The testicles, which are part of the male reproductive system, are two oval-shaped organs in a sac called the scrotum.
While the testicles are functional in producing and storing sperm, they are also functional in the production of the hormone testosterone, which is effective in the production of libido, increase in muscle mass and formation of secondary sex characters (beard, mustache).
Testicular cancer is a disease in which malignant tumor cells develop in one or both testicles. It is one of the most common urological cancers in young men aged 18-35 years.
Testicular cancers are detected by the doctor in a routine examination or more often by the patient himself. The most common finding is painless swelling and stiffness in the testis. In addition, there may be symptoms such as heaviness in the scrotum, pain in the lower abdomen and groin, or sudden accumulation of fluid in the scrotum (hydrocele).
For early diagnosis of this type of cancer, it is recommended that men self-examine their testicles once a month after a hot shower.
Undescended testis, even if surgically descended, is a risk factor. If there is a congenital anomalies related to the penis, testis or kidneys, the susceptibility may increase. In addition, family history, infertility, genetic events such as Kleinfelter syndrome, caucasian race, cannabis use, and a previous history of testicular cancer are other risk factors for testicular cancer development.
It is absolutely necessary to perform a general examination of the patient (especially if there is a palpable mass in the abdomen?). In addition, both testicles should be carefully examined respectively. In this examination, the general structure of the palpable mass in the testis (is it hard, has irregular borders? approximate dimensions? In which localization in the testis?) is evaluated.
The internal structure of the testis, the characteristics and dimensions of the mass, and the vascularity of the tumor are evaluated if Scrotal Doppler Ultrasonography is performed.
In testicular cancer, the serum levels of some markers secreted by cancer cells into the blood are measured. These substances, called markers, help in making a specific diagnosis of secreting cancer. In addition, the level of these markers helps in determining the clinical stage of the tumor (stage of spreading to the body). These are called AFP, Beta-HCG, LDH.
MR, Computed Tomography or PET-CT can be used to evaluate lymph node involvement and metastasis, or to evaluate post-treatment response.
Stage of testicular cancer (Is it limited in the testis? Has it spread to the side formations of the testis? Has lymph node involvement occurred, and if so, what size and which node? Is there any spread to another organ in the body? What are the levels of AFP, beta-HCG, LDH in the blood?) The histologic type of cancer and the size of the tumor affect the prognosis and treatment of the disease.
Testicular cancers are malignencies that can be cured frequently. Both diagnosis and treatment of testicular cancer require removal of the testis by a surgical operation called inguinal orchiectomy, to be performed over the groin. Surgical operation should be done without losing time.
Further treatment and follow-up protocols are determined according to the pathology results. Some patients may require treatments such as a second operation, lymph node removal surgery (RPLND),radiotherapy, or chemotherapy. It requires a multidisciplinary study, especially with the participation of a medical oncologist.
Despite the response to the treatment applied in testicular tumors, recurrence (recurrence of the disease) may occur. The probability of recurrence is highest in the first 2 years. Therefore, close follow-up of the patient is very important.
The risk of developing cancer in the patient's other testicle is also increased. Therefore, the patient should examine his testis intermittently. Removal of the cancerous testis does not affect the reproductive potential and sexual life of the patient.
However, depending on chemotherapy/radiotherapy treatment, reproductive functions and ejaculation of semen may be impaired. Sperm freezing is also recommended for patients before surgery and chemotherapy. With the help of frozen sperm, it is possible for the patients to have a child after treatment period.
Although studies have shown a decrease in sperm parameters and subfertility (propensity to infertility) for men with one testis, it has been understood that the paternity rates of these individuals are similar to those of men with two testicles.
However, it is recommended to take some precautions before surgery. Additional treatments (radiotherapy and chemotherapy) may be required later, depending on the stage. These treatments may suppress spermatogenesis. The most important of these measures is to perform sperm freezing before testicular removal or before radiotherapy and chemotherapy.
Prostheses with normal testicular tissue consistency, shape and size have been developed for individuals who have lost their testicles due to testicular cancer or any other reason and want to get rid of its psychological cosmetic effect. These prostheses can be placed during or after cancer surgery.
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