Diagnostic of Testicular Yolk sac Tumor
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University Hospital of Ludwig Maximilian University of Munich
Department of Adult and Pediatric Urology, Andrology
The Department of Adult and Pediatric Urology, Andrology offers the full range of services in the areas of its specialization. Men and boys with diseases of the reproductive system can be diagnosed and treated in the medical facility. Doctors also treat infertility and erectile dysfunction. Medical care is provided to men and women with diseases of the urinary system, namely kidneys, ureters, bladder, and urethra. The department is certified as the Prostate Cancer Center by the German Cancer Society (DKG), which indicates the excellent quality of the services provided in this area. The department's urologists have a perfect command of the innovative treatment methods, including holmium laser enucleation of the prostate (HoLEP), photodynamic therapy, and da Vinci robot-assisted surgery. The department employs comprehensively trained and experienced doctors who apply advanced medical achievements in their practice. Each patient is provided with an individual approach, considering their specific needs and wishes.
Department of Adult and Pediatric Urology, Andrology
The Department of Urology annually examines more than 480 patients with suspected testicular yolk sac tumor. The doctors carefully examine the epididymis with modern imaging techniques and perform biopsy with a histological test of the material obtained. The department is headed by Prof. Dr. med. Martin Kriegmair, who is a member of the German Society of Urology, as well as of the European and American Association of Urologists.
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology provides high-precision diagnostic examinations and effective treatment for diseases of the genitourinary system and reproductive system in men and boys. Of particular interest is drug therapy and surgical treatment of prostate, bladder, kidney, testicular, and penile cancers. The department is part of the Comprehensive Cancer Center Ulm (CCCU). For the patient, this means that their clinical case is studied by a multidisciplinary tumor board, which determines the optimal treatment tactics. The department is also certified by the German Cancer Society (DKG), so all therapeutic procedures meet strict national and international standards. The department's team of urologists also has unique clinical experience in the minimally invasive treatment of kidney stone disease, benign prostatic hyperplasia, neuro-urological dysfunction, and all urologic diseases in children. During the surgical treatment, the specialists at the medical facility successfully use minimally traumatic surgical techniques. They perform endoscopic, laser, minimally invasive, and robot-assisted surgery using the innovative Da Vinci system. The department treats about 3,000 inpatients and 9,000 outpatients with clinical cases of varying complexity annually. The number of surgical procedures performed and treatment outcomes are regularly published by the authorized commission of the Initiative Quality in Medicine (IQM).
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the full range of diagnostics and treatment of the urinary system in men and boys. The department has a long history, rich traditions, and is also a recognized center of excellence in the treatment of all urological diseases. The department specializes in the treatment of malignant urological diseases, reconstructive surgery, pediatric urology, treatment of urinary tract dysfunction and kidney stone disease.
Department of Urology
According to the Focus magazine, the Department of Urology ranks among the top German medical institutions specializing in prostate cancer treatment! The department offers the full range of high-precision diagnostic studies and effective therapeutic options for men with diseases of the genitourinary system. The doctors of the department specialize in the treatment of prostate cancer, benign prostatic hyperplasia, kidney, testicular cancers, urolithiasis, erectile dysfunction and urinary incontinence. There are also excellent qualifications in the field of reconstructive urology.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers all types of modern diagnostic and therapeutic services for patients with urologic diseases. Of particular interest is the treatment of urogenital tumors in men and urogynecological diseases. The department also specializes in kidney transplantation, which is carried out within the specialized center. This center is the largest in Germany and Europe and annually demonstrates high treatment success rates. In addition, the department's competence covers the treatment of urological problems in boys of all age groups.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers the full range of advanced methods of diagnostics and treatment of all genitourinary system diseases, including in children. Of particular interest is the treatment of patients with urinary tract and kidney tumors, kidney stone disease, prostate diseases, treatment of urinary incontinence, andrologic disorders and urological problems in young patients. Since 2010, the department has been certified as the Prostate Cancer Center (certified by the German Cancer Society, recertified in 2016).
