one and will stay the same size.

 

Men who are unsure of whether they want an implant or not can have the procedure performed at a later date if they wish. 

To watch a video discussing orchidectomy please click the link below.

After Surgery

  • There will be a dressing covering the incision site on the groin. This can usually be removed 24 hours after the operation. The stitches (sutures) in the wound will usually be dissolvable but may take some weeks to fully disappear.
  • Men can have a bath or shower, normally after 24 hours, but it is important not to rub soap on the wound area. The wound should be dried by gently patting it with a clean towel/gauze pad.
  • The groin and scrotal area can feel bruised and swollen after the operation. It is advisable to wear close fitting underwear, such as briefs or ‘Y’ fronts or a scrotal support rather than boxer shorts. This will help the bruising settle. Painkillers which may have been prescribed should be taken on a regular basis, (not just when pain is felt) for the first 48 hours until comfortable. Always read the instructions to ensure they are administered correctly. Often simple paracetamol combined with an anti-inflammatory medication (such as ibuprofen) are effective at reducing discomfort.
  • Although this is a minor operation, it is important to take things easy for the first week. Men should be able to return to work within a few weeks. However if they are going to be reviewed in an outpatient clinic or referred to an oncologist for further treatment; it may be a good idea to await for these arrangements to be made before returning to work as further time off may be needed.
  • Occasionally a collection of blood may form under the surgical wound (haematoma) or the wound may become infected. Men should seek medical advice if they think there may be infection. It is sometimes useful to phone the unit that performed the operation or contact a GP.
  • It is important to avoid heavy lifting and or strenuous exercise for the first few weeks. Men should only start driving when they are able to do an emergency stop without hesitation.
  • Sexual activity can begin again after two weeks as long as it is not uncomfortable. 

Having an orchidectomy should not affect a man’s ability to have an erection, but the psychological stress associated with a potential diagnosis of cancer may affect performance.

Men should be given a follow up appointment within a few weeks of orchidectomy to see a hospital specialist (oncologist) where the results of the operation will be discussed along with the need for any further recommended treatment. 

About 5% of men with testicular cancer may also have pre-cancerous or cancerous cells in the opposite testicle. If this is suspected a biopsy of the opposite (contralateral) testicle may be taken at the same time as the orchidectomy.

Tips

  • Men who are diagnosed or suspected of having testicular cancer will usually be given the details of a urology specialist nurse or “Key worker” who will act as their point of contact during and after treatment and who can provide them with relevant information and advice. They will usually also have access to other medical professionals who may be involved in a man’s care and may be able to liaise with them if there are any problems.
  • Once a diagnosis of testicular cancer is suspected things will begin to move very quickly; surgery will be booked and scans arranged usually within a two-week period. Men should try and plan ahead and involve all of their family so that they can help with any arrangements that need to be made while having treatment (childcare, work etc.).
  • Men will need to take time off work during and after treatment. It is advisable to keep any correspondence/ letters and contact details of the health professionals involved or procedures performed as proof of treatment in case an employer wants evidence. It may also be a good idea to talk to a human resources department if available and inform them of the situation.
  • Although the hospital where a man has been treated can issue you a sick certificate to cover stay in hospital they will not be able to provide a long term sick certificate. This will need to be obtained from a G.P.                                

To read personal stories of men who have been affected and treated for testicular cancer please click here

To download a PDF about being diagnosed with testicular cancer please click here

 

Last reviewed 26/1/17 Next review July 2017

 

References available on request.

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