Although testicular cancer is less common than other cancers, it is the most common cancer in men between the ages of 15-35. Even if they have spread outside the testicle, their chances of being treated are very high.
I- Germ cell tumors: 90% of them are germ cell tumors, these cells are the cells that make sperm. There are two main types: Seminoma and Non-seminoma.
-Seminomas: They grow and spread more slowly than non-seminomas. Classic seminoma (95%) is seen between the ages of 25-45. spermatocytic seminoma (5%) is often seen after the age of 60. About 15% of seminomas are HCG-producing tumors.
- Non-seminomas: There are 4 types. Embryonal carcinoma, passenger gland carcinoma, chriocarcinoma, teratoma. Most of the nome seminomas are mixed tumors that may contain these types.
Embryonal carcinomas are present in 40% of germ cell tumors, but pure types are only 3-4%. They tend to grow and spread rapidly. They can produce alpha fetoprotein (AFP) and Beta HCG.
Passenger secretory carcinoma; It is the most common testicular tumor in children, they respond very well to treatment, but it is very rare in adults. They almost always produce AFP.
Choriocarcinoma; It is the rare but most aggressive type. Pure types cause distant organ metastases very quickly and through blood. They can be seen mixed with other types. They produce Beta HCG.
Pure teratomas are very rare. They do not produce AFP and Beta HCG, they often occur together with other types.
Carcinoma in situ (CIS) (intratubular germ cell neoplasia.): It is a non-invasive tumor that is the initial form of all germ cell tumors. They are a microscopic diagnosis and may not necessarily turn into an invasive form.
II- Stromal Tumors: They arise from hormone-producing cells or supporting tissues (stroma) in the testicle. They account for 5% of testicular tumors in adults and 5% in children. They constitute 20%. The most important types are; They are Leidig cell and Sertoli cell tumors. Although most of them are benign tumors, some of them may spread to other regions, in which case they do not respond well to chemo and radio therapy.
III- Secondary (metastatic) testicular tumors: These are metastases of other organs to the testicle. It is the most common lymphoma. Leukemia can also be seen in boys.
Risk Factors:
1-Undescended Testis:
2-positive family history.
3-HIV infection.
4-Carcinoma in situ.
5-Previous history of testicular cancer.
6-Age: Most common between the ages of 15-35.
7- Race: It is 4-5 times more common in the white race than in the black and yellow race.
In early diagnosis, testicular examination that the person performs at regular intervals is very important.
Symptoms and signs:
1-Enlargement or mass in the testicle (especially painless)
2- Feeling of heaviness in the scrotum.
3-Coarse dull pain in the abdomen or groin.
4-Sudden fluid collection in the scrotum.
5-Enlargement and tenderness in the breasts.
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6-Waist and back pain.
DIAGNOSIS:
1-Physical examination and medical history:
2-Ultrasonographic examination:
3-Tumor markers: AFP and Beta HCG:
With these findings, in case of suspicion of testicular tumor, inguinal orchiectomy is performed and the testicle is removed and taken for pathological examination.
Once the tumor type is determined, staging for treatment is performed. In terms of 1- Computed tomography (abdominal and lung if necessary) 2- Serum tumor markers are retested after a certain period of time after the testicles are removed.
Stage 1: Tumor is limited to the testicle.
Stage 2: Tumor. It has spread to the lymph nodes in the abdomen outside the testicle.
Stage 3: The tumor has spread to other organs of the body, especially the lung and liver spread is common.
TREATMENT: The following treatments can be applied depending on the tumor type and stage.
1-Close Follow-up
2-Surgical treatments: Inguinal Orchiectomy (removal of the testicle), retroperitoneal lymph node dissection (removal of lymph nodes around the large arteries and veins in the posterior abdominal wall), removal of metastases in special cases.
3-Chemotherapy.
4-Radiotherapy:
5-High dose chemotherapy and stem cell transplantation.
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