Checking First Things First
The physical exam includes feeling for changes in size, shape or texture of the testicles. The doctor may ask questions about symptoms, and the duration of them. A thorough examination will be conducted on any male presenting with a painless testicular lump, or complains of scrotal heaviness, dull ache or acute pain.
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An ultrasound will be ordered to show images of the scrotum. The high frequency waves can detect tumors of the testicles, even those that are very small and undetectable by physical exam.
If a tumor is found on ultrasound, a biopsy will be order of the tumor tissue to determine if it is cancerous. The biopsy is done after surgically removing the testicle that is affected by the tumor. The most common type of testicular cancer (40%) is seminoma. The other type is nonseminoma testicular cancer.
If the doctor is unsure of the cause for swelling of the scrotum (if that is a symptom) other tests may be run such as other bloodwork including a CBC, sedimentation rate, urinalysis, urine culture, and a urethral smear. If the doctor thinks there is any possibility that it could be prostatic disease instead, the doctor may order a PSA. If another possibility is an intestinal obstruction, a flat plate abdominal and lateral decubiti may be ordered, a radionuclide testicular scan and scrotal ultrasound will also usually be ordered.
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Diagnosis and Staging
The screening and diagnosis is not only to determine if it is testicular cancer, but also to determine the type of cancer as well as the stage of cancer. Different tests are performed in order to determine the type and stage after the diagnostic tests are done to make the initial diagnosis of testicular cancer.
The testicular cancer type is determined by microscopic exam after the extraction of the testicle and the analysis is used to make the type determination. The two types are seminoma and nonseminoma. In some cases both types are present in a tumor. If that is the case, the cancer is treated as if it is nonseminoma.
The next step after typing the cancer is to determine the stage that the cancer is at. The stage is determined by finding out how far the cancer has spread if at all, outside of the testicle. The tests used to determine staging are:
Computerized tomography (CT) CT scans are very much like x-rays of the abdomen. They are used to look for any signs of cancer in the abdominal lymph nodes.
A chest x-ray may be done to determine if the cancer has spread to the lungs.
Blood tests may be done to check for elevated tumor markers that will show if any signs of the cancer have remained in the body after the testicle was removed.
These tests are used to assign a stage to the cancer.
It is important to determine by diagnostic testing what stage the cancer is in because the stage will dictate what forms of treatment are best.
Stage I cancer is limited to the testicles alone
Stage II cancer has spread to the lymph nodes in the abdomen
Stage III cancer has spread to other parts of the body such as the bones, brain, liver or lungs.
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- monarch13 monarch13 Jul 12, 2008 @ 1:29 pm
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