Focus on testicular tumours

The symptoms of a testicular tumour are often only mild at the beginning of the disease. The disease usually becomes conspicuous in the course of the disease due to an increase in the size of the affected testicle, often without accompanying pain. Rarely does a testicular tumour attract attention due to symptoms of metastasis, such as back or flank pain, breathing difficulties, fatigue or weight loss. Occasionally, unilateral or bilateral enlargement and tenderness of the breast may accompany the tumour as an expression of a hormonal disorder caused by the testicular tumour.

If you experience the following symptoms, you should urgently consult a doctor to clarify the cause:

• Nodular change in the testicle even without pain
• Enlargement of the testicle even without pain
• Pulling testicular pain
• Pain in the groin area
• Feeling of heaviness in the testicles
• Breast growth on one or both sides

If you are suspected of having a testicular tumour, various examination procedures are necessary in order to make an accurate diagnosis. These include, for example, a physical examination, laboratory tests, an ultrasound scan and, if necessary, a computerised tomography (CT) scan. Additional examinations such as magnetic resonance imaging (MRI) or skeletal scintigraphy may also be required. At our Testicular Tumour Centre, we offer you all modern diagnostic procedures in cooperation with other specialist disciplines at the University Hospital:

Medical history and physical examination
The initial consultation and urological examination are important components of the diagnostic process and provide initial indications as to whether a testicular tumour may be present. A blood sample is taken to look for certain tumour markers typical of testicular tumours.

Sonography (ultrasound examination)
Sonography is a painless and radiation-free examination to detect a testicular tumour and any metastases in the posterior abdominal cavity or liver.

Computed tomography (CT)
Computed tomography is a special X-ray examination (using a contrast medium) that illuminates the body layer by layer and can therefore visualise the exact location and size of any metastases in the abdomen or chest. However, very small metastases cannot be reliably detected with a CT scan, which is why the examination is often repeated at intervals of several months.

Magnetic resonance imaging (MRI)
MRI is not an X-ray examination, but is based on the effects of magnetic fields. The advantage over a CT scan is that the examination does not expose the patient to radiation. The disadvantages can be the very long duration of the examination and the difficult interpretation of the findings, which requires an experienced radiologist.

Positron emission tomography (PET)
In a PET scan, the activity of tumour metastases in the body is measured by administering a small amount of radioactive substance into the bloodstream. One of the strengths of the examination lies in the ability of PET to differentiate between non-vital and vital tumours. It is therefore used to assess residual tumours after testicular tumour chemotherapy and can help to evaluate the success of the therapy. Without prior chemotherapy, it is not advisable to perform a PET scan; CT or MRI should be favoured here due to the lower radiation exposure. If necessary, your attending physician at our Testicular Tumour Centre will tell you whether a PET scan is advisable for you.

Tissue sample
The tissue sample is necessary to classify the tumour, i.e. to identify the degree of malignancy and characteristics of the tumour in order to develop a targeted tumour therapy. Tissue is usually obtained as part of the surgical removal of a testicle with a malignant tumour. It is rarely necessary to obtain tissue from a testicular tumour metastasis by means of a CT-supported biopsy from the abdominal cavity or by means of a thoracoscopy.

In the early stages of the disease, surgical removal of the affected testicle is often sufficient to achieve freedom from tumours. The operation is performed via the groin. In the case of so-called high-risk tumours, additional chemotherapy or radiotherapy may be necessary (so-called adjuvant therapy). Metastatic testicular tumours are usually treated with chemotherapy and, depending on the type of tumour, in some cases also with radiotherapy or surgical removal of the metastases.

Surgical therapy
We offer the complete spectrum of surgical testicular tumour therapy, from surgery on the testicular tumour itself (including testicle-preserving surgery if necessary) to surgical removal of metastases. In around 95% of men, only one testicle is affected, in which case the remaining healthy testicle usually takes over the functions of the removed testicle.

Radiotherapy
Radiotherapy for seminoma is carried out in close cooperation with the Clinic for Radiotherapy. This has the latest radiotherapy techniques at its disposal, including intensity-modulated radiotherapy (IMRT) using RapidArc® technology, which enables targeted radiotherapy of the cancer foci while sparing the surrounding healthy tissue as much as possible. As part of a clinical trial, attempts are being made to minimise the radiation dose.

Chemotherapy
Chemotherapy is carried out on testicular tumours either to prevent a relapse of the disease in the presence of certain disease characteristics (adjuvant) or if metastases are detected. Depending on the type and duration of the treatment, it is carried out either on an outpatient or inpatient basis at the oncology and urology clinics. The side effects of chemotherapy also depend on the type of medication and its dosage. Our experienced treatment team tries to minimise the side effects as much as possible through preventative measures and medication. After intensive chemotherapy, we offer our patients a comprehensive range of psycho-oncological and socio-medical measures for physical and mental recovery, including the organisation of follow-up treatment.

Preserving fertility
In almost all cases, a testicular tumour is unilateral. With a healthy testicle on the opposite side, the fertility of the affected man is maintained in most cases even after removal of the tumour-infected testicle. In cases of doubt or if there is an existing desire to have children, we offer a fertility examination based on a sperm sample (spermiogram) in cooperation with our colleagues at the Fertility Centre (link: Fertility Centre) even before a planned operation. Sperm obtained during this examination can be frozen at this point as a "fertility reserve" and stored for the long term. If the spermiogram does not show any sperm capable of fertilisation, we can offer patients the removal of healthy testicular tissue (so-called testicular sperm extraction = TESE) as part of the upcoming testicular tumour operation, which can save a second operation for a TESE later on. This tissue is then examined by colleagues at the Fertility Centre for sperm capable of fertilisation, which can then be frozen at the patient's request.

Our network
We have access to a broad network for the interdisciplinary treatment of our patients. All necessary appointments in other departments are promptly coordinated for you in the testicular tumour consultation.

Further treatment options and counselling services

• Pain therapy for chronic pain
• Accompanying psychosomatic therapy/psychotherapy
• Rehabilitation programmes/social services

Most men notice the first signs of testicular cancer themselves. In the early stages of the disease, typical symptoms are

• a swelling or lump in the testicle (this can also be painless)
• a "feeling of heaviness" or "pulling" in the testicles or in the groin area

With advanced disease, the following symptoms may occur

• Increasing enlargement of the testicles
• Back pain due to enlargement of the lymph nodes in the abdomen
• Enlargement or painfulness of the mammary glands

However, if the disease spreads throughout the body, a variety of other symptoms may also occur. The earlier testicular cancer is recognised, the easier it is to treat and the better the chances of recovery. If you notice any abnormalities in the testicles or experience any of the other symptoms mentioned above, it is therefore essential to consult a doctor experienced in the treatment of testicular tumours.

Firstly, the doctor will ask you about your symptoms in detail and carry out a thorough physical examination. In particular, a thorough palpation of the testicles is necessary. A harmless ultrasound examination of the testicles is then carried out, which can often confirm or refute the suspicion of testicular cancer. Blood tests look for tumour markers, which can be significantly elevated in the blood of people with testicular cancer. In most people, these simple tests can already disprove or confirm the suspicion of testicular cancer. Sometimes additional X-ray examinations of the abdomen or lungs are necessary.

If the suspicion of testicular cancer is confirmed, the suspected testicle must be surgically exposed and the affected testicle completely removed. This is a relatively simple and safe operation, which is performed on an inpatient basis and under general anaesthetic.
As the healthy testicle on the opposite side takes over the function of the removed testicle, long-term side effects such as infertility, impotence or an impairment of sexual experience do not occur in most cases as a result of this operation.
Only a histological examination of the removed testicle under the microscope can usually confirm the diagnosis of testicular cancer. The histological examination also provides information about the type of tumour tissue and the spread of the tumour in the testicle itself.

Various treatment methods are available for the treatment of testicular cancer, depending on the type of tumour tissue and the spread of the disease. The tumour-infected testicle is almost always removed first via an incision in the groin.
Additional operations may be necessary to remove lymph nodes in the abdomen or metastases in individual body organs. Radiotherapy as well as surgery can be used to treat smaller metastases of testicular cancer in the lymph nodes of the abdominal cavity. Chemotherapy is usually used for testicular cancer if the disease has spread throughout the body or to reduce the risk of recurrence (so-called "adjuvant therapy"). A combination of surgery, radiotherapy and/or chemotherapy is also often necessary.
As the correct selection of the various treatment methods is complicated, the treatment must be carried out by a doctor who has experience in the treatment of testicular cancer. Only then will the best healing results be achieved.

All treatment methods in medicine can have undesirable effects. This is of course also the case with the treatment of testicular cancer. The removal of a single testicle has no effect on a man's potency. The desire for sexuality, erection, sexual experience, sperm production, ejaculation and fertility, i.e. the ability to father children, remain mostly unaffected by the unilateral removal of the testicle.
For cosmetic reasons, a testicular prosthesis can be inserted, which can help to restore the body's appearance.
Although removal of the lymph nodes in the abdomen does not usually affect potency or sexual experience, ejaculation can be lost in some people, and with it the ability to father children. Special surgical techniques can reduce this risk.
Radiotherapy usually only has a few side effects at first. Nausea, vomiting and diarrhoea can occur, but are easily managed with appropriate medication. Performance may be impaired during radiotherapy. Sperm production and therefore the ability to conceive children can also be temporarily impaired by radiotherapy. However, sperm production usually recovers quickly. Your doctor can inform you about the possible long-term consequences of radiotherapy.
The side effects of chemotherapy depend on the choice of medication and the duration of treatment. Nausea and vomiting may occur, but can often be easily controlled with the appropriate medication. For the duration of the treatment and for a few weeks afterwards, the hair on the head will fall out completely - however, the hair will grow back once the treatment is complete. Performance is usually also limited for the duration of treatment. You will be informed in detail about the special features of chemotherapy and other possible consequences by the doctors treating you. Chemotherapy can also affect sperm production and therefore the ability to have children. Before undergoing chemotherapy, it should therefore be clarified whether it makes sense to collect sperm and preserve it "as a precaution" for later artificial insemination.

Most people with testicular cancer can be permanently cured of their disease. In general, the earlier testicular cancer is recognised and treated, the easier and better! But people with advanced tumour stages can also be cured. However, the treatment is then more intensive and associated with more side effects.

Most people with testicular cancer lead a completely "normal" life after the end of treatment, just as they did before. Testicular cancer is not hereditary and not contagious! However, in order to rule out malformations in the conception of children as reliably as possible, contraception should be used during chemotherapy or radiotherapy and in the first 12 months afterwards.
Relapses after successful treatment are rare, but can occur especially in the first few years after the end of treatment. For this reason, structured aftercare is recommended for testicular tumour patients. Even if testicular cancer relapses, the disease can still be cured. This is why regular follow-up examinations by an experienced doctor are absolutely essential, even after treatment has been successfully completed - because the earlier a relapse is recognised, the better the treatment options!

The prospects of curing people with testicular cancer have steadily improved in recent years as a result of clinical trials. Existing treatment methods are reviewed and improved and new treatment methods are developed.
The chances of success for patients who are treated in clinical trials are generally better. For this reason, the aim is to treat as many patients with testicular tumours as possible in clinical trials. Ask your doctor about this!