Testicular Cancer

There is an increase in testicular cancer, which threatens the health of young men. Although it is one of the rare types of cancer, testicular cancer is the most common type of cancer in men between the ages of 20-35. Thanks to the developed treatment methods, it is possible to completely cure the disease in the vast majority of cases. Undescended testicles, called “cryptorchidism”, is one of the main factors that increase the risk of testicular tumors. This increases the risk of developing cancer 3-14 times. In addition to undescended testicles, which is seen in 5-12 percent of testicular tumor patients, there are also causes such as having testicular tumors in first-degree relatives (especially siblings), the presence of “Klinefelter” syndrome, a genetic disease, a previous testicular tumor in the contralateral testis, and infertility.

What is Testicle?

The testicles are part of the male reproductive system, two oval glands that sit behind the penis in a sac of skin called the scrotum. In addition to this function, the testicles produce and store sperm, producing testosterone, which is responsible for facial hair, increased muscle mass as well as sex drive (libido) development. Sperm formation and testosterone secretion are controlled by the hormones FSH and LH secreted from the pituitary.

What is Testicular Cancer?

Testicular cancer is a tumoral growth that starts in the testicles and can sometimes spread to other parts of the body. Testicular cancer occurs when cancerous (malignant) cells develop in the tissues of a testicle. Testicular cancer is most common in men aged 20 to 35 years. The disease is usually successfully treated. The incidence of testicular cancers in the right testis is 52.3%, and the incidence in the left testis is 47.7%. Cancerous cells may develop in both testicles, but this is very rare. (2-3 percent)

Abnormal Testicular Development

Conditions that cause abnormal development of the testicles can increase the risk of testicular cancer.

HIV Infection

HIV-infected men, especially those with AIDS, are at increased risk of testicular cancer.

Other Testicular Cancer History

About 3 to 4 percent of men who recover from a testicular cancer treatment also have cancer in the other testicle.

Klinefelter Syndrome

Klinefelter syndrome is also among the factors that increase the risk of testicular cancer.

What are the Types of Testicular Cancer?

About 90 to 95 percent of testicular cancers are made up of cells known as “germ cells” used in sperm production. There are two main types of testicular cancers: Seminoma and non-seminoma.

Seminoma Tumors

Seminoma tumors have these two main features:

• Tends to develop more slowly than non-seminoma tumors
• Although it usually occurs between the ages of 25 and 45, it can also be seen in older ages.

Non-seminoma Tumors (Non-seminoma)

Characteristics of non-seminoma tumors are:

• Tends to develop faster than seminoma cancers
• There are four main subtypes: Teratoma, choriocarcinoma, yolk sac tumor, and embryonal carcinoma
• It usually occurs in late adolescence and early 30s.

Other Tumors

Mixed Tumors

A testicular cancer can sometimes contain a mixture of seminoma cells and non-seminoma cells, or a combination of different subtypes of non-seminoma cells (mixed tumors).

Stromal Tumors

Stromal tumors occur in the cells of the supporting (structural) and hormone-producing tissue of the testicles, they are usually benign and are removed by surgery.

Note: Some testicular cancers begin as a condition called intratubular germ cell neoplasia (ITGCN or IGCN). In this case, the cells are abnormal, but they do not spread beyond the area where the sperm cells develop. ITGCN is not cancer; however, there is a 50 percent chance of developing into testicular cancer within five years. About 5 to 10 percent of people diagnosed with testicular cancer have ITGCN. ITGCN has similar risk factors to testicular cancer. ITGCN is difficult to diagnose because there are no symptoms and can only be diagnosed by testing a tissue sample.

What Are the Signs and Symptoms of Testicular Cancer?

Often a swollen testicle or a hard lump on the testicle is the first sign of testicular cancer. There is usually no pain in the testicles; However, pain or discomfort may be felt in the scrotum, the bag-like organ where the testicles are located in men.

Other symptoms of testicular cancer include:

• A pulling sensation or discomfort in the scrotum
• A testicle that appears larger than normal
• Mild pain in the lower abdomen and groin area
• Fluid accumulation in the scrotum (Hydrocele)

Depending on the stage of testicular cancer, other symptoms may develop, including:

• Back pain
• coughing
• Swelling in one or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. A blood clot in a large vein is called a deep venous thrombosis or DVT. A blood clot in an artery in the lung is called a pulmonary embolism. This causes shortness of breath.
• weight loss
• Infection: Testicular infection is called orchitis. Infection of the epididymis is called epididymitis. If infection is suspected, the patient may be prescribed antibiotics. If antibiotics do not resolve the problem, further testing will be needed, often with suspicion of testicular cancer.
• Tenderness or enlargement of the breasts: In rare cases, some testicular tumors produce hormones that cause breast tenderness or enlargement of breast tissue, a condition called gynecomastia.

Diagnosing testicular cancer at an early stage increases the success rate in treatment, therefore, when the above symptoms are seen, a doctor should be consulted without delay.

How Is Testicular Cancer Diagnosed?

Physical examination, testicular ultrasound and blood tests are needed for diagnosis in testicular tumors. In addition to these examinations, chest x-ray and tomography should also be taken against the risk of tumor spreading. Because, as with many tumors, late diagnosis can be dangerous. A 6-week delay in the diagnosis of testicular cancer doubles the risk of death from cancer.

When a palpable mass in the testis is detected, unless proven otherwise by tests, this mass is considered to be a tumor and treatment is started in this way. The diseased testis should be removed without delay, the necessary pathological examination should be made, and the diagnosis should be confirmed.

The following blood tests are also used to measure the levels of tumor marker proteins.

• Alpha-fetoprotein (AFP)
• Beta-human chorionic gonadotropin (beta-hCG)
• lactic dehydrogenase (LDH)
• placental alkaline phosphatase

According to the results of all tests (CT scan, MRI scan, chest X-ray) and pathological examination, subtypes that vary according to the stage and cell structure of the disease are defined. In line with the results obtained, it is determined whether an additional treatment such as “chemotherapy” or “radiotherapy” is needed. After the operation, a good follow-up should be done according to the stage and type of the tumor. As in other cancer types; With early diagnosis and appropriate treatment in a short time, the chance of success will be very high.

What are Testicular Cancer Treatment Methods?

Treatment of testicular cancer varies depending on the extent of spread of cancerous cells, the type of cancer, and the general health status of the patients. In testicular cancer, Stage 1, the cancer is found only in the testis; Stage 2 means the cancer has spread to the lymph nodes in the abdomen or pelvis, while Stage 3 means the cancer has spread beyond the lymph nodes to other parts of the body, such as the lungs. It can be said that the basic treatment technique is surgery, especially in cancer diagnosed at an early stage. In other words, if the cancer is only in the testis (stage 1), removal of the testis (orchidectomy) may be considered the only treatment required. If the cancer has spread beyond the testis, chemotherapy and/or radiotherapy may also be administered to the patient. Testicular cancer can recur or spread to other parts of the body. Therefore, follow-up care is important after successful treatment.

Operation

The main treatment for testicular cancer is to remove the testis affected by the cancer, which is called an orchidectomy. It would not be wrong to say that the main treatment method in early-diagnosed testicular cancer is surgery.

After surgery, a team of experts, including an oncologist, needs to review all the results. For example, if the cancer is more advanced, another surgical procedure may be needed to remove the lymph nodes in the abdomen.

Chemotherapy

If the cancer has spread outside the testicle or has recurred after surgery, chemotherapy is usually used to treat testicular cancer. Even if the cancer has not spread, the doctor may apply a course of chemotherapy to the patient if needed. The reason for this is to reduce the possibility of testicular cancer recurrence in the future.

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. Radiotherapy is used to treat seminoma type testicular cancers because seminomas are very sensitive to radiation. Radiotherapy can be used to prevent the cancer from recurring after the operation or in cases where the cancer has spread beyond the testis.