Treatment of Testicular Seminoma in Germany

Seminoma is the most common testicular cancer, accounting for 90% of all cases. In Germany, it is successfully cured in 95% of cases. If a neoplasm is detected at stages 1-2, the probability of cure reaches 98-99%. Even at stage 3, the five-year patient survival rate reaches 75%. Testicular cancer treatment in Germany involves the use of surgical interventions, including laparoscopic and robot-assisted ones, and chemotherapy, while radiation therapy is resorted to less often.

Content

1. Diagnostics of testicular cancer
2. Surgical treatment of seminoma in Germany
3. Active surveillance after tumor removal surgery
4. Chemotherapy for seminoma in Germany
5. Radiation therapy for seminoma in Germany
6. Treatment in Germany with Booking Health at an affordable price

Diagnostics of testicular cancer

The first complaint of patients with testicular cancer is usually an increase in the size of the testicle or the appearance of a palpable dense mass. There is no pain syndrome. This is a key difference from inflammatory testicular disease, which is more common.

Ultrasound scanning is the main method of medical imaging in urology. With this method, the doctor can detect the tumor. However, ultrasound scanning does not provide information about the histological type of the neoplasm. Therefore, at the time of the initial diagnosis of testicular cancer, it is still impossible to understand whether it is a seminoma or not.

The diagnosis is clarified only after examining the tumor tissue in the laboratory. For most types of cancer, doctors perform a biopsy to determine the histological type of the tumor. Nonetheless, with testicular cancer, this procedure is not done because of the risk of spreading metastases. A histological examination is carried out after a surgical intervention to remove the testicle.

Scrotal MRI is rarely used. It is the most accurate and safest method for imaging the testicles. But there is usually no need for it, since the doctor receives a sufficient amount of information with the help of ultrasound examination. MRI is required only in complex diagnostic cases, when the tumor mimics another disease, and the doctor needs to carry out differential diagnostics, for example, with a chronic testicular abscess.

Other less commonly used medical imaging techniques include: 

• Computed tomography of the scrotal organs – only with contraindications to MRI, if the information obtained using ultrasound scanning is not enough to establish the diagnosis.
• CT scan of the abdomen and retroperitoneal space – for detecting metastases in the retroperitoneal lymph nodes or liver.
• CT scan or chest X-ray – for detecting lung metastases.
• MRI of the brain – for detecting metastatic foci in the brain.
• PET-CT – for scanning the whole body and detecting metastases of any location. 

Laboratory tests are used for determining tumor marker levels. With testicular cancer, the levels of AFP (alpha-fetoprotein), hCG (chorionic gonadotropin), and LDH (lactate dehydrogenase) may increase. Patients with seminoma do not have an increase in AFP levels, and LDH levels are a nonspecific marker. The most important is the hCG levels. This indicator can be used to assess the effectiveness of testicular cancer treatment and early detection of recurrence.

Surgical treatment of seminoma in Germany

At any stage of testicular cancer, the first treatment the patient receives is tumor removal surgery. Prior to this surgery, doctors cannot know for sure which tumor they are dealing with, since a biopsy is not done. Further treatment is planned based on the histological type of the neoplasm, its size, and blood vessel invasion.

Orchifuniculectomy or radical inguinal orchiectomy is the name of a surgical procedure for tumor resection. During the intervention, surgeons perform resection of the testicle, epididymis and spermatic cord. Doctors use the inguinal approach to avoid the spread of cancer cells. An incision is made in the lower abdomen.

This surgical procedure is minimally traumatic. Patients do not require long-term recovery. Complications are extremely rare, especially if you are undergoing cancer treatment in Germany. If diagnosed in the first stage, most testicular cancer patients will not need any other treatments.

Retroperitoneal lymphadenectomy is a surgical intervention for retroperitoneal lymph node removal. It is often used for non-seminoma types of testicular cancer, but rarely for seminoma. This is due to the fact that for the treatment of testicular cancer in the early stages with metastases or a high probability of metastasis radiation or chemotherapy is preferable, and in the advanced stages of cancer, chemotherapy is preferred. Therefore, retroperitoneal lymphadenectomy is usually performed in case of relapse or insufficient effectiveness of chemotherapy.

The standard surgery, which is performed in most departments of urology, involves making a large incision in the abdomen to remove the lymph nodes. This is a traumatic and unsafe surgical intervention, after which it takes a long time to recover. But if you opt for German testicular cancer treatment,  the malignancy with metastases in the retroperitoneal lymph nodes will be resected using a minimally invasive operation. Doctors use the following surgical interventions:

• Laparoscopic interventions are performed through short incisions in the abdomen, under the control of a miniature video camera.
• Robot-assisted surgical interventions are analogous to laparoscopy, but the intervention is performed by the "slave manipulators" of the robot, which the doctor controls remotely.

Robot-assisted interventions are most often used in urology. They are considered the safest. Although clinical evidence of the higher efficiency of robotic surgery has not yet been obtained, it is likely that due to more complete removal of the retroperitoneal lymph nodes, the risk of testicular cancer recurrence after surgery is reduced. In addition, robot-assisted operations have safety advantages. Patients suffer from complications less often, the postoperative period passes faster and easier, they lose less blood and are discharged from the department of urology earlier.

