3. Signs and symptoms of testicular cancer include swelling or discomfort in the scrotum.

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These and other signs and symptoms can be caused by testicular cancer or other conditions. Check with your doctor if you have any of the following:

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• A painless lump or swelling in any testicle.

• Change in testicular sensation.

• Dull pain in the lower abdomen or groin.

• Sudden accumulation of fluid in the scrotum.

• Pain or discomfort in the testicle or scrotum.

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4. Tests for the detection (search) and diagnosis of testicular cancer.

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The following tests and procedures can be used:

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• Physical examination and medical history: Examining the body to check for general signs of health, including checking for signs of illness such as lumps or anything else that seems unusual. The testicles will be checked for bumps, swelling, or pain. A history of the patient's health habits, as well as past illnesses and treatments will also be recorded.

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• Testicular ultrasound: A procedure in which high energy sound waves (ultrasound) are reflected off internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram.

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• Serum tumor marker test: a procedure in which a blood sample is examined to measure the amount of certain substances that enter the bloodstream of organs, tissues or tumor cells in the body. Certain substances are associated with certain types of cancer when found in high concentrations in the blood. These are the so-called tumor markers. The following tumor markers are used to detect testicular cancer:

  • Alpha-fetoprotein (AFP).

  • Human beta-chorionic gonadotropin (β-hCG).

  Tumor marker levels are measured before inguinal orchiectomy and biopsy to help diagnose testicular cancer.

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• Inguinal orchiectomy: A procedure to completely remove the testicle through an incision in the groin. The testicular tissue sample is then viewed under a microscope to check for cancer cells. (The surgeon does not cut the scrotum in the testicle to take a tissue sample for biopsy, because if cancer is present, this procedure can cause it to spread to the scrotum and lymph nodes. It is important to select a surgeon who is experienced in this type of surgery.) When cancer is found, the type is determined. cells (seminoma or non-seminoma) to help plan treatment.

5. Several factors affect prognosis (chance of recovery) and treatment options.

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The prognosis (chance of recovery) and treatment options depend on the following conditions:

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• The stage of the cancer (whether it is in or near the testicle, or has spread to other parts of the body, and blood levels of AFP, β-hCG, and LDH).

• The type of cancer.

• The size of the tumor.

• Quantity and size  retroperitoneal  lymph nodes.

6. Methods of treatment of patients with testicular cancer.

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Various treatments are available for testicular cancer patients. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment.

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Testicular tumors are divided into 3 groups depending on how well the tumors respond to treatment:

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1. Good forecast

For a non-seminoma, all of the following conditions must be met:

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• The tumor is found only in the testicle or in the retroperitoneal space (the area outside or behind the abdominal wall); 

• The tumor has not spread to organs other than the lungs; 

• The levels of all tumor markers are slightly higher than normal.

For a seminoma, all of the following conditions must be met:

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• The tumor has not spread to organs other than the lungs; and

• Level  alpha-fetoprotein  (AFP) is normal.  Human beta-chorionic gonadotropin  (β-hCG) and  lactate dehydrogenase  (LDH) can be at any level.

2. Interim forecast

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For a non-seminoma, all of the following conditions must be met:

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• The tumor is found only in one testicle or in the retroperitoneal space (the area outside or behind the abdominal wall); 

• The tumor has not spread to organs other than the lungs; 

• The level of any of the tumor markers is more than slightly higher than normal.

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For a seminoma, all of the following conditions must be met:

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• The tumor has spread to organs other than the lungs; 

• AFP level is normal. β-hCG and LDH can be at any level.

3. Poor prognosis

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For a non-seminoma, at least one of the following must be true:

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• The tumor is located in the center of the chest between the lungs; or

• The tumor has spread to organs other than the lungs; or

• The level of any of the tumor markers is high.

There is no poor prognosis group for testicular seminoma!

Five types of standard treatments are used:

1. Operation

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Surgical removal of the testicle (inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging. Tumors that have spread to other parts of the body can be partially or completely removed with surgery.

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After a doctor removes any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy.

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2. Radiation therapy

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Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy:

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• External beam radiation therapy uses a device outside the body to direct radiation to cancer.

• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor.

How radiation therapy is given depends on the type and stage of cancer treatment. External beam radiation therapy is used to treat testicular cancer.

3. Chemotherapy

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Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is injected directly into the cerebrospinal fluid, organ or body cavity, such​​ like the abdomen, drugs mainly target cancer cells in these areas (regional chemotherapy). How chemotherapy is given depends on the type and stage of cancer treatment.

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4. Observation

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Surveillance closely monitors the patient's condition, giving no treatment if there is no change in test results. It is used to detect early signs of cancer recurrence. Patients are regularly monitored for certain examinations and tests.

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5. High-dose chemotherapy with stem cell transplantation

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High doses of chemotherapy are prescribed to kill cancer cells. Healthy cells, including hematopoietic cells, are also destroyed in cancer treatments. Stem cell transplantation is a treatment to replace hematopoietic cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of a patient or donor, frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and returned to the patient as an infusion. These re-injected stem cells germinate (and regenerate) the body's blood cells.

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Stem cell transplant:

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• Step 1.  Blood is drawn from a vein in the donor's arm. The donor can be a patient or other person. The blood goes through a machine that removes stem cells. The blood is then returned to the donor through a vein in the other arm.

• Step 2. The patient receives chemotherapy to destroy the hematopoietic cells. The patient may receive radiation therapy (not shown).

• Step 3. The patient receives stem cells through a catheter placed in a blood vessel in the chest.

7. Treatment options for testicular cancer by stage

Testicular cancer can usually be cured in patients receiving adjuvant chemotherapy or radiation therapy after initial treatment.

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Stage 0 (Testicular intraepithelial neoplasia)

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Stage 0 treatment may include the following:

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• Radiation therapy .

• Observation.

• Surgery to remove the testicle.

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Stage I testicular cancer

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Treatment for seminoma may include the following:

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• Operation  to remove  testicles with  subsequent  observation  ...

• For patients requiring proactive treatment rather than monitoring, treatment may include: ​

  • Surgery to remove the testicle followed by chemotherapy.

Treatment for nonseminoma may include the following:

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• Surgery to remove a testicle with long-term follow-up.

• Surgery to remove the testicle and lymph nodes in the abdominal cavity with long-term follow-up.

• Surgery followed by chemotherapy for patients at high risk of recurrence with long-term follow-up.

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Stage II testicular cancer

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Treatment for seminoma may include the following:

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• When  tumor  5  centimeters  or less:

  • Surgery to remove the testicle, followed by radiation therapy to the lymph nodes in the abdomen and pelvis.

  • Combined chemotherapy.

  • Surgery to remove the testicle and lymph nodes in the abdominal cavity.

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• When the tumor is larger than 5 centimeters:

  • Surgery to remove the testicle, followed by combination chemotherapy or radiation therapy for the lymph nodes in the abdomen and pelvis with long-term follow-up.

Treatment for nonseminoma may include the following:

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• Surgery to remove the testicle and lymph nodes with long-term follow-up.

• Surgery to remove the testicle and lymph nodes, followed by combined chemotherapy and long-term follow-up.

• Surgery to remove the testicle, followed by combined chemotherapy and reoperation if cancer remains, with long-term follow-up.

• Combination chemotherapy before testicular removal surgery to treat cancer that has spread and is considered life-threatening.

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Stage III testicular cancer

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Treatment for seminoma may include the following:

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• Surgery to remove the testicle followed by combined chemotherapy. If tumors remain after chemotherapy, treatment can be one of the following:

  • Follow-up without treatment if the tumor does not grow.

  • Observation of tumors less than 3 centimeters in size and surgery to remove tumors larger than 3 centimeters.

  • PET scans two months after chemotherapy and tumor removal surgeries that appear with cancer on scans.

• Clinical study of chemotherapy.

Treatment for nonseminoma may include the following:

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• Surgery to remove the testicle followed by combined chemotherapy.

• Combined chemotherapy followed by surgery to remove the testicle and any remaining tumors. Additional chemotherapy may be given if the removed tumor tissue contains growing cancer cells or if subsequent tests indicate that the cancer is progressing.

• Combination chemotherapy before testicular removal surgery to treat cancer that has spread and is considered life-threatening.

• Clinical trial of chemotherapy.

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Treatment for recurrent testicular cancer may include the following:

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• Combined chemotherapy  ...

• High-dose chemotherapy and stem cell transplantation.

• Surgery to remove cancer that has:

  • return more than 2 years after complete remission; or

  • returns in only one place and does not respond to chemotherapy.

• Clinical trials of new therapy.

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Testicular cancer treatments can cause infertility.

Certain testicular cancer treatments can cause infertility, which can be permanent. Patients who wish to have children should consider a sperm bank before starting treatment. A sperm bank is the process of freezing semen and storing it for later use.

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Need help?

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To organize treatment for testicular cancer in Turkey, leave a request on the Medikal & Estetik Group website. You will be contacted by a specialized doctor-coordinator who will help you choose the best medical center. Send him your medical records, he will redirect them to the hospital of your choice and request a treatment program.

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We will help you organize your trip and stay in touch with you throughout your treatment - from the moment you contact us and even after you return home.

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Medikal & Estetik Group is an independent medical service that does not represent the interests of any of the clinics. Patients do not pay for our services - medical centers do it.

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Doctors-coordinators will advise you and help you with the choice. Medikal & Estetik Group services are free of charge for you and do not affect the clinic bill.

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