Testicular Cancer

What is testicular cancer?

Testicles (popularly known as eggs or testicles) are a pair of organs that are part of the urogenital system and produce the sperm necessary for reproduction. Testicles also produce the male hormone, namely “testosterone”. Testicles are normally the size of an average walnut.

Testicular cancer is the uncontrolled cell proliferation within the testicle. This uncontrolled proliferation can invade the entire testicle and surrounding tissues or spread to distant places, that is, metastasize. Testicular cancer is rare compared to other types of cancer, and its incidence is roughly 1 in 250 men. The average age of occurrence is 33. Risky situations for the development of testicular cancer are having a history of previously undescended testicles or having a family history of testicular cancer.

What types of testicular cancer are there?

There are different cell types in the testicle and different types of testicular cancer can develop from them. However, the most common of these are cancers that develop from germ cells (�) and there are two types whose treatments are quite different from each other. 1-Seminomas: There are two types of seminomas. Classic type seminoma is more common between the ages of 25 and 45. Spermatocytic seminoma is seen in people in their sixties and can increase the level of the hormone called human chorionic gonadotropin (hCG) in the blood.

2-Non-seminomatous testicular tumors: There are 4 subtypes of this type. These are embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma. These are rarely found pure. They often occur together in the same cancer at different rates. These tumors secrete tumor markers called hCG and alpha-feto protein (AFP). Non-seminornatous testicular tumors reproduce much faster than seminomas and spread rapidly to distant places, especially to the lymph nodes in the abdomen. Sometimes seminoma and non-seminomatous testicular tumors can coexist, in which case they are treated like non-seminomatous testicular tumors.

Can testicular cancer be diagnosed early?

Testicular cancer often causes a hard, palpable mass. Sometimes, one testicle may swell and appear larger than normal. For early diagnosis, healthy men can examine their testicles once a month after each bath and consult a doctor in case of doubt.

How is testicular cancer diagnosed?

Generally, testicular tumors are noticed by patients and they consult a doctor. After the doctors examine the patient, ultrasound is performed (Figure) and the diagnosis of testicular tumor becomes clear. In addition, the patient is asked for blood levels of the tumor markers (AFP and hCG) mentioned above. A high AFP level indicates that the patient’s cancer always has a non-seminomatous part. In addition, serum lactate dehydrogenase level, which is a third tumor marker and generally indicates widespread disease, is also checked. Once the diagnosis is clarified, the patient is prepared for surgical treatment, that is, testicle removal.

How is surgical treatment performed in testicular cancer?

Biopsy is not performed in testicular tumors because there is a risk of spreading the tumor. Instead, except for special cases such as the patient having only one testicle, the entire cancerous testicle is removed through an incision made in the groin area. This procedure is called “radical orchiectomy” surgery. The removed testicle is sent to the pathology center for microscopic examination. Before or after surgical treatment, a computed tomography (CT) scan is performed by administering intravenous medication to the lungs and abdomen to determine whether the cancer has spread to any place in the body. In some cases, magnetic resonance (MR) imaging, PET-CT and bone scintigraphy may be added to the evaluation. After the surgery, it is checked whether the tumor markers return to normal levels. If tumor markers are still high after surgery, it indicates that cancer may be somewhere in the body.

How is the treatment process guided after testicle removal?

At this stage, the patient is staged using the above-mentioned examinations. For this purpose, a staging system called TNM is generally used. Below isa simple summary of this.

Stage I: Cancer is limited to the testicle and there is no disease elsewhere in the body

Stage II: There is disease in the lymph glands in the abdomen (under the diaphragm/regional)

Stage III: There is disease in the lymph nodes in the rib cage and/or lungs and/or other organs.

Treatment of testicular tumors is planned by bringing together different medical branches depending on many pathological and clinical factors. The branches that are likely to be involved in the treatment process can be summarized as follows. Urology, Pathology, Radiology, Nuclear Medicine, Medical Oncology, Radiation Oncology. UROPARK physicians make plans for the patient to receive world-class treatment by contacting these branches. Generally speaking, Stage I Due to pathological factors in the disease; The patient is either only followed up or given preventive chemotherapy. In stage II and III disease; The treatment process usually starts with chemotherapy, depending on the size and number of lymph nodes and taking into account the patient’s pathology. If there are lymph nodes that do not disappear after chemotherapy, they are surgically removed. In addition, if serum tumor markers do not return to normal after testicle removal, the treatment process similarly begins with chemotherapy. Although rare, radiotherapy also contributes to one stage of the treatment in seminoma cases.

What is the course of testicular tumors?

Since testicular tumors are rapidly proliferating tumors, they generally respond to chemotherapy. Therefore, its clinical course is good except for advanced stage cancers.