Department of Adult and Pediatric Urology, Andrology
According to the Focus magazine, the Department of Adult and Pediatric Urology, Andrology ranks among the best departments in Germany specializing in prostate cancer treatment! The department offers the full range of diagnostic and therapeutic services in the fields of its expertise. The department's medical team specializes in the treatment of diseases of the urinary tract in women and men, as well as in the treatment of pathologies of the reproductive system in adult men and children, andrological diseases in men. The primary focus of the clinical practice of the department's doctors is medical care for patients with kidney, bladder, ureteral, urethral, prostate, testicular and penile cancers. The department's specialists keep pace with medical innovations, so most surgical interventions are performed using sparing laparoscopic techniques that do not require large incisions in the skin and soft tissues. To treat prostate cancer, doctors successfully use robot-assisted prostatectomy with the da Vinci surgical system. This intervention has many advantages over classical surgery and is available only in the best hospitals in the world. In addition, the department's doctors demonstrate excellent results in the treatment of kidney stone disease, urinary incontinence and pelvic organ prolapse. A specially trained team of doctors has been formed for the treatment of urological pathologies in children. Of particular interest is the correction of congenital genitourinary anomalies in young patients.
Department of Urology
According to the Focus magazine, the Department of Urology ranks among the top medical institutions in Germany specializing in prostate cancer treatment! The department offers the full range of diagnostics and treatment of urinary tract diseases in men. Of particular interest are kidney transplantation, treatment of benign and malignant urologic diseases. The department has become one of the pioneers in the field of minimally invasive robot-assisted surgery (da Vinci), thanks to which it has exceptional experience in this area. In addition, the department became the second medical facility in Germany, which performed kidney transplantation using a da Vinci robotic system.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department has all the diagnostic and therapeutic options to provide first-class medical care for patients with diseases of the genitourinary system. The priority focus is reconstructive urology, in particular, the whole range of urethral surgery, procedures for the treatment of urinary incontinence (including artificial sphincter implantation, sling procedures), as well as penile surgery for congenital or acquired malformations, prosthetics in case of erectile dysfunction.
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology offers the diagnostics and treatment of all diseases of the urinary system organs (kidneys, ureters, bladder, urethra, etc.), as well as of the male reproductive organs in adults and children. The department specializes in the surgical and drug treatment of oncological diseases, correction of complex malformations, and plastic reconstructive urology. The department is the certified Prostate Cancer Centre.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers services for the diagnostics and treatment of diseases of the kidneys, urinary tract and pathologies of the reproductive organs in men. The therapeutic options are complemented by the treatment of urological problems in children. The department's doctors focus on the patients with oncopathologies (prostate cancer, renal cell cancer, bladder cancer, testicular cancer). Of particular interest is minimally invasive therapy of stones in the kidneys, ureters and bladder. The doctors have in their arsenal conventional and the very latest conservative, drug and surgical therapies, which allow them to achieve the best result in clinical cases of varying severity.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the widest range of modern diagnostic and therapeutic methods for accurate detection and treatment of diseases of the genitourinary system in men and boys. The priority focus of the department is the treatment of prostate cancer (certification of the German Cancer Society).
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology provides high-precision diagnostics and effective treatment of the full range of diseases of the kidneys, urinary tract, bladder, prostate, testicles and their appendages, vas deferens and penis. The treatment of urologic cancers is of particular interest. The focus of pediatric urologists is on young patients with congenital and acquired malformations of the genitourinary system. The department has its in-house advanced operating rooms, an X-ray unit, and two stations with 57 beds. The high quality of medical care is confirmed by many prestigious certificates, including the DEKRA certificate and the certificate of the European Board of Urology. As one of the best urologic facilities in Germany and a leading urology clinic in Munich, the department has been offering patients the daVinci robot-assisted surgery since 2009, which has many advantages for patients: minimal pain, speedy recovery, the highest level of precision compared to conventional surgical interventions.
Department of Urology
According to the Focus magazine, the Department of Urology is included in the ranking of the top German departments for prostate cancer treatment! The department offers the full range of diagnostics and treatment of diseases of the kidneys, bladder and urinary tract, male genital organs. The department has advanced experience in urologic surgery and is one of the most reputable medical institutions specializing in the treatment of benign and malignant prostate diseases. In 2009, the department was certified by the German Cancer Society as the Prostate Cancer Center.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the best German medical facilities for prostate cancer treatment! The department offers all diagnostic and therapeutic services in the field of its competence and specializes in the treatment of diseases of the genitourinary system in men of all age groups. The department has 46 beds for inpatient medical care. One of the key focuses is prostate cancer treatment (certification of the German Cancer Society as a Prostate Cancer Center). The doctors of the department are also highly professional in the treatment of diseases of the external genital organs in men, pathologies of the kidneys, adrenal glands, ureters, bladder and urethra in men and women.
