Testicular Cancer Symptoms, Diagnosis and Treatment
The testicle is an egg-shaped, spongy organ surrounded by a tight sheath. At the top of this egg-shaped organ, there is a separate, rubbery tubular structure. Sperm matures in this organ called epididymis before being expelled from the body. Under normal conditions, the consistency of the testicles should be uniform and there should be no significant difference in the size of both testicles. The most important thing to know about testicular tumors is that the success of treatment is very high. Early diagnosis further increases this success.
What are the symptoms of testicular tumor?
Until proven otherwise, a mass, swelling, or hardness within the testicle should be considered a potential tumor. Half of men diagnosed with a testicular tumor will have noticed a painless swelling or enlargement in their testicles before receiving this diagnosis. About 25-50% of those diagnosed with this diagnosis also complain of pain or tenderness. Patients may also describe a dull pain along with the mass.
Unfortunately, there is a delay in consulting a doctor due to these symptoms, and this delay is approximately 5 months on average. Since the disease may spread during this delay, it is very important to consult a urologist as soon as symptoms appear.
Tests that the urologist may use are ultrasonography and tumor markers. Ultrasonography is a simple and non-invasive test and is very valuable for confirming the diagnosis and for differential diagnosis in doubtful cases. Tumor markers are proteins produced by tumors that are studied from a patient’s blood sample. Detection of these markers above normal limits is very significant in terms of diagnosis, and their presence within normal limits does not indicate that a tumor is not present.
What are the stages of testicular tumor?
Stage A: The tumor is only in the testicle.
Stage B: The tumor has spread to the lymph nodes in the abdominal area.
Stage C: The tumor has spread to the lymph nodes in the abdomen and beyond (most commonly to the lung).
Chest and abdominal tomography and tumor marker levels are used to determine the stage of the disease.
How are testicular tumors treated?
In cases where a tumor is thought to be present or a tumor is suspected, the testicle is removed through a small incision made in the groin. Meanwhile, a prosthesis can be placed instead of the testicle removed for cosmetic reasons.
What will determine the course of treatment is the pathology of the removed organ. Because testicular tumors are classified according to their cell types, and these cell types determine both the behavior of the tumor and the treatment it will respond to.
Testicular tumors are divided into two main groups: seminoma and non-seminoma.
a- Seminomas behave better and are sensitive to both radiotherapy and chemotherapy. Low-stage seminomas can be treated with radiotherapy alone.
b- For non-seminoma tumors, observation, surgery and chemotherapy options may be available, depending on their stage and risk factors.
Surgery (retroperitoneal lymph node dissection-RPLND) can be performed to determine the lymph node spread in the abdominal area (for staging purposes) in low-stage non-seminomatous tumors, and it can also be performed to remove the mass left behind after chemotherapy in more advanced stages.
The first treatment for patients presenting with advanced disease is chemotherapy. The treatment usually applied is the BEP protocol, in which 3 agents are given together (Bleomycin, Etoposide, CisPlatin). This treatment is given 3 or 4 times in 3-week cycles.
What are the response of testicular tumor to treatment and the effects of treatments on patients?
Removing one testicle does not affect the patient’s sexual life because the other testicle produces sufficient testosterone. Although chemotherapies can negatively affect the ability of the remaining testicle to produce sperm, this effect is usually temporary.
After lymph node surgery (RPLND), some patients’ ejaculation function is impaired. However, with the nerve-protective techniques applied today, this problem is almost never seen.
However, due to the potential negative effects of both chemotherapy and surgery, patients may want to keep their sperm in a sperm bank before treatment.
Testicular tumors may recur despite treatment and therefore close monitoring is required. The most risky period for relapse is the first two years. However, they should be monitored for at least 5 years, with examinations such as physical examination, chest radiography, tumor marker and computed tomography, and according to the scheme determined for each case.
Since the possibility of tumor development in the remaining testicle is higher than normal, the patient should regularly examine himself in this regard. The best time for examination is after a warm bath or shower, when the scrotal skin is relaxed.
How common are testicular tumors?
It is quite rare. Each year, only 3 in every 100,000 men receive this diagnosis. Although these figures are low, testicular tumor is the most common cancer in men aged 20-34. Olympic champion skater Scott Hamilton and Tour de France champion cyclist Lance Armstrong were diagnosed with testicular tumors and treated.
Are there risk factors for testicular cancer?
The only known risk factor is a history of undescended testicles (cryptorchidism). Cryptorchidism is the name given to the condition in which the testicles fail to descend from the abdominal cavity, where they form during fetal development, to the scrotum at birth. It has been observed that 5-10% of those who have undergone surgical treatment due to such a condition develop a testicular tumor (the tumor can develop in both testicles). Therefore, it is extremely important for those diagnosed with undescended testicles to have their testicles examined regularly.
What is the success rate of testicular tumor treatments?
In low-stage disease, success rates approaching 100% have been achieved by applying effective surgery, chemotherapy and radiotherapy (one or more). Even in advanced stage disease, success rates are over 85%.
How should I examine my testicles?
The most effective way to recognize a testicular tumor early is to self-examine every month. After a hot bath or shower, such a moment is very suitable for examination, as the skin of the scrotum relaxes. First, it should be observed whether there is a change in appearance, and then the presence of a mass should be investigated by sliding each testicle between the thumb and other fingers. There may also be benign masses, but most of the masses detected are cancer-related. In case of doubt, a urologist should be consulted for the correct diagnosis.