Investigations for testicular cancer

To help to diagnose testicular cancer doctors recommend various investigations, including an ultrasound scan, x-rays and blood tests.

The ultrasound test can often distinguish between cancer and lumps or swelling due to other causes. It uses sound waves to build up a picture of the testes.

Explains what his cancerous lump looked like on the ultrasound screen.

Age at interview 46

Gender Male

Age at diagnosis 42

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Oh a scan is like a microphone, a long, flat microphone, which is applied to the scrotum. You don’t feel anything, you see on the screen a black and white outline of what it’s looking at and basically solid structures look white, the normal testicle looks white and you can see the outline of the other lump, what you hope to see is a fluid filled lump, which appears black on the screen. In this particular instance it was of a different texture, it was a different kind of white from the remaining testes but it was quite clearly white rather than black. So it was quite apparent this was a malignancy, or at least it was a tumour of some kind and there aren’t very many benign tumours of the testicle.

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Many men were aware of ultrasound scans as a procedure that women have during pregnancy. One man said he felt a little foolish, waiting for his ultrasound scan with a group of pregnant women. He also felt frightened because he didn’t know what was going to happen.

Describes what it is like to have an ultrasound test.

Age at interview 36

Gender Male

Age at diagnosis 29

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Can you describe how it was to have the ultrasound?

A little bit embarrassing actually because you’re sitting there with a lot of ladies who are pregnant and you know you have to sit in one of the hospital gowns and one of the dressing gowns that they give you which don’t fit (laughs), they’re tight everywhere. And so you, again you’re feeling a little bit foolish and you’re sort of like sitting there thinking I wonder, you know I wonder what they’re thinking about me you know.

Mm.

And really not understanding what is going to happen as well. So it’s frightening and you know when I had the ultrasound didn’t really know how they did it and, but it showed up on the screen what, I could see

Can you explain in detail how they did it, for other people who may be in the same situation?

Oh right yes. Well basically it’s the instrument they use looks very similar to an electric razor, it’s got a lead coming out the back of it and then it’s got kind of like a, it looks basically like an electric razor and they just move it around. It doesn’t make a noise or anything. They put a lubricant on the area that they’re checking and they scan one side and then they scan the other. And it’s not discomfort, no discomfort at all, embarrassing (laughs). And, but the, I could actually see the screen and even I could see that there was a difference in the two testes.

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The ultrasound scan doesn’t hurt, but some men found it uncomfortable, cold, messy or embarrassing. Sometimes an ultrasound scan is also used to see whether or not there are secondary tumours in the abdomen.

Recalls that the ultrasound raised suspicion of cancer and was used to check his testes and abdomen.

Age at interview 33

Gender Male

Age at diagnosis 32

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There was a fairly matter of fact approach that the hospital took. The, the ultrasound operator was a male doctor, I don’t know whether that was really, his manner was very you know confident and he was very comfortable in what he was doing. I felt at ease with him, so I don’t know whether necessarily his gender was you know relevant but his manner was very good at putting me at ease. He applied the jell to my genital area and started the scan, that was quite anx., that made me quite anxious you know, the various pauses and that, where he would appear to stop the scan and sort of almost take freeze-frames. So every time you did that your heart would sink thinking ‘What’s he detected there?’

On concluding the scan of that area he said that there was definitely something there on the testicle, his suspicion was very strongly that it would be testicular cancer and that the likelihood of surgery was very, very high. So on that basis he was, his suspicions were strong enough to suggest to me that he would then want to go on and check my abdomen, and arrange for a series of chest x-rays that day. At that point I was really quite concerned. I wasn’t really prepared for the likelihood of a spread of cancers from, from that area to be so, you know, I thought we would probably go through various other stages of investigation before you know the likelihood of secondary tumours would have been raised with me.

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CT (CAT) scans are usually done after the testicle has been removed to check for any sign that the cancer has spread to the lungs or to the lymph glands in the abdomen. The CT scan takes a series of X-rays which are fed into a computer to build up a three dimensional picture of the inside of the body. Some men said that the CT machine looked like a ‘polo-mint’, others described it as a ‘big mechanical doughnut’ with a moving bed going through the middle of it.

Older CT machines can take over 30 minutes to take all the necessary x-rays. One man remembered that he was told to ‘take a deep breath’, ‘hold it’, and then ‘relax’ over a period of 45 minutes. However, modern CT machines can take all the necessary x-rays in only take a few minutes.

Some men recalled the ‘bitter’, aniseed or liquorice flavoured drink they were given before the CT scan. They were asked to arrive in the x-ray department an hour before the scan to have this drink. The drink contains a dye, which allows areas of their body to be seen more clearly. A few men were also given a dye by injection (into a vein). This injection made some men feel warm, particularly in the groin area.

Describes the CT scan and remembers the liquid he had to drink before the scan.

Age at interview 42

Gender Male

Age at diagnosis 42

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What was it like having a CT scan?

It was quite exciting really (laughs), you see it on Casualty and things like that. The worst part of the CT scan was the fluids that they make you drink. Before the CT scan the nurse came out with this, about a litre, a couple of pints of this colourless liquid which tasted a bit like aniseed and you had to drink the lot of it er in a fairly short space of time. The first couple of cups down, I quite like aniseed and liquorice so that wasn’t too bad to start with, but by the time you’re sort of through a pint of it it’s starting to taste fairly unpleasant and not very nice. So they fortunately gave you some, lots of squash to at least give it a different flavour and make it a little bit easier to take that down. The CT scan itself basically it’s, the machine you sit on a sliding trolley or you lie on a sliding trolley which slides in and out of a ring which is probably the best way of describing it. And it’s all fairly automated I think and you know a voice from the machine prompts you to take a deep breath and hold it at different stages through the examination. I think they were doing the full body, fully body scan, I’m not sure they did the head but they did, certainly doing the abdomen and the chest. It doesn’t take very long, may be 10 minutes in total from the start of the thing going but they did come through about half way, half way through and thrust another straw at me, and some sort of thick syrupy substance I had to swallow. It think these are all dyes or they have an effect of a dye in showing up different organs or allowing them to distinguish organs on the scan.

But they didn’t have to inject anything?

No injections er no.

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Describes how he had dye injected into a vein during the CAT scan.

Age at interview 29

Gender Male

Age at diagnosis 28

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Yes CAT scan is quite a weird, a weird thing actually. You basically, you go along and you get given a jug of two pints of liquid liquorice sludge is probably the easiest way of explaining it. And that they ask you to drink over about 40 minutes. And what I later found out was obviously this is what colours up in terms of they can see what they need to see. Now funny enough the CAT scan was probably my most nerve-wracking and daunting part of it all and to be honest it’s not really a lot. And just simply because it all suddenly hit me about what was going on and what was about to happen.

So I drank this sludge, then asked to get into a gown and then you go and sit in an anteroom and then you go in to have the CAT scan. Now the thing about the CAT scan is it’s a very daunting odd-looking machine, it is actually very, very nerve-wracking. And what they ask you to do is that you go in there and they inject again another fluid inside of you which they, the funny thing is they said right okay this is for, it might hurt a little bit, you’ll get a metallic taste in the back of your throat er and you might feel that you want to wet yourself.

Where does the injection go?

In the arm, I had one in the arm. You’re actually lay like this inside it, so your arm is behind the CAT scan, you’re actually inside the CAT scanner.

Does the injection go into your vein or

Yes it goes into your veins. So basically that, you lay back and it’s actually over surprisingly a lot quicker than I thought it would be. You literally just lay back and it takes, it took me four, three or four bursts of about ten seconds where you hold your breath, it takes its pictures and then that’s it you know, then you’ve finished.

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Some men remembered having an investigation called Magnetic Resonance Imaging (MRI). This test uses magnetism to build up cross-sectional pictures of the body. The MRI machine was also described as a ‘big, big, doughnut’. The MRI test doesn’t hurt, but can take up to an hour, and one man remembered the clanking noise and his feelings of claustrophobia. However, one man recalled that he quite enjoyed it.

Describes his experience of an MRI scan.

Age at interview 50

Gender Male

Age at diagnosis 44

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You remembered that you’d had an MRI, a magnetic resonance imaging scan. Can you say a bit about that please?

Yeah that’s a bit like, it’s like an extended CT scan. You’re put into an enclosed tube, very claustrophobic and in my case it was done as a, it was done as sort of an experiment to see what they could actually see in compared to a CT scan. It was like a teaching hospital and they were interested in research. So they inject some dye into your veins, you’re in this enclosed unit and you basically, you wear headphones because it’s extremely noisy, it’s like a magnet that’s sort of revolving around you and theres a tremendous clonking noise. And they take a more detailed scan than a CT scan will take. It’s , it can be sort of frightening I think because you’re sort of, your head is enclosed, it’s like being in a cave and you can’t see anything and they’ve got sort of cameras on you so that you now they’re looking at you and it’s quite an experience really. It didn’t actually show up any difference to what they thought anyway from the CT scan so it was just sort of something else that they did.

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Lymph angiograms are never done nowadays, but two men who both had testicular cancer many years ago, recalled their ‘harrowing’ experience of this test.

Describes his experience of a test which is not done nowadays, a lymphangiogram.

Age at interview 43

Gender Male

Age at diagnosis 26

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I had to have another test which was called a lymphangiogram. Now they tell you this and they say that they inject a dye in your feet, er in the lymph nodes in your feet and this dye goes through your lymphatic system and they can tell when they x-ray you whether your lymph nodes are affected by any tumours. So you go in there and you think fine they’re just going to inject my feet okay.

It was one of the most harrowing experiences of my life er it was done in the x-ray department or the radiology department as they call it. And apparently not many of these are done so at the time they said could the staff, which usually are mostly women, could they watch just to see it being done. So of course I agreed, fine, just laying there while a house doctor comes down and it turns out that they have to, they inject between my toes anyway or in between my big toe and the next toe in each foot a local anaesthetic which isn’t very nice anyway because it’s a very tender area. And then the house doctor comes down, and make an incision in your foot further up your feet where hopefully he can find the lymph node. Hopefully you won’t feel this because the local anaesthetic is taking effect. Hes cutting into your feet to find these lymph nodes and then they inject the lymph nodes with this dye.

So it turns out that he took quite a time finding the lymph node after cutting my foot, consequently the anaesthetic was running out. Then I started feeling him cutting into my foot, and I’m watching it as well, I can see it at the end, and theres this parade of women radiologists looking at me. I’m trying to stay macho and actually I was crying because it was very painful which then affects my pride in front of all these women.

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Waiting for the results of these tests can be an anxious time (see ‘Waiting for results’).

Delays in seeing a specialist

The survival rate for testicular cancer is exceptionally good. Most men can now be completely cured, even if the cancer has spread beyond the testicle....