Yolk sac tumors are malignant neoplasms that most often develop in the organs of the reproductive system. They are usually detected in childhood and adolescence, as well as in young people. The disease can be cured if you get medical care at a good hospital. You are welcome to visit the Booking Health website to make your appointment for diagnostics and treatment abroad.
Content
- What is a yolk sac tumor?
- Clinical diagnostics
- Early diagnostics of yolk sac tumors
- Instrumental diagnostics
- Tumor marker blood tests
- Which hospital is it best to visit for testicular cancer diagnostics?
What is a yolk sac tumor?
Yolk sac (endodermal sinus) tumors are malignant germ cell tumors developing from primitive cells. They are similar in their structure to the mesenchyme of the yolk sac.
These neoplasms are found in pure form or as part of mixed germ cell tumors. They produce the alpha-fetoprotein (AFP) tumor marker, which can be determined during the initial diagnostics of the disease, and can be used to assess the effectiveness of treatment and early detection of a relapse after surgical treatment.
Pure yolk sac tumors are the most common in childhood. In adults, these are predominantly a component of mixed neoplasms. A pure yolk tumor is considered to be prognostically favorable. It responds well to treatment and rarely recurs. Metastases are very rare. The best prognosis is noted in the age group up to 3 years.
A yolk sac tumor can have any localization. It usually affects testicles in men and ovaries in women, but there are also extragonadal (outside the reproductive system) neoplasms.
Yolk sac tumors in adult men are usually associated with other types of testicular cancer such as teratoma, seminoma, choriocarcinoma, or fetal carcinoma. A pure yolk sac tumor is the most common neoplasm in childhood. The median age at diagnosis is 18 months. Mixed tumors are most often detected in adolescents and young men over the age of 20 years.
Yolk sac tumors rarely affect women's ovaries. They account for up to 15% of all germ cell neoplasms of the ovaries. Ovarian neoplasms are usually diagnosed before the age of 40 years. The average age of detection of a yolk sac tumor in the ovary is 19 years. Moreover, 40% of the neoplasms in the ovaries are found before menarche. As a rule, only one ovary is affected, and the simultaneous development of tumors in two ovaries is less common. In 60% of cases, it is a pure yolk sac tumor, and in 40% of cases, it is a component of a mixed ovarian tumor.
Clinical diagnostics
You can suspect the presence of a neoplasm in the testicle of a man by its symptoms. As a rule, they are the reason for visiting a doctor. This type of tumor, however, does not have any unique symptoms, so the final diagnosis will be established only after a histological examination of tissue samples.
The main symptoms are as follows:
- testicular swelling;
- enlargement of the size of the testicles;
- scrotal pain.
Most of these symptoms are not associated with cancer. They are caused by other testicular diseases, such as epididymitis (inflammation of the epididymis).
Some neoplasms cause signs of hormonal disorders. A yolk sac tumor is not one of them, but it can be a component of a mixed tumor. Its other components are able to produce hormones such as estrogen, testosterone, and human chorionic gonadotropin (hCG), which cause female-type breast enlargement, early puberty in boys, and the development of secondary male sexual characteristics in childhood (facial hair growth, coarsening of the voice, oily skin, and acne).
Symptoms of the advanced stage of the disease with metastasis spread to the lymph nodes and internal organs include the following:
- lower back pain;
- shortness of breath, cough, and chest pain;
- abdominal pain;
- headaches, fatigue, and fever.
Early diagnostics of yolk sac tumors
Both yolk sac tumors and other types of testicular cancer are rare oncological diseases. Their screening is not carried out in any country in the world.
In most cases, diagnosis begins after the onset of symptoms. Nonetheless, the survival rate of patients still remains at a high level as yolk sac tumors are a prognostically favorable type of cancer, and it manifests symptoms at an early stage. At the time of detection of testicular enlargement, many men do not yet have metastases in their retroperitoneal lymph nodes.
For men who want to self-diagnose testicular cancer, there are several options:
- self-examination once every several months: testicular palpation to detect lumps;
- medical check-ups once every year;
- AFP test, which checks a specific tumor marker of yolk sac tumors (at an early stage, this tumor marker can be elevated only in 60% of cases);
- scrotal ultrasound helps to detect any type of cancer at an early stage.
Instrumental diagnostics
Testicular cancer cannot be diagnosed with clinical diagnostic methods. When a tumor is suspected, various medical imaging techniques are used to visualize the lump and establish the clinical stage of the disease, and the exact type of tumor can be determined based on the results of a histological examination. Even earlier, it can be assumed by tumor marker levels.
A testicular ultrasound scan is the main method of primary tumor diagnostics. This is usually the very first examination prescribed for a patient with testicular complaints. An ultrasound scan is sufficient to distinguish cancer from other diseases such as epididymitis, orchitis, hydrocele, or varicocele. Benign tumors usually do not affect the testicles. If a solid tumor is detected, most likely it is cancer. The detection of a neoplasm in the testicle is therefore the reason for surgery to remove it.
A chest X-ray scan can be carried out to search for lung metastases. Pure yolk sac tumors rarely metastasize, especially in children.
A CT scan can be used to search for metastases in the retroperitoneal lymph nodes, liver, lungs, and other organs. This diagnostic test is more accurate than X-ray or ultrasound scans.
An MRI scan can only be used in cases where symptoms of the nervous system develop. This is the best method for imaging the brain and spinal cord. With the help of an MRI scan, doctors can detect metastases in these organs.
A PET (positron emission tomography) scan can be performed if a doctor suspects the presence of metastases (for example, due to very high tumor marker levels) but does not know exactly where they are located. PET scans the entire body. Doctors inject radioactive substances into the body, which accumulate in tumor foci more than in normal tissues due to high metabolism activity. The zones of accumulation of the radiopharmaceutical are then determined with a gamma camera. A PET scan also helps to distinguish scar tissue after surgery or radiation therapy from a cancer recurrence.
Tumor marker blood tests
Doctors do not perform a biopsy for testicular cancer. Tumor marker tests help to suggest the histological type of the tumor. When doctors know what type of tumor they are dealing with, they can better plan further treatment.
The two main tumor markers are AFP and hCG. Patients with a pure yolk sac tumor or in the presence of components of this type of neoplasm have elevated AFP levels in their blood. hCG levels can also be elevated since this tumor marker is produced by other types of cancer that are part of a mixed tumor.
When conducting diagnostics, lactate dehydrogenase (LDH) levels are also determined. This marker is not specific for yolk sac tumors. LDH levels can be elevated in many other cancers, including tumors outside of the testicle. In addition, LDH levels can be elevated in non-oncological pathologies. But LDH levels give a doctor information about the possible presence of metastases. A strong increase in LDH levels in the patient's blood indicates a high probability of metastasis.
After treatment, determining tumor marker levels, primarily AFP, helps to:
- monitor the effectiveness of treatment;
- early detect a tumor recurrence.
AFP levels drop to normal values if the neoplasm is completely removed. Maintaining high AFP levels after surgical treatment indicates a residual tumor or metastases. This is a reason for further diagnostics for a patient, additional treatment with chemotherapy, and for monitoring dynamics with repeated determination of tumor marker levels.
AFP levels can be used not only to assess the effectiveness of surgical treatment. They can be used to judge how well chemotherapy is working. If there is a response to treatment, tumor marker levels decrease. Their elevation helps to timely determine that the treatment is ineffective and not to continue it further. In such situations, doctors at foreign hospitals change a treatment regimen to get better results.
Which hospital is it best to visit for testicular cancer diagnostics?
You can visit one of the foreign hospitals to diagnose a yolk sac tumor or any other type of testicular cancer. Modern hospitals in developed countries use state-of-the-art equipment and employ highly qualified urologists and oncologists. When you opt to have medical care at such hospitals, you can expect accurate diagnostics and successful treatment of oncological diseases.
There are a few reasons for you to undergo your treatment abroad:
- testicular tumors can be diagnosed even at an early stage;
- safe diagnostic methods, including in childhood;
- foreign hospitals give preference to diagnostic procedures that do not impair reproductive function;
- accurate testicular cancer staging allows for ideal treatment planning;
- foreign hospitals have state-of-the-art equipment for accurate diagnostics of oncological diseases;
- doctors at foreign hospitals can assume the histological type of the tumor even before the histological examination of tissue samples, which affects the choice of treatment tactics.
You can get information about hospitals, doctors from foreign hospitals, and the cost of treatment on the Booking Health website. On our website, you can make an appointment for your diagnostics at one of the world's best hospitals and compare the cost of treatment at different hospitals to choose the most suitable option at the best price. The specialists from the Booking Health company will help you to choose a hospital and organize your trip. When making your appointment through the Booking Health service, the cost of treatment will be lower due to the absence of additional fees for foreign patients.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
National Center for Biotechnology