Testicular cancer is a rare but usually easily treatable cancer that mainly affects young men between the ages of 15 and 40. It develops in the testicles, the male sex glands responsible for the production of sperm and hormones such as testosterone. Thanks to modern diagnostics and therapies, testicular cancer has a very good prognosis, especially if it is detected early. In this article, we explain what testicular cancer is, what symptoms it causes, how it is diagnosed and which laboratory values play a key role.

What is testicular cancer?

Testicular cancer usually develops from the germ cells, the cells in the testicles that produce sperm. Over 90% of cases are so-called germ cell tumors, which are divided into two main groups: seminoma-like (seminomas) and non-seminoma-like tumors (e.g. embryonal carcinomas or teratomas). More rarely, tumors arise from other cell types, such as the supporting tissues of the testicles.

The exact causes are not fully understood, but risk factors include:

• Undescended testicles (cryptorchidism): If a testicle has not descended into the scrotum, the risk increases.
• Family history: Men with first-degree relatives who have had testicular cancer are more at risk.
• Previous testicular cancer: A tumor in the other testicle increases the risk.
• Genetic factors: Certain genetic changes can play a role.

Testicular cancer is rare (about 1-2% of all cancers in men), but the incidence has increased slightly in recent decades.

Symptoms of testicular cancer

The symptoms of testicular cancer are often inconspicuous, which can make early detection difficult. The most common sign is a painless lump or induration in the testicle, which men often notice themselves during self-examination. Other possible symptoms are

• Feeling of heaviness or swelling in the scrotum: The testicles may feel larger or heavier.
• Pain or discomfort: Rarely there is dull pain in the testicles or lower abdomen.
• Enlargement of the breast (gynecomastia): Some tumors produce hormones that cause the breast tissue to grow.
• Back pain or shortness of breath: These occur in advanced cancer when metastases (metastases) develop in the lymph nodes, lungs or other organs.

As the symptoms are often non-specific, regular self-examination of the testicles is important in order to detect changes at an early stage.

Diagnosis of testicular cancer

The diagnosis usually begins with a physical examination, during which the doctor palpates the testicles for lumps or swellings. An ultrasound of the testicles is the most important imaging procedure to make a tumor visible and to rule out benign changes (e.g. cysts). If a tumor is suspected, the affected testicle is often surgically removed (testicle removal, orchiectomy) in order to examine the tissue under a microscope. Imaging procedures such as CT or MRI help to find metastases in lymph nodes or other organs.

Laboratory values, especially tumor markers, are crucial to support the diagnosis, determine the tumor type and monitor the course of the disease.

Important laboratory values for testicular cancer

Certain tumor markers in the blood are particularly important in testicular cancer, as many germ cell tumors produce substances that are detectable in the blood. The following markers are routinely measured:

1. Alpha-fetoprotein (AFP):
   • Significance: AFP is a protein that is normally produced in the fetus during pregnancy. In testicular cancer, it is often elevated in non-seminomatous tumors (e.g. embryonal carcinomas).
   • Normal range: <10 ng/ml (depending on the laboratory).
   • In testicular cancer: Elevated values indicate a non-seminomatous tumor. Seminomas do not usually produce AFP.
   • Special feature: Liver diseases or other types of cancer can also increase AFP, so the value is not specific.
     
2. Beta-human choriogonadotropin (β-HCG):
   • Significance: β-HCG is a hormone that is normally produced during pregnancy. It is elevated in some types of testicular cancer, both seminomas and non-seminomatous tumors.
   • Normal range: <5 mIU/ml.
   • In testicular cancer: Elevated values are typical for tumors that contain trophoblast cells (e.g. choriocarcinomas). Seminomas can also show slightly elevated values.
   • Special feature: β-HCG can also be elevated in other types of cancer or during pregnancy.
     
3. lactate dehydrogenase (LDH):
   • Significance: LDH is an enzyme that is released in the event of cell damage or high cell turnover. It is a non-specific marker that increases in advanced testicular cancer.
   • Normal range: 135-225 U/l (depending on the laboratory).
   • In testicular cancer: Elevated values indicate a large tumor burden or metastases, especially in seminomas.
   • Special feature: LDH is not specific to testicular cancer and can also be elevated in other diseases (e.g. liver or heart problems).
     
4. Blood count:
   • Significance: The blood count provides information on general health and possible accompanying symptoms of cancer.
   • For testicular cancer:
     • Anemia (low hemoglobin): May occur with advanced cancer or blood loss.
     • Leukocytes: Increased or decreased values may indicate impaired immune defense or tumor activity.
     • Thrombocytes: Changes are rare, but can occur with metastases or chemotherapy.
   • Special feature: The blood count is non-specific, but important for monitoring during treatment.

Significance of tumor markers

The tumor markers AFP, β-HCG and LDH are not only important for diagnosis, but also for classification, prognosis and aftercare:

• Diagnosis: Elevated markers often confirm the suspicion of testicular cancer and help to differentiate between seminomas and non-seminomatous tumors.
• Staging: Higher values may indicate metastases or a larger tumor burden.
• Therapy monitoring: After surgery or chemotherapy, the markers should fall. A renewed increase may indicate a recurrence (relapse).
• Prognosis: Very high marker values before treatment may indicate a more aggressive disease.

Important: Not all testicular cancers produce tumor markers. Around 10-20% of patients have normal values, despite the presence of a tumor. Imaging and tissue examination are therefore essential.

Treatment and progression

The treatment of testicular cancer depends on the type, stage and spread. The first step is usually the removal of the affected testicle (orchiectomy). Depending on the stage, this is followed by

• Monitoring: In early stages without metastases, regular monitoring may be sufficient.
• Chemotherapy: Used for metastases or higher risk, often with very good results.
• Radiotherapy: Frequently for seminomas, less frequently for non-seminomatous tumors.
• Surgery: removal of metastases in lymph nodes or other organs, if necessary.

The prognosis is excellent, especially with early diagnosis: the cure rate is over 95% for tumors without metastases and remains high even in advanced stages.

Conclusion

Testicular cancer is a rare but easily treatable cancer that mainly affects young men. A painless lump in the testicle is the most common symptom, which is why regular self-examination is so important. Laboratory values, in particular the tumor markers AFP, β-HCG and LDH, play a central role in diagnosis, classification and aftercare. They provide information on the type of tumor, its spread and the success of treatment. Supplemented by ultrasound and tissue examination, they enable precise diagnosis. Thanks to modern therapies, testicular cancer is now curable in most cases, especially if it is detected early. If changes in the testicles are suspected, a doctor should be consulted immediately.

Editorial office: X-Press Journalistenbüro GbR

Gender note. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple references and gendered designations are avoided for the sake of better readability ected.