If a person is suspected to have testicular cancer due to the presence of signs and symptoms, testicular cancer investigations are required to confirm the diagnosis of the disease. Further, these investigations can help in determining the extent of loco-regional invasion or spread of the disease to other body parts, which in turn help in choosing an appropriate treatment option. Following are some commonly used diagnostic tools for testicular cancer:
1. Ultrasound: Ultrasound of the scrotum is generally the first test performed when testicular cancer is suspected. In this technique, sound waves at very high frequency are used to produce images of the internal body structures. Using a special instrument, sound waves are directed towards the target body parts to be examined, which are reflected off the internal body parts and collected by a special probe to produce a real-time image of the tissues reflecting varying degrees of sound on a computer screen. This helps the doctor to examine both the testes along with the nearby structures for any abnormal areas. This test can distinguish testicular cancer from non-cancerous conditions such as testicular torsion, hydrocele, varicocele, spermatocele, and epididymitis.
2.Blood tests for tumor markers: Tumor markers are generally proteins or other substances produced by normal cells and cancer cells as well. However, in case of cancer, the level of these markers rises in blood, urine, or other body fluids, which can be detected by certain laboratory tests. Human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH) are common tumor markers for testicular cancer. Assessment of levels of these markers is very useful in testicular cancer as the blood level of these markers convey useful information concerning diagnosis, staging, prognosis (course of a medical condition), disease progression/recurrence, and response to treatment.
-HCG: HCG is a glycoprotein consisting of 2 subunits – alpha and beta. HCG level in blood is generally measured with the help of beta-subunit. An elevated level of HCG is usually associated with embryonal carcinoma, choriocarcinoma, and seminoma. Extremely high level of HCG is generally detected in choriocarcinoma. However, an increase in the level of HCG can also be seen in other cancer types such as prostate, bladder, ureteral, renal cancer, etc.
-AFP: An elevated level of AFP is usually associated with embryonal carcinoma and yolk sac tumors. Seminomas and choriocarcinoma do not increase the level of AFP. However, increased level of AFP may also be found in patients with hepatocellular carcinoma, liver cirrhosis, hepatitis, etc.
-LDH: LDH is an enzyme which helps in energy production and normally found in almost all body tissues. An elevated level of LDH is generally associated with the tissue damage. In patients with testicular cancer, it is usually related to tumor burden, disease prognosis, and indicates the response to treatment.
3.Inguinal orchiectomy: If the abnormal area(s) are observed during the ultrasound examination, the doctor may recommend high inguinal orchiectomy (surgical resection of the affected testicle). Orchiectomy is considered most important for pathological diagnosis and as a curative procedure for testicular cancer. The entire tumor along with the affected testicle and spermatic cord (containing part of the vas deferens), and associated blood and lymph vessels (that can provide passage for cancer spread) are removed during the procedure. The collected sample is then tested in a laboratory to find out the type and extent of disease.
4.Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to diagnose the extent of locoregional invasion and spread of disease to the distant organs. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect any signs of disease progression/recurrence.
-Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
-Positron emission tomography (PET) scan: This technique uses a radioactive substance (fluorodeoxyglucose [FDG], etc) that is given via intravenous injection prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose unsuspected spread of disease to distant body parts. It is usually combined with CT scan (PET/CT). The indications of PET are very limited in testicular germ cell tumor, mainly in recurrent NSGCT.
-Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
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