Testicular Cancer and Treatment

What are the risk factors for testicular tumors?

undescended testis

hypospadias

Decreased spermatogenesis or infertility

Family history of testicular tumor (sibling/father)

Presence of testicular tumor on the contralateral side.

With which complaints do patients with testicular tumors apply?

Painless mass in bags and eggs: It is considered malignant until proven otherwise.

Pain (may accompany in 20-27% patients)

Gynecomastia 7% (more common in non-seminoma tumors)

Back and flank pain 11% (if the tumor has spread to these areas, there may be pain)

Orchitis (in 10% of patients, the event may be accompanied by testicular inflammation)

How is the diagnosis of testicular tumors made?

The diagnosis of testicular cancer is usually made by physical examination. It generally presents as a painless, unilateral intrascrotal mass. If there is a suspicion of a mass in the testis, it is considered a malignant disease until proven otherwise. In 20-30% of the patients, there is also pain other than the mass. Pain may be due to bleeding into the tumor or secondary inflammation in 10% of cases.

Scrotal US (99%)

Serum tumor markers

AFP, B-HCG, LDH

What diseases can testicular tumors be confused with?

Epididymoorchitis, Hydrocele, Testicular torsion, Spermatocele, Hematocele, Inguinal hernia, Hamatoma, Epidermoid cyst

How are testicular tumors treated?

After physical examination, ultrasound and tumor markers, if tumor suspicion is strong, it is necessary to take the testicle containing the tumor. The testicle is removed by a surgical operation called inguinal orchiectomy, to be performed over the groin. The resulting testicular tissue is sent to pathology. The disease is staged according to the results of the pathology. For this, lung tomography, whole abdomen CT / MR, tumor markers are examined. The disease is staged and additional treatment is planned accordingly.

How is staging done in testicular tumors?

Staging is very important in terms of planning appropriate treatment and obtaining information about prognosis. “The currently recommended staging system is the TNM system. Although it is not a detectable disease, high serum tumor markers after orchiectomy should suggest metastasis or residual disease. The decrease in tumor markers to normal levels after orchiectomy does not indicate the absence of tumor metastasis.

Clinical Staging

Stage I: Tumor confined to the testis

Stage II A: Lymph Nodules < 2 cm in the abdomen

Stage II B: Presence of > 2 cm , < 5 cm lymph nodes in the abdomen

Stage II C: Presence of > 5 cm Lymph Node in the abdomen

Stage III: Supraclavicular or mediastinal lymph node involvement

Stage IV: Other Organ Involvement

Surgical treatment:Retroperitoneal lymph node dissection (RPLND) may be performed in men with advanced or high-risk cancer.

Chemotherapy:Chemotherapy drugs can be administered to treat cancerous cells that have spread outside the testicles.

Radiation Therapy: Radiotherapy can be used in some testicular cancer patients. In addition, radiotherapy can be used with chemotherapy in some patients who have metastases or are not suitable for surgery.

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