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The Truth About Testicular Cancer Markers, and Detection with Pregnancy Tests

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The Truth About Testicular Cancer Markers, and Detection with Pregnancy Tests

Kim Jones

It seems like every few months, a story pops up somewhere where somebody managed to detect their testicular cancer with a pregnancy test. Yes, it's true! This can be done. In a strange coincidence of nature, the hormone called beta human chorionic gonadotropin, or HCG for short, which is emitted from the cells that form the placenta when a woman is pregnant and is what the pregnancy test looks for, can also be emitted by some types of testicular cancer. Since HCG should never be elevated in men except for in a few rare and very specific situations, a positive pregnancy test result in a man is almost a sure sign of testicular cancer! 

The latest story on this is that of Byron Geldard, from Huntingdon, Cambridgeshire in the UK, first reported in the Daily Mail, and then The Telegraph, Liftbump, and other UK based media outlets. The problem with many of these stories is that an incomplete truth, or even dangerous misinformation can often emerge. In Geldard's story, the Daily Mail had it correct and quoted Dr Danish Mazhar, Consultant Medical Oncologist at Cambridge University Hospitals, who said: "The pregnancy hormone (HCG) is often (but not always) produced by testicular tumours," meaning that a simple pregnancy test is not a foolproof test for testicular cancer. Other types of testicular cancer tumors produce another type of marker called alpha-fetaprotein, or AFP, which the pregnancy test won't detect. A third type is an enzyme called lactate dehydrogenase, or LDH, which is not reliable enough to be used as a primary indicator for testicular cancer, but is commonly used as a secondary one to gauge the extent of disease. Guess what? The pregnancy test doesn't look at this either, and it's also possible to have testicular cancer that doesn't give off any markers at all.

Which types of markers the various types of testicular cancer may or may not give off are known and very well understood. There are two main types of testicular cancers, which are called seminomas and non-seminomas. Seminomas are very simple, and 95% of the time are the classical seminomas. Non-seminomas are a bit more complicated, and are divided into embryonal carcinoma, choriocarcinoma, yolk sac, and teratomas.

Seminoma can occasionally give off HCG, but never AFP. 

For non-seminomas:

Embryonal Carcinoma can give off HCG and/or AFP, but might not give off either.

Choriocarcinoma always gives off HCG.

Yolk Sac almost always elevates AFP, but in rare cases might not.

Teratomas do not give off either type of marker. 

With the exception of seminomas, testicular cancer tumors are rarely a pure type. Non-seminomas are commonly mixed with another non-seminoma type of the cancer, or a seminoma, to form a mixed germ cell tumor. Information like this is good to keep handy because of the fact that testicular cancer is still considered a relatively rare cancer, which means there are a lot of oncologists out there that just aren't that familiar with the disease. If your pathology report says 100% pure seminoma, but your lab results are showing elevated AFP, it's a sign that something might have been missed in your pathology and that you need to get a second opinion! 

As you can see, properly detecting and diagnosing testicular cancer is a bit more complicated than just taking a pregnancy test. There's only one sub-type of testicular cancer that a pregnancy test will detect every single time, and that's choricarcinoma, but which tends to be more rare. It's a crap shoot with all of the other sub-types, as only some "can" emit the HCG marker, and others won't do so at all. Reader beware! Any article or story you see discussing how testicular cancer was detected with a pregnancy test that only talks about HCG, but makes no mention of AFP, or the possibility of no markers at all, are not giving you a complete set of information. And any story that suggests or implies the reliability of a pregnancy test for diagnosing testicular cancer without mentioning other required tests, is dead flat wrong, and very dangerous misinformation. If you suspect testicular cancer, don't 'Net MD' yourself into thinking you're okay if you take a pregnancy test and it turns out negative, because a pregnancy test hardly represents a proper work up for a patient that could have testicular cancer. 

If you suspect testicular cancer and take a pregnancy test,
a negative result can NOT, by itself, rule out testicular cancer. 
 

