Physical Exam and Ultrasonography
During a careful exam a doctor may find a firm lump in the testicles. An ultrasound (a noninvasive radiological test) of the scrotum can show tumors in the testicles and in nearby structures. Still, if there is suspicion of an abnormality, even a normal exam or ultrasound does not rule out a tumor.
Blood tests to find tumor markers (proteins produced by most testicular cancers) are often done when a testicular tumor is suspected. Elevated levels of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (less often) raise the clinical suspicion of specific malignant testicular tumors. The urologist may use levels of these tumor markers before surgery as a baseline.
The only way to know if the swelling is cancer is for a surgeon to look at the testicle during surgery. Sometimes a small piece of tissue is removed and looked at under a microscope by a pathologist (a doctor who interprets the changes caused by disease in tissues and body fluid). This is known as a frozen section biopsy. If the biopsy shows that the lump is a cancer, then the testicle will be removed. This operation is known as orchiectomy. Further testing with a CT scan or MRI (magnetic resonance imaging) is not advised until after surgery, when the diagnosis of the tumor is complete.