ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Testicular Cancer

Testicular cancer, which is a very rare type of cancer, occurs due to uncontrolled proliferation of cells in the testicle. It is possible to talk about certain risk factors, especially genetics, in the formation of testicular cancer. It can be said that the success rate of the treatment will increase to a great extent in cases where testicular cancer is diagnosed early, where the risk of recurrence is low, as is the probability of its occurrence. For this reason, it is critical for men to apply to a health institution without delay in any abnormality that occurs in their testicles. 

What is Testicular Cancer?

The testicles, which are located in the scrotum and consist of two parts, the right and the left, are the organ where sperm, which are male reproductive cells, are produced. The testis, which also produces the male hormone testosterone, is one of the most important parts of the male reproductive system.

Testicular cancer, also known as testicular cancer, is a type of cancer seen in the testicles located in the lower part of the penis. This type of cancer, which is more common in young men in general, can be seen in one testis in some cases, and in both testicles in some cases. 

What are the Causes of Testicular Cancer?

Although the exact cause of testicular cancer, as in other types of cancer, is not known, it is possible to talk about some risk factors:

      Age

      Genetic factors

      undescended testis

      abnormal development of testis

      Testicular inflammation (orchitis)

      HIV infection

      Infertility

It can be said that age is one of the most important risk factors for testicular cancer. It can be said that testicular cancer is most commonly seen in men between the ages of 15-35. However, it should not be forgotten that the disease can be seen in all age groups.

Undescended testis syndrome, also known as cryptorchidism, is among the risk factors that come to the fore with age. In this syndrome, which is a congenital disorder, one or both testicles remain undescended. Men with this syndrome have a higher risk of developing testicular cancer. In order to prevent undescended testis syndrome, children in the 1-2 age group can be treated by applying orchiopexy to this disease.

Hereditary factors also increase the risk of testicular cancer. It can be said that the incidence of this cancer is higher in individuals with a family history of testicular cancer, especially in first-degree relatives.

Despite the fact that all these risk factors have been identified, there may be cases where testicular cancer is not seen in a man who meets all risk factors, unlike other types of cancer. Studies show that most men with testicular cancer do not have any of these risk factors. In this sense, it can be said that risk factors are not a major factor in the formation of testicular cancer.

What Symptoms Are Observed in Testicular Cancer?

Common symptoms of testicular cancer are listed below: 

      Mass formation or swelling in the testis

      Fluid accumulation in the testis

      Different size of testicles

      Pain in the lower abdomen, groin and testicles

      Discomfort in the testicle area

      Back pain, shortness of breath, chest pain in case of metastasis

Generally, painless swelling and masses in one or both testicles are among the most common symptoms. It should be kept in mind that all symptoms of cancer, especially swelling, may be caused by different factors. For example, any injury or inflammation in the testicular area can also cause these symptoms. However, as early diagnosis of testicular cancer will increase the success rate of treatment, it would be best to consult a healthcare provider in case of any symptoms.

In cases where testicular cancer metastasizes, different symptoms can be seen. Lymph nodes, lung and liver are some of the most common areas of spread of this cancer. When cancerous cells spread to the lymph nodes, pain is usually seen in the lumbar region. In lung metastases, symptoms such as coughing, coughing up blood, shortness of breath and chest pain are common. The most common symptom of liver metastasis is abdominal pain.

Testicular cancer can rarely metastasize to the brain. In this case, quite severe headaches are observed in patients. 

What are the Types of Testicular Cancer?

Classification of testicular cancer is generally made according to cell structure and type. However, it can be said that the basis of almost all testicular cancers is the germ cell. The germ cell is the origin of about 95% of all cases. These cells, whose task is to produce sperm, also take part in the development of organs and tissues in the fetus.

There are two different subtypes of germ cell: 

Seminoma

Although it can be seen in men of all ages, seminoma, which is more common in older men, constitutes about half of all testicular cancer cases. Because the non-aggressive type of seminoma responds better to radiation therapy, treatment is more likely to be successful in these cases. 

Nonseminoma

Nonseminoma, also called non-seminoma, is a type of testicular cancer that generally occurs in young men between the ages of 15 and 30. Cancerous cells that develop and spread very rapidly are divided into different subtypes. Embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma are non-seminoma types of cancer. These subspecies generally manifest themselves as a mixture of two different species. 

How Many Stages is Testicular Cancer Divided?

It is of great importance to know the stage of the cancer in order to determine the appropriate treatment methods in testicular cancer.

Stage 0

Stage 0, also called carcinoma in situ, originates from the germ cells. At this stage, cancerous cells have not yet spread to the tissues. It is not possible to talk about a palpable mass at this stage, in which patients generally do not have any symptoms. Cancer usually occurs by chance and the definitive diagnosis is made by methods such as biopsy.

It should also be kept in mind that carcinoma in situ will not turn into cancer in all cases. For this reason, doctors may also prefer to observe for a certain period of time before the treatment plan. 

Stage I

Cancerous cells are seen only in the testis at this stage. If cells that are not found in another tissue or organ are diagnosed at this early stage, the tumor can be removed and treated. If the testis is completely removed by surgical methods, prosthesis can be applied. 

Stage II

At this stage, cancerous cells may spread to the lower abdominal region. The tumor that has spread to the lymph nodes in the abdomen can be removed by surgical methods as in the first stage. In this case, it should be noted that some patients may experience infertility.

Stage III

In this advanced testicular cancer, cells have metastasized. In addition to lymph nodes, cancerous cells spