In this video, CancerBro explains testicular cancer diagnosis/investigations. Watch this video to better understand how testicular cancer is diagnosed and share it with your friends to spread cancer awareness.
CancerBro, if anyone comes with a testicular mass is it always testicular cancer only?
No, not necessarily, conditions other than testicular cancer may also be present similarly. For this, we have to further investigate the patient.
The next step is testicular ultrasound. It helps us to differentiate whether the mass is intra-testicular or extra-testicular, that is, whether it is inside or outside the testis.
Then we have to see whether it is solid or cystic.
A solid, intratesticular mass goes in the favor of testicular cancer.
The next step is to do blood tests, to check for tumor markers.
Before discussing the tumor markers in detail, we will first discuss the subtypes of testicular cancer.
Testicular tumors may be broadly divided into seminomas and non-seminomas.
The non-seminomatous germ cell tumors may be further divided into embryonal carcinoma, endodermal sinus or yolk sac tumor, choriocarcinoma or teratoma.
Now, let’s discuss the tumor markers for testicular germ cell tumors according to the subtypes.
First we will discus about seminoma. In seminoma, LDH is the most commonly elevated tumor marker, and beta-HCG may be elevated in some cases.
Next comes choriocarcinoma, in which beta HCG is significantly elevated, and LDH maybe elevated in some cases.
In endodermal sinus or yolk sac tumors, AFP is significantly elevated and LDH maybe elevated in some cases.
And in embryonal carcinoma all the three, that is, AFP, beta HCG and LDH maybe elevated.
So after doing testicular ultrasound and tumor markers, the next step is systemic imaging. This helps us to diagnose the spread of the disease to other part of the body.
For systemic imaging, we require the CT scan of abdomen, pelvis and thorax.
Very rarely, we may require MRI brain or bone scan to look for the spread of the disease to brain or bones.
So after doing testicular ultrasound, tumor markers and system imaging, we are very close to diagnosis, but to be 100% sure, we require a tissue histropathology.
So for that, we do high inguinal orchiectomy, in which the involved testis is removed.
The procedure is both diagnostic as well as therapeutic because it provides tissue for histopathological diagnosis, as well as it removes the involved testis.
A pathology report after high inguinal orchiectomy confirms the diagnosis of germ cell tumor. It also tells us whether it is a seminoma or non-seminoma or whether it is a mixed germ cell tumor, having components of both.
It also tells about the sub-type of non-seminoma, that is, whether it is embryonal carcinoma, endodermal sinus or yolk sac tumor, choriocarcinoma or teratoma.
CancerBro, as you previously told, even the tumor markers can help to differentiate the various sub-types of germ cell tumors.
The tumor markers may not br elevated in all the cases, and even if they are elevated they are highly overlapping in different sub-types, so 100% diagnosis is rarely possible with just the tumor markers.
Therefor, for the confirmation of the diagnosis of testicular germ cell tumor, we require both, that is histopathology and tumor markers.
Rarely, it is possible that histopathology shows seminoma, but AFP is elevated, such cases are related as non-seminoma.
So, always remember that elevation of AFP strictly goes in the favor of non-seminoma even if the hispathological diagnosis is suggestive of a seminoma.
Once the diagnosis of the testicular germ cell tumor is confirmed, the next step is staging and risk stratification of the disease.
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