Introduction
The diagnosis of testicular cancer involves several individual steps and examinations. The first step is clinical diagnosis, which usually involves the discovery of the primary tumor in the testis, followed by exploration of its possible spread and spread to other organs and tissues. Surgical diagnostics are then performed.
During this procedure, the affected testicle is removed and histological (fine tissue) examination is performed. Only by summing up these two partial steps can an adequate therapy for testicular cancer be started.
- Clinical diagnosis: 97% of testicular cancer can be detected by palpation of the testicles by the doctor.
The specialist responsible for this is the urologist. The urologist carefully examines both testicles and first compares their size and condition. In the affected, usually enlarged testicle, the tumor can usually be palpated as a wood-hard tumor.
The urologist can differentiate the epididymis and the spermatic cord from the testicle and examine them for possible changes in size or tissue structure. In addition, the lymph nodes in the groin and around the inguinal canal are also palpated in order to detect possible swelling of the lymph nodes in the groin region as a sign that the testicular tumor has spread.
The next step is an ultrasound examination of both testicles. With the so-called high-resolution scrotal sonography, over 98% of all tumors can be detected.
For example, if in rare cases a testicular tumor in its early stages is not yet detected during palpation, preliminary stages can still be identified with the ultrasound examination. This method is used to further determine the consistency of the palpated hardening in the testicle. Here a distinction is made between cystic (cavities with water retention) and solid (solid) lesions.
The early forms of germ cell tumors can be easily detected by ultrasound, since so-called microcalcifications are found within the testicular tissue, which are shown in the ultrasound image as “snow flurries” or “starry skies”. It is important that both testicles are included in the examination, since testicular cancer occurs on both sides in 1% of cases. You can find more information on this topic here: Ultrasound of the testicle
- Spreading diagnostics: In this diagnostic section, any metastases are detected and the size and spread of the primary tumor within the testis is determined.
This can be detected particularly well in a computer tomogram with contrast medium, which is why such an examination is obligatory in testicular cancer. Computed tomography is performed of the thorax (chest), abdomen (upper and lower abdomen) and pelvis. With the help of this imaging, doctors can decide whether the operation also requires the removal of affected lymph nodes.
Furthermore, the liver and lungs, the organs that, apart from the lymph nodes, are mainly affected by scattering in testicular cancer, can be assessed. If metastases are found there, this is an important criterion for the staging (classification into aggressiveness stages) of testicular cancer and the selection of therapeutic measures.
- Tumor markers: The determination of specific hormones and proteins in the blood is a further step in the diagnosis of testicular cancer. Depending on the tissue origin, the tumor cells release different of these substances.
The general rule for tumor markers is that an increase in their concentration in the blood indicates tumor activity. If these levels continue to rise in the course of time, a progression of testicular cancer must be assumed. Thus, tumor markers in testicular cancer are important for monitoring the progression of the disease and for assessing the success of the therapy.
At the beginning of chemotherapy or radiotherapy, the tumor markers may also increase, but this is more likely to be a positive sign, as it indicates the death of tumor cells, which leads to an increased release of these substances into the blood. The most important markers in testicular cancer are apha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) for non-seminomas, and placental alkaline phosphatase (PLAP) for the seminoma. However, a tumor marker determination alone is never sufficient for a determination of a tissue type, as this examination is not specific enough.
It is only indicative in combination with the other diagnostic tests.
The absence of a testicle can be psychologically very problematic for men, even if medically this does not mean any influence on potency or fertility. Therefore there is the possibility to compensate the loss at least cosmetically by inserting a plastic artificial testicle into the scrotum in a second operation after the operation wound has healed. Thus, neither optically nor by touching it is recognizable for medical laymen that a testicle has been removed.
- Surgical diagnostics: Surgery for testicular cancer is both a therapeutic and a diagnostic measure. In this procedure, the affected testicle is always removed and a sample is taken from the other testicle with a small incision, as there is a small probability that the cancer will occur in both testicles at the same time (approx. 1%).
In most cases, the testicle affected by the tumor is removed through a small incision in the groin. The scrotum therefore remains unharmed. In case of an uncertain diagnosis, for example a lump visible in ultrasound, whose malignancy cannot be assessed with certainty, the testicle is first exposed and examined more closely.
In addition, the pathologist will perform a histological examination of a sample of the node in question during surgery. Afterwards the decision is made whether the testicle can be preserved or whether removal is necessary. Depending on whether lymph nodes in the groin or also in the area of the collarbone or in the abdominal cavity are affected, they are also removed during the operation.
The removed testicle and, if necessary, the lymph nodes and tissue samples are sent to the pathology department for examination and evaluation under a microscope. The pathologist’s findings are made a few days later. Only then is it clear what type of testicular cancer is involved, how malignant and advanced it is, and how it can be treated accordingly.
