What tests should patients with testicular cancer do

Testicular cancer is a serious male disease that mainly occurs in young and middle-aged people. Its early symptoms are not obvious, so it is difficult to detect. Testicular cancer poses a great threat to the patient's physical health and reproductive function, so early detection and timely detection of testicular cancer is crucial. So what tests can detect testicular cancer? Today, let's discuss what tests patients with testicular cancer should do.

The main examination items for testicular cancer are as follows:

1. Local inspection:

1. Testicular enlargement. Some testicles are completely replaced by tumors. Although they may be smooth, their normal elasticity has disappeared. Generally, there is no obvious tenderness.

2. Testicular tumors are often solid lumps. Sometimes, the patient's testicles are similar in size, but the affected side feels noticeably heavier than the healthy side.

3. The translucency test is negative, and there is no sense of fluctuation. However, a small number of patients in the advanced stage develop hematoma due to the influence of the tumor on the tunica vaginalis or hematoma due to the complications of effusion or tumor bleeding. In the past, some people advocated puncturing and aspirating the effusion of the tunica vaginalis before careful examination, but this is no longer adopted. Instead, surgical exploration is advocated to avoid damaging the tumor and causing implantation by piercing the layers of the tunica vaginalis, which affects the treatment effect.

In addition to examining the scrotum, other parts of the body should also be carefully examined, especially the abdomen for lumps, liver enlargement, lower limb edema, and supraclavicular lymph node enlargement.

Patients with testicular tumors should also undergo the following auxiliary examinations: such as chest and bone X-rays, CT examinations, radionuclide scanning, B-ultrasound, pyelography, experimental biochemical immunoassays, and even lymphangiography, in order to observe or speculate the scope and extent of metastasis. Physical examination can touch the enlarged testicle on the affected side, which is tough and heavy, and the translucency test is negative. The concentrations of testicular tumor markers, human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) may be increased in the serum of patients with seminoma, choriocarcinoma, embryonal carcinoma or mixed germ cell tumor, respectively. B-ultrasound shows that the testicles are uniformly enlarged, the echo is enhanced but uneven, and the blood flow signal is strong. CT examination mainly observes the metastasis of retroperitoneal lymph nodes.

2. Laboratory examination:

Mainly for serum β-HCG, AFP and LDH detection, these serum tumor markers are of great significance for treatment, follow-up and prognosis. β-HCG is synthesized by syncytiotrophoblast cells, with a serum half-life of 24-36 hours. It is elevated in the blood of patients with choriocarcinoma, embryonal carcinoma and seminoma. Elevated AFP is seen in pure embryonal carcinoma, teratoma, yolk sac tumor and mixed tumors, but pure choriocarcinoma and pure seminoma do not synthesize AFP.

The serum half-life of AFP is 5-7 days. Elevated LDH can be seen in testicular tumors, but its sensitivity and specificity are not high. The degree of increase can be used to indicate the severity or extent of the lesion. The increase after treatment can also indicate recurrence. The time required for LDH to return to normal can predict the patient's prognosis, especially for intermediate-risk patients. The longer it takes to return to normal, the worse the prognosis.

3. Imaging examination:

Scrotal B-ultrasound can help confirm the mass in the testicle and is the preferred method in clinical practice. Abdominal and pelvic CT is used to understand the situation of lymph node metastasis, and chest plain film and CT are used to evaluate the presence of lung metastasis. Therefore, abdominal/pelvic CT is an important basis for staging and grading of all patients. In the follow-up after treatment, positron emission tomography (PET) has high sensitivity and specificity for the evaluation of residual tumors after treatment.