Seminoma metastasis resection is a rare type of surgery for this tumor. The cancer is usually healed before it progresses to the metastatic stage. If distant metastases appear, then chemotherapy, but not surgery, is considered the first-choice treatment option. Nonetheless, some patients require the surgical removal of lung, liver and brain metastases if chemotherapy is not effective enough or if there is a threat of life-threatening complications, when there is no time to wait for the effect of medications.

Active surveillance after tumor removal surgery

In stage 1 testicular cancer, the tumor is removed and after that most patients receive no further treatment. At the same time, the risk of neoplasm recurrence is 15-20%. If chemotherapy or radiation therapy is used after surgery, the likelihood of recurrence is reduced to almost zero.

But in this case, patients inevitably suffer from side effects. Therefore, doctors in Germany often prefer to use active surveillance. Patients are regularly examined, and additional treatment is carried out only if testicular cancer recurrence is detected. This approach does not diminish the chances of recovery, but it avoids overtreatment in 80-85% of patients in whom testicular cancer is successfully cured with surgery alone.

Active surveillance includes the following: 

• Medical examination, tumor marker tests – once every 3 months in the first year, and then once every 6 months.
• Computed tomography of the abdominal cavity and retroperitoneal space – once every 6 months in the first year, and then once a year. 

The period of active surveillance lasts 10 years. However, most patients have relapses in the first year after surgery. If testicular cancer has not returned during this time, the disease is most likely successfully cured.

Chemotherapy for seminoma in Germany

Doctors in German hospitals treat testicular cancer with metastases, as well as with a high risk of metastasis spread, using chemotherapy. It is prescribed after the surgical intervention so that the tumor does not develop again. Just 1 or 2 cycles are often sufficient, although some patients with advanced testicular cancer require 3-4 cycles of chemotherapy.

Pharmacotherapy is considered the second most important and effective treatment option after surgery. Its prescription after tumor removal minimizes the risk of recurrence by destroying metastatic foci in the retroperitoneal lymph nodes. Even at the final stage of the disease with distant metastases, chemotherapy can often cure cancer.

For most patients, a standard combination of chemotherapy drugs is sufficient to cure cancer. In case of insufficient response or early relapse, it is possible to use the second line of chemotherapy with other medications. The treatment of multiple distant metastases in Germany sometimes involves the use of high-dose chemotherapy with stem cell transplant. This treatment option is effective even in the most severe cases of testicular cancer.

Radiation therapy for seminoma in Germany

Although seminoma is sensitive to radiation, radiation therapy is rarely used for its treatment. This is because chemotherapy is better tolerated and more effective for advanced testicular cancer.

In Germany, radiation therapy can be used in the following situations: 

• Early stage of testicular cancer, after tumor removal, for the prevention of recurrence from the retroperitoneal lymph nodes.
• Advanced stage of testicular cancer with distant metastases – radiation therapy is used to suppress distant metastatic foci, most often in the brain. 

In Germany, radiation therapy in the early stages of testicular cancer involves the use of low doses of radiation. As a rule, the course of treatment lasts only 2-3 weeks.

Due to the use of quality equipment, radiation therapy provided in Germany is safer. Doctors in this country treat cancer with advanced technologies: intensity-modulated radiation therapy, image-guided radiation therapy, stereotactic radiotherapy and radiosurgery. In Germany, small metastatic brain tumors can be irradiated within a single session using the Gamma Knife or CyberKnife stereotactic equipment.

Treatment in Germany with Booking Health at an affordable price

You are more likely to be cured of testicular cancer in Germany. Plus, German testicular cancer treatment will be safer and less traumatic. Medical facilities in this country use cutting-edge technologies: laparoscopic and robot-assisted surgical interventions, very accurate and safe radiation therapy options, modern chemotherapy regimens based on international protocols. The departments of urology in German hospitals are equipped with state-of-the-art medical equipment.

To undergo testicular diagnosis and treatment in one of the German hospitals, you can use the services of the Booking Health company. On our website, you can get information about the cost of testicular treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Testicular treatment in German hospitals will be easier and faster for you, and the cost of treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide information on treatment in Germany. Booking Health will fully organize your trip to this country. We will provide the following benefits for you:

• We will select the best German hospital, whose doctors specialize in testicular seminoma treatment.
• We will solve the problem of the language barrier, and we will provide communication with the doctor of the German hospital.
• We will reduce the waiting time for the medical care program. You will undergo testicular treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in Germany will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
• We will take care of all organizational issues: we will prepare documents, meet you in Germany and take you to the hospital, book a hotel, and provide interpreting services.
• We will prepare a program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Germany.
• We will organize additional diagnostic examinations and treatment in the German hospital.
• We will buy medicines in Germany and forward them to your native country.

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help reduce the cost of treatment for testicular cancer, organize your trip to the German hospital, and you can fully focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed