How Is Testicular Cancer Diagnosed?
Diagnosing Testicular Cancer: Ultrasounds, Blood Markers, and Orchiectomy
Last updated and reviewed on June 28, 2026.
Diagnosing testicular cancer involves a series of steps that happen quickly because testicular cancer can grow and spread relatively fast, and early treatment is important. The process typically starts with a man noticing something wrong with a testicle and seeing a doctor, who then orders an ultrasound. From there, a combination of blood tests, imaging of the rest of the body, and surgery to remove the testicle establishes the diagnosis and determines the stage. One unusual feature of testicular cancer diagnosis is that the first surgical procedure, removing the testicle, is both a diagnostic and a therapeutic step at the same time.
Getting an accurate diagnosis matters enormously because the type of tumor, the tumor marker levels, and the extent of spread all drive treatment decisions. Being evaluated at a center with experience in testicular cancer, ideally by a urologic oncologist, gives you the best chance of getting this right from the start.
What Tests Are Used to Diagnose Testicular Cancer?
- Medical history and physical examination: The process starts with a medical history and a thorough physical examination. Your doctor will ask about your symptoms, how long you have noticed a lump or change in the testicle, whether there has been any pain, and whether you have any relevant history such as cryptorchidism, a prior testicular cancer, or a family history of the disease. The physical exam includes a careful examination of both testicles, the epididymis, the spermatic cord, and any lymph nodes in the groin that may be enlarged.
- Scrotal ultrasound: Scrotal ultrasound is almost always the first test ordered when testicular cancer is suspected, and it is the most important imaging tool for evaluating a testicular mass. The ultrasound uses high-frequency sound waves to create detailed images of the inside of the testicle. It can accurately distinguish between a solid mass within the testicle (which is highly suspicious for cancer) and a fluid-filled cyst or other benign condition outside the testicle. Scrotal ultrasound is painless, takes about 20 to 30 minutes, and does not use radiation. It is highly accurate: a solid mass inside the testicle on ultrasound is cancer until proven otherwise, and that assumption guides what happens next.
- Serum tumor markers: Blood tests to measure tumor markers are a critical part of testicular cancer diagnosis and staging, and they are drawn before surgery so that baseline values are established. The three main tumor markers are:
- Alpha-fetoprotein (AFP): Can be elevated in certain nonseminoma tumor types, particularly yolk sac tumors and embryonal carcinoma. It is never elevated in pure seminoma. An elevated AFP in a man with a testicular mass is a strong indicator of nonseminoma histology.
- Human chorionic gonadotropin (beta-hCG): Can be elevated in both seminoma and nonseminoma. Very high hCG levels, particularly in the range of tens of thousands or higher, are characteristic of choriocarcinoma. Mildly elevated hCG can be seen in seminoma.
- Lactate dehydrogenase (LDH): Can be a general marker of cell death and tumor burden. An elevated LDH in the setting of testicular cancer indicates more extensive disease and is part of the staging system.
These markers are used not just for diagnosis but also to track how well treatment is working. After surgery, they should fall according to predictable half-lives, and a rise during follow-up may signal recurrence before it is visible on imaging.
- Radical inguinal orchiectomy (surgery to remove the testicle): This is the definitive diagnostic procedure for testicular cancer. When a solid mass is found in the testicle on ultrasound, the standard approach is to remove the entire affected testicle through an incision in the groin rather than the scrotum. This procedure is called a radical inguinal orchiectomy. It is performed through the groin (inguinal) approach rather than directly through the scrotum because cutting through the scrotum would disrupt the lymphatic drainage of the testicle and could potentially spread cancer cells to the inguinal lymph nodes rather than the retroperitoneal lymph nodes where testicular cancer naturally drains, which would complicate staging and treatment.
The removed testicle is sent to a pathologist who examines it under a microscope to determine the exact type of tumor, whether it is a seminoma or nonseminoma (and which specific subtypes are present), and whether the cancer has started to grow into nearby structures like blood vessels within the testicle. These features all factor into the staging and treatment planning.
It is worth noting that a scrotal biopsy, in which a small piece of the testicle is removed for examination while the rest of the organ is left in place, is not done for suspected testicular cancer because of the risk of disrupting the normal lymphatic drainage. The standard is to remove the entire testicle.
- CT scan of the chest, abdomen, and pelvis: After the testicle is removed, staging is completed with a CT scan of the chest, abdomen, and pelvis with contrast. This imaging looks for enlarged lymph nodes in the retroperitoneum (the most common first site of spread), metastases to the liver, and metastases to the lungs. The size and distribution of any enlarged lymph nodes and the presence or absence of distant spread are key factors in determining the overall stage of the disease.
- MRI of the brain: Brain MRI is not done routinely in all testicular cancer patients but is ordered when there is advanced disease, very high tumor markers, or symptoms that might suggest brain involvement. Brain metastases from testicular cancer are uncommon but can occur in patients with advanced nonseminoma, particularly with very high hCG levels, suggesting choriocarcinoma elements.
- Pathology and molecular testing: The pathologist who examines the removed testicle will provide a detailed pathology report describing the tumor type, the subtypes present, and whether there is lymphovascular invasion (cancer cells inside blood vessels or lymph vessels within the testicle), which is an important risk factor for spread in Stage I disease. The report will also describe the surgical margin, which in this case is the spermatic cord, and whether the cancer has extended to the outer covering of the testicle.
Molecular testing is not as central to routine testicular cancer management as it has become for some other cancers, because testicular cancer responds so well to established chemotherapy regimens regardless of most molecular features. However, research into the molecular biology of platinum-resistant germ cell tumors is an active area, and molecular testing may play a larger role in the future for the small subset of patients whose cancer does not respond well to standard treatment.
What’s Next: The next page in this guide is Signs and Symptoms of Testicular Cancer. If you would like to read another page in this guide, return to the Testicular Cancer 101 Guides page or choose another topic.
Sources
- American Cancer Society. Tests for Testicular Cancer. https://www.cancer.org/cancer/types/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html
- National Cancer Institute. Testicular Cancer Treatment (PDQ) Patient Version. https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq
- Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical Treatment of Advanced Testicular Cancer. JAMA. 2008;299(6):672-684. https://pubmed.ncbi.nlm.nih.gov/18270356/
- Albers P, et al. EAU Guidelines on Testicular Cancer. European Urology. 2023. https://www.sciencedirect.com/science/article/pii/S030228382302732X?utm_source=chatgpt.com
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines: Testicular Cancer. 2024. https://jnccn.org/view/journals/jnccn/10/4/article-p502.xml