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Testicular Cancer

The incidence of testicular cancer, which typically threatens the health of young men, is increasing day by day. While testicular cancer is a rare type of cancer, it is the most commonly occurring cancer in men aged 20-35. Thanks to advancing treatment methods, the disease can be completely cured in the vast majority of cases. One of the main factors that increases the risk of testicular tumors is "cryptorchidism," which refers to undescended testicles. This condition increases the risk of cancer development by 3-14 times. In addition to undescended testicles seen in 5-12% of testicular tumor patients, other factors that contribute to the risk include having a first-degree relative (especially brothers) with testicular cancer, the presence of the genetic disorder "Klinefelter syndrome," previous testicular tumor in the opposite testicle, and factors like infertility.

What is a testis?


Testes, which are part of the male reproductive system, are two oval glands situated within a skin pouch called the scrotum, located behind the penis. Testes produce and store sperm. In addition to this function, they also produce testosterone, which is responsible for the development of facial hair, increased muscle mass, and sexual drive (libido), among other functions. Sperm production and testosterone secretion are controlled by the FSH and LH hormones released from the pituitary gland.


What is testicular cancer?


Testicular cancer is a tumor growth that originates in the testicles and sometimes can spread to other areas of the body. It occurs when cancerous (malignant) cells develop in the tissues of a testicle. Testicular cancer is the most common cancer in men aged 20 to 35. The disease is often treatable with success. The frequency of occurrence of testicular cancer is 52.3% in the right testicle and 47.7% in the left testicle. Cancerous cell development can occur in both testicles, but this is very rare (2-3%).


What are the risk factors for testicular cancer?


Risk factors for testicular cancer generally include:


Age

Most cases occur between the ages of 15 and 40. Testicular cancer is the most common cancer in men aged 20 to 35.


Race/Ethnicity

The risk of developing testicular cancer is five times higher in white men compared to black men. The risk of this disease is higher in America and Europe, and lower in Africa or Asia.


Family history of testicular cancer

A family history increases the risk of testicular cancer. If testicular cancer has occurred in a family, the likelihood of it occurring in a male sibling and/or son in the same family increases.


Undescended testicle (cryptorchidism)

Men with testicles that did not descend into the scrotum before birth are at a higher risk. Even if corrective surgery is performed to address this condition, these men still carry a risk of developing testicular cancer.


Abnormal testicular development

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


HIV infection

Men who acquire HIV infection, especially those with AIDS, are at an increased risk of testicular cancer.


History of cancer in the other testicle

About 3 to 4% of men who have undergone cancer treatment and have been cured in one testicle will have cancer detected in the other testicle.


Klinefelter syndrome

Klinefelter syndrome is also a factor that increases the risk of testicular cancer.


What are the types of testicular cancer?


Approximately 90 to 95 percent of testicular cancers originate from cells known as "germ cells," which are involved in sperm production. Testicular cancer comprises two main types: Seminoma and non-seminoma.


Seminoma Tumors:


Seminoma tumors exhibit the following primary characteristics:

  • They tend to develop more slowly than non-seminoma tumors.

  • They usually manifest between the ages of 25 and 45 but can occur at older ages.


Non-Seminoma Tumors:


Characteristics of non-seminoma tumors include:

  • They tend to grow faster than seminoma cancers.

  • There are four main subtypes: Teratoma, choriocarcinoma, yolk sac tumor, and embryonal carcinoma.

  • They are commonly seen in late adolescence and the early 30s.


Other Tumors


Mixed Tumors:

Occasionally, a testicular cancer may involve a mixture of seminoma cells and different subtypes of non-seminoma cells (mixed tumors) or a combination of various subtypes of non-seminoma cells.


Stromal Tumors:

Stromal tumors originate from the cells that constitute the supportive (structural) and hormone-producing tissue of the testicles. They are usually benign and can be removed through surgery.


Note: Some testicular cancers begin as a condition known as intratubular germ cell neoplasia (ITGCN or IGCN). In this condition, cells are abnormal but do not spread beyond the area where sperm cells develop. ITGCN is not cancer, but it carries a risk of transforming into testicular cancer, with approximately a 50 percent likelihood within five years. Around 5 to 10 percent of individuals diagnosed with testicular cancer also have ITGCN. Diagnosing ITGCN is challenging as it presents no symptoms and can only be diagnosed by testing a tissue sample.


What are the signs and symptoms of testicular cancer?


The initial sign of testicular cancer is often a swollen testicle or a hard lump within the testicle. Testicles typically don't cause pain, but discomfort or pain can be felt in the scrotum, the pouch-like structure in males where the testicles are located.

Other symptoms of testicular cancer include:

  • A pulling or uncomfortable sensation in the scrotum

  • A testicle that appears larger than normal

  • Mild pain in the lower abdomen and groin area

  • Accumulation of fluid in the scrotum (Hydrocele)

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

  • Coughing

  • Swelling of one or both legs or shortness of breath from a blood clot; these can be symptoms of testicular cancer. A blood clot in a major vein is known as deep vein thrombosis or DVT. A blood clot in an artery in the lung is called a pulmonary embolism, which causes shortness of breath.

  • Weight loss

  • Infection: Testicular infection is called orchitis. Infection of the epididymis is called epididymitis. If infection is suspected, antibiotics may be prescribed. If antibiotics do not resolve the issue, further tests may be needed, often to rule out testicular cancer.

  • Breast tenderness or growth: Rarely, some testicular tumors produce hormones that cause breast tenderness or the growth of breast tissue, a condition known as gynecomastia.

Early detection of testicular cancer enhances the success of treatment, so if any of the above symptoms are observed, it's important to consult a doctor promptly.


How is testicular cancer diagnosed?


Diagnosing testicular tumors typically involves physical examination, testicular ultrasound, and blood tests. In addition to these examinations, chest X-rays and tomography are taken to assess the risk of tumor spreading. Just like with many cancers, delaying diagnosis can be dangerous. A 6-week delay in diagnosing testicular cancer can double the risk of death due to cancer.


If a palpable mass is found in the testicle and is not disproved by tests, it is assumed to be a tumor, and treatment is initiated accordingly. The affected testicle needs to be removed promptly, and the necessary pathological examination must be conducted to confirm the diagnosis.


The following blood tests will also be performed to measure the levels of tumor marker proteins:

  • Alpha-fetoprotein (AFP)

  • Beta-human chorionic gonadotropin (beta-hCG)

  • Lactate dehydrogenase (LDH)

  • Placental alkaline phosphatase


Based on the results of all tests (CT scan, MRI scan, chest X-ray) and pathological examination, the stage of the disease is determined, and subtypes that vary based on cell structure are identified. Depending on the results obtained, the need for additional treatments like "chemotherapy" or "radiotherapy" is determined. Following surgery, appropriate monitoring is crucial based on the stage and type of the tumor. Like with other cancer types, early diagnosis and timely appropriate treatment offer a very high chance of success.


What are the treatment methods of testicular cancer?


The treatment of testicular cancer varies depending on the extent of cancer spread, the type of cancer, and the overall health of the patients. Stage 1 means that the cancer is confined to the testicle; Stage 2 indicates that the cancer has spread to the lymph nodes in the abdomen or pelvis. In testicular cancer, Stage 3 implies that the cancer has spread beyond the lymph nodes to other parts of the body, such as the lungs.


Especially in cases where the cancer is diagnosed in the early stages, surgery is often the primary treatment method. This means that if the cancer is localized only in the testicle (Stage 1), the sole treatment may involve removing the testicle (orchidectomy). If the cancer has spread beyond the testicle, chemotherapy and/or radiotherapy may be administered.


Testicular cancer can recur or spread to other parts of the body. Therefore, post-treatment follow-up care is crucial after successful treatment.


Surgery:

The primary treatment for testicular cancer involves the surgical removal of the affected testicle, a procedure called orchidectomy. In cases where testicular cancer is diagnosed early, surgery is often the main treatment method.

After the surgery, a specialized team including an oncologist will review all the results. For instance, if the cancer has advanced further, another surgical procedure might be necessary to remove lymph nodes in the abdomen.


Chemotherapy:

If the cancer has spread beyond the testicle or recurs after surgery, chemotherapy can often be administered to treat testicular cancer. Even if the cancer hasn't spread, the doctor might recommend a course of chemotherapy as a preventive measure. This is done to reduce the likelihood of testicular cancer recurring in the future.


Radiation Therapy:

Radiation therapy uses radiation to kill cancer cells. It is used to treat seminoma type testicular cancers, as seminomas are highly sensitive to radiation. Radiation therapy might be applied after surgery to prevent cancer recurrence or in cases where the cancer has spread beyond the testicle.


FREQUENTLY ASKED QUESTIONS ABOUT TESTICULAR CANCER

What are the stages of testicular cancer?


Stage 1: In Stage 1, the tumor is localized only in the testicle.

Stage 2: In Stage 2, the tumor has spread to the lymph nodes in the abdominal area.

Stage 3: In Stage 3, the tumor has spread to the lymph nodes in the abdominal area and beyond (most commonly to the lungs).


Can I still have children after testicular cancer?


After undergoing orchidectomy (surgical removal of one testicle), infertility or erectile problems are generally not common. This is because the remaining testicle compensates by producing more sperm and testosterone hormone. However, chemotherapy and radiation therapy treatments can lower fertility. Additionally, if both testicles and lymph nodes are removed during treatment, fertility can be affected.


Can testicular cancer be prevented?


There is no known way to prevent testicular cancer, but early diagnosis is crucial. Men should perform a testicular self-exam (TSE) once a month. If any changes are noticed in the testicles (such as lumps or nodules, hardness, persistent pain, or changes in testicle size), it's important to consult a doctor without delay.


The best time for a testicular self-exam is when the scrotal skin is relaxed, which can be during or after a bath.


Both hands should be used to examine each testicle. The index and middle fingers should be placed under the testicle, and the thumbs should be placed on top of the testicle. The testicles should be gently rolled between the fingers. (Different testicle sizes are normal.)


A cord-like structure may be noticed above and behind the testicle. This structure is called the epididymis. The epididymis stores and transports sperm and should not be mistaken for a lump.


Any hardness in the testicle should be checked for the presence of a mass or swelling. If any lump is felt, a doctor should be consulted. (Lumps can be pea-sized or larger and are often painless.)


What is the prognosis (chance of recovery) for men with testicular cancer?


This type of cancer is successfully treated in over 95% of cases. Even men with unfavorable risk factors have an average chance of around 50% for recovery.

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