What is a testicular tumor?

It is the uncontrolled growth of the cells that make up the testicle.

How many types of testicular tumors are there?

Testicular cells can be broadly divided into germ cells (the cells responsible for sperm production) and stromal cells (the cells that support sperm production). Cancers originating from the first class are called germ cell tumors, and these are the most commonly seen types of testicular cancer. Germ cell tumors are further divided into seminomatous and non-seminomatous types. Non-seminomatous tumors are more common.

What is the frequency of testicular tumors?

It is not one of the most commonly occurring tumors. Less than 1% of all cancers are testicular cancer. Its proportion among urological cancers is less than 5%. In Western countries, 3 to 5 cases of testicular tumors are detected per 100,000 people annually. However, in the age range of 20 to 40 years, this rate increases to 6 per 100,000.

At what ages are testicular tumors more commonly seen?

It is a disease of young men. It is much more common between the ages of 15 and 40. Although it is a rare cancer when considering all age groups, it is the most common cancer in young men.

What are the symptoms of testicular tumors?

Typically, a painless mass or hardness is noticed in the testicle. In some patients, it can cause swelling of the entire testicle.

Who is at risk for developing testicular tumors?

Patients who have had a testicle removed due to testicular cancer, or those who have had only the tumor removed from a testicle without removing the entire testis, have an increased risk of developing cancer in the remaining testicle or the operated testicle, compared to normal men. The risk of cancer is also higher in individuals with a family history of testicular cancer or those with a history of undescended testis (even if surgically corrected).

How is testicular tumor diagnosed?

If a mass is detected in the testicle during examination, the patient is evaluated with ultrasound. If a mass is also detected in the testicle via ultrasound, a diagnosis of testicular tumor is made.

Is every mass in the testicle cancerous?

No. The testicle can also have benign (non-cancerous) masses; however, it is not possible to distinguish between benign and malignant masses without pathological evaluation. In the differentiation of benign and malignant masses, elevated levels of hCG and/or AFP in the blood are guiding factors. If AFP and/or hCG levels are elevated, the mass is likely malignant. However, even if the mass is malignant, AFP and/or hCG levels may be normal. Therefore, normal results for these tests do not exclude the possibility of testicular cancer. If the physician still has doubts about the benign or malignant nature of the mass, an MRI of the testicle can be performed. Even if all findings suggest a benign mass, a definitive diagnosis cannot be made without surgical removal and pathological evaluation. In other words, if a mass is detected in the testicle, surgery is inevitable (except for cysts, which are fluid-filled masses that do not require surgery).

Testis kanser tiplerinde hCG ve AFP düzeylerinde artış tespit edilme yüzdeleri

Can't the distinction between benign and malignant be made by performing a biopsy instead of surgery?

Yes, a definitive diagnosis can be made with a biopsy; however, if the biopsy results indicate malignancy, the biopsy procedure may change the route of metastasis and make further monitoring much more difficult. Therefore, if there is a possibility that the mass is benign, it is recommended to remove the mass surgically rather than confirm the diagnosis through biopsy due to the risk of malignancy.

If the likelihood of benignity is high, only the mass is removed during surgery. A pathological evaluation (frozen section) is performed during the surgery. If the pathologist confirms that the mass is benign, the remaining part of the testicle is not removed.

How is testicular cancer treated?

The first step in the treatment of testicular cancer is the surgical removal of the testicle. The surgery can be performed through a 5-6 cm incision at the groin. The subsequent steps of treatment vary depending on the type of cancer and whether it has spread to the body (metastasis).

How is treatment approached for patients with only one testicle or both testicles affected by tumors?

In cases where there is a tumor in both testicles or a testicular tumor in a patient with only one testicle, and the tumor is smaller than one-third of the testicle, the entire testicle may not need to be removed, and only the tumor can be excised.

In such cases, the remaining testicular tissue should be closely monitored for recurrence. In fact, some patients may receive low-dose radiation therapy (radiotherapy) after surgery to prevent recurrence.

What is the post-surgery treatment?

After this stage, treatment is shaped by the type of cancer and the level of spread (metastasis). The most common area for metastasis is the lymph nodes in the back of the abdomen (retroperitoneal lymph nodes). Afterward, it can also spread to the lungs, liver, and brain. Metastasis investigation can be done with computed tomography (CT) or MRI. In addition to these imaging methods, if hCG and/or AFP levels were high before surgery, monitoring of hCG and AFP levels is conducted after surgery. If the levels do not return to normal, it indicates that the disease is still ongoing. However, if the levels were high before surgery and return to normal afterward, it does not necessarily mean that the disease has not spread. Imaging for metastasis should still be done. If the cancer has spread to any part of the body (metastasis), chemotherapy should be administered. If the cancer is pure seminoma, only radiation therapy (radiation treatment) may be sufficient after surgery.

In cases where the disease has not spread, is surgery alone sufficient?

In cases where no metastasis is detected, and if hCG and AFP levels were high before surgery but have returned to normal afterward, and the pathological evaluation indicates a low potential for disease spread, no further treatment may be necessary. These patients need to come for frequent follow-ups. If their work or socio-cultural situation does not allow for this, this alternative should not be applied.

In patients without metastasis, considering the possibility of metastases that may not be detected by imaging methods, low-dose chemotherapy could be considered as a more appropriate treatment option. Even if no metastasis is found, patients who receive chemotherapy or radiation therapy after surgery should be closely monitored, although not as frequently as those who have not received any treatment.

How successful is the treatment for testicular cancer?

In testicular cancer that is diagnosed early, the cure rate for this disease is over 90%.

How does testicular cancer and its treatment affect fertility and sexual function?

One testicle is sufficient for both sexual functions and fertility.

However, if there is already a defect in sperm production before treatment (chemotherapy, radiation therapy), the treatment may increase the risk of infertility. Testicular cancer patients are more likely to be infertile before the cancer diagnosis, compared to healthy men. Therefore, it is recommended to collect and freeze sperm from these patients before starting treatment. If infertility occurs in the future, the frozen sperm can be used for in vitro fertilization.