My personal pathology was 90% embryonal carcinoma and 10% yolk sac mixed germ cell tumor, but my cancer emit neither HCG nor AFP!  My LDH was slightly elevated, but considering I was injured at the time (from doing something incredibly stupid, I might add), it could have just as easily been elevated from that as it could have from cancer. We'll never know. With my primary HCG and AFP markers always having been negative, the only way to track my cancer during treatments and on surveillance has been radiologically. I still get blood draws and tumor marker checks at every surveillance appointment for HCG, AFP, and LDH, but they're more useful for potentially catching a second testicular cancer (knocks on wood) that might just happen to elevate one of the markers, than it is for tracking my previous cancer that never emit any. Had I depended on a pregnancy test to tell me if the ache in my right testicle was cancer or not, and then brushed off a negative result for a few months until more severe symptoms appeared, I might not be here today! Luckily, I was smarter than that, and you should be too.

I spoke to Michael Muriett, Testicular Cancer Awareness Foundation Vice President and Director of Education, who had the following to say. "We walk a very dangerous line when information like this is published in mainstream, and even more so in Social Media. The impression is given to these men that there is a quick and easy solution. Publishing stories like this without the additional, medical based, factual information in regards to tumor types, cancer marker levels, and how they can be effected can give a false sense of security to people. The best, and wisest route to take will always be consultation with a doctor, cancer screening from that doctor or a hospital, and promoting things like the monthly TSE for early detection."

Although neither the Daily Mail or The Telegraph mentioned the AFP marker, they both did a reasonably good job, assuming one read the entire article, of making it pretty clear that a pregnancy test isn't a foolproof test for testicular cancer, but can be used as a diagnostic tool. Things went terribly wrong at LiftBump however, where the author, 'Katie', with no contact information posted, completely misquoted the Trust spokeswoman mentioned in The Telegraph piece. The LiftBump piece said, "A spokeswoman for the Trust told the Telegraph that a pregnancy test can be used to diagnose, or rule out, testicular cancer, because the disease produces the same hCG hormone that is produced by a developing placenta." Wrong. They never said that. It can produce the HCG hormone, but might not, and the spokeswoman clearly stated in The Telegraph, and even quoted in LiftBump that, "if [a pregnancy test] is negative, it just means that further tests are needed." Yet somehow, LiftBump managed to add into the spokeswoman's statement that a pregnancy test could be used to "rule out" testicular cancer. That is absolutely dead flat wrong. It can not, and this is incredibly confusing, misleading, and dangerous misinformation that has now been shared 24,000 times over on Facebook, with 415,000 views as of 10PM Eastern on March 12th, 2015. Unbelievable. And yes, the LiftBump piece being shared on social media is how I personally first saw this story.

As always, know the signs and symptoms of testicular cancer, and keep doing monthly self-exams. If you detect a mass or have other signs and symptoms, feel free to take a pregnancy test, but please do the proper thing and get to a doctor immediately regardless of what any pregnancy test might say. They simply are not a reliable diagnostic tool for detecting testicular cancer by themselves. Properly working up a patient suspicious for testicular cancer requires the care of a doctor, and for other tests to be run. Even Snopes says so.


ADDENDUM, APRIL 2016

In light of how popular this blog has become, reaching the top of Google search rankings for "testicular cancer pregnancy test", I wanted to add a bit of information that I received from Dr. Phillip M. Pierorazio, MD, who is the Director of the Division of Testis Cancer at Johns Hopkins University, and also a TCAF board member

According to Dr. Pierorazio, "Only 15% of early-stage seminomas and 20-40% of NSGCT (non-seminomatous germ cell tumors) will secrete HCG. Even in cases of advanced (metastatic spread to lymph nodes or other sites) testicular cancer, only about 50% of tumors (seminomas or NSGCT) will secrete HCG." More information on the different types of testicular cancer tumor markers can be found here

Dr. Pierorazio continued, "Therefore, HCG (and pregnancy tests) are an unreliable screening test for testicular cancer.  If you feel an abnormality during testicular self-exam the first thing you NEED TO DO is contact a physician and make an appointment.  If the doctor is concerned, an ultrasound (painless) and blood tests (mostly painless) are the next correct steps.  If you’re curious while you wait, try a pregnancy test.  If it’s positive then you know the diagnosis and find the nearest testicular cancer expert.  If the pregnancy test is “negative” that does NOT necessarily mean that you do NOT have testicular cancer.

Remember, upwards of 80% of testicular cancers will NOT secrete HCG so do not rely on a home pregnancy test to prove you are cancer free!"

Steve Pake
TCAF Blog

Cross-posted at StevePake.com

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