How frequent are testicular cancers, what are the most frequent ages?

Although being a rarely seen as 6-11 among 100,000 men and the prevalence of all male cancers is between 1 – 1.5% , it is the most common type of cancer among young adults (15-35 years).

Why Is Testicular Cancer Increasing?

Testicular cancers are more common in countries with high income. Among the mass tumors that we call solid tumors, even in the presence of metastatic disease (splashing or spreading elsewhere), treatment rates are high, 85-90% of patients have full treatment options. However, as the tumor has the potential to spread rapidly, it requires surgery and treatment as soon as possible.

What are the causes of testicular cancer?

Generally, patients present with unilateral painless swelling and mass (stiffness). 20% of patients present with scrotal (testicular skin-subcutaneous skin and subcutaneous area) pain. Unless otherwise proven, painless scrotal stiffness should be accepted as a testicular tumor without a history of inflammatory disease. Back and side pain is seen in 11% of cases; In addition, in 10-20% of cases, hemoptysis (bloody cough), nausea, vomiting, seizures and bone fractures may occur due to metastatic mass.

What are the risk factors for testicular cancer?

Undescended  testis (testes of undescended or late stroke of the testes), Klinefelter syndrome, first-degree relatives (father, sister) testicular cancer, the presence of testicular cancer on the other testis, and infertility (infertility) more frequently seen in people with testicular cancer.

How is Diagnosis in Testicular Cancer?

In the case of suspected physical examination, stiffness is detected by hand in all or in the testis. In this case, the patient is considered to be testicular cancer until proven otherwise. In the examination, the patient is screened for lymph nodes, organ examinations and breast growth because of body spread. Acute epididymoorchitis (testicular and organ-epididymal inflammation) and testicular cancer should be differentiated; Clinically, fever, pain, swelling, flushing, and heat increase are favorable to epididymoorchitis but may not always be clearly distinguished. AFP, β-HCG and LDH tests, which we call testicular cancer tumor markers, should be performed. In addition, diagnosis should be supported by scrotal USG (ultrasound); USG is 100% sensitive in mass detection.

Are Tumor Markers in Testicular Cancer Not Sufficient for Diagnosis?

Serum tumor markers (AFP, β-HCG, LDH) help in the diagnosis, staging (the extent of the disease), predicting response to treatment, predicting prognosis (path to disease), and histological diagnosis. However, these markers are high in 51% of patients; in other words, these markers are not secreted in each cancer cell (depending on the histopathological type). In this case, high markers do not exclude cancer.
(β-HCG is a marker used in cancers of pregnant women and women.)

How is definitive diagnosis in testicular cancer?

Physical examination, tumor markers and scrotal ultrasonography can be used to establish a high rate of diagnosis. Even if the diagnosis is not fully confirmed despite these tests, it is recommended that the testis be removed and examined pathologically in case of suspicion. The definitive diagnosis is confirmed by the pathological examination of testicular tissue.

What to do if a patient has a single testicle or other testicular cancer suspicion?

If the patient has only one testicle, if the mass is not too large and if it is possible to remove the mass (testicular sparing surgery), only removing the mass can be performed.  Or, if there are tumors in both testicles of the patient, at least one testicular sparing surgery can be performed. This approach is attempted if the mass is less than 2 cm. Close follow-up of patients in this condition is required after the surgery.

What is made after pre-diagnosis in testicular cancer?

When testicular cancer is suspected, the incision on the groin and the cord containing the testicle and the surrounding membrane are removed. This procedure is called radical inguinal orchiectomy. It is considered as a Urological emergency surgery. Since testicular cancer has the potential to spread rapidly, it should be done immediately.

How is Testicular Cancer Followed After Diagnosis?

Pathologically, when the disease is confirmed, it should be determined whether the disease has spread to another place without delay. For this purpose, all abdominal tomography, lung tomography, and tumor marker levels in blood should be monitored periodically after the surgery.

How is treatment and follow-up after surgery in testicular cancer?

Treatment and follow-up is performed according to the pathology of the removed mass and according to the stage of the disease. Patients are classified according to prognostic factors and planned. Generally, tumor markers, physical examinations and imaging are followed periodically in tumors with no prognosis and limited testis. Some patients (stage I seminoma) may be treated with protective radiotherapy, single dose chemotherapy due to possible spread to the posterior wall of the abdomen; or if the patient’s situation is suitable, close follow-up can be performed .
In stage I nonseminamatic group, chemotherapy, retroperitoneal lymph node dissection (removal of lymph tissues around the main vessels in the posterior abdominal wall) or follow-up can be performed.
Radiotherapy is applied in stage II disease-seminoma.
In stage II and other diseases (spreading, metastatic), treatment is chemotherapy. According to the risk status, 3 or 4 doses of chemotherapy are applied. RPLND (retroperitoneal lymph node dissection) or follow-up is applied to the patients evaluated after each chemotherapy. Treatment rates of metastatic testicular cancer are high when the correct chemotherapy is applied at the right time. However, patients may be exposed to the side effects of these drugs during chemotherapy, they should be warned about these and after their approval, treatment should be started. Patients who end each course (chemotherapy treatment period) should be re-evaluated.
In some patients, adjuvant chemotherapy or secondary chemotheraphy is applied when resistance to primary chemotherapy or postoperative disease (live tumor cell) is reported. On a very low group of patients, despite these therapies, can spread, and these patients can be treated with more powerful (rescue chemotherapy) chemotherapy regimens, salvage surgery or  high-dose chemotherapies near bone marrow transplantation.

Are there any protective methods in testicular cancer?

Although there is no known preventive method in testicular cancer, treatment rates are quite high when disease is detected in early period. Men aged 15-35 years with the most common age should be advised and taught at least once a month for self-testicular examination (such as women doing breast examination for breast cancer). People who think that there is an abnormality in their testicles should consult a doctor immediately.

How should people with undescended testis be evaluated?

In normal development, the testes descend into the scrotal area from the postpartum abdomen (at the kidney level) at birth. In some people this may be delayed, but in 90% of children around the age of 1, the testicle is replaced. People who do not descend should be evaluated for the operation or drug treatment should be decided. For the testes, which cannot be descended to the testis and which is especially in the abdomen, it is recommended to remove(orchiectomy). Men who has a testis descended to the scrotum after normal time should be informed about testicular cancer.
One part germ (primitive embryo) cell cancers can develop on the posterior wall of the abdomen. These are called nontesticular germ cell cancers. This group of patients is usually detected in the imaging after complaints. Especially young male patients should be evaluated by Urologist. After the appropriate diagnosis, treatment should be planned and the operation performed if necessary.