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BTCS Professionals
Information for healthcare professionals, including doctors, nurses and allied healthcare professionals.
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What will happen next?

BTCS clinic

What happens when you find a lump?

Be assured that testicular cancer is very rare, but also very treatable. Only around four in a hundred men seen with a testicular lump will have a lump which is caused by cancer. The first thing to do is go and see your GP.

If the doctor suspects the lump could be cancer he/she will send you for an urgent referral, current NHS guidelines recommend this should happen within two weeks. The first test arranged is normally an ultrasound scan of the testicles. Dan will tell you what it feels like.

Testicular cancers are well detected with ultrasound and it is very common for the urologist to decide you need an orchidectomy (removal of the testicle) on the findings of this test alone. The operation will be performed very soon after the scan, often within a week.

For more information regarding the operation, please download the patient information leaflet for orchidectomy here.

The urologist will arrange for you to have a CT scan of your chest, abdomen and pelvis and a blood test to measure your tumour markers. This is to assess if the testicular cancer has spread to other areas of the body. The most likely places for this to happen are the lungs and the retroperitoneal lymph nodes. Most people know where the lungs are, but have no idea what retroperitoneal lymph nodes are.

Lymph nodes

Lymph nodes are tiny bean-shaped glands, located in many different areas of the body. The main locations are the neck, under the arms, and in the groin. The body has over 300 lymph nodes filtering selected white blood cells and foreign elements. The lymph node is a component of the lymphatic system which moves lymph node fluid, waste substance, and nutrients throughout your body, bloodstream and tissues.

Here is a picture of where the retroperitoneal lymph nodes are:

Lymph Nodes

Tumour markers

Testicular cancers often produce hormones that can be measured in the blood. They are often called tumour markers. There are three different markers that testicular cancers can make:

  • AFP or alpha feta protein
  • HCG or human chorionic gonadotrophin
  • LDH or lactate dehydrogenase

If you have abnormal levels of any of these markers in your blood, then you could have testicular cancer. But you could have a cancer without raised markers. Not all testicular cancers make these chemicals.

The level of the tumour markers may be used by your doctor to decide which treatment or follow up schedule you should have. Occasionally the tumour markers levels can be very high when the urologist sees you, and the team may decide to treat you with chemotherapy before an orchidectomy.

Raised AFP is never found in pure seminoma - if it is, it means there must be at least some non-seminoma cancer cells in the tumour.

The level of the marker in your blood will be tested throughout your treatment and your follow up. This is because the marker will go down as your treatment works or it could rise again if your cancer comes back after you have finished your treatment. You will still be tested for markers as part of your follow up, even if you have not had raised markers in the past.

Tom having a blood test
Tom having a blood test

 

All this information then is sent to the Multidisciplinary Team.

It is possible to cure testicular cancer at all stages, even if it has spread. In most cases the most curable part of your treatment has already occurred at this stage and a programme of intense follow-up is recommended, called active surveillance. However, this depends on the team assessing the stage of your testicular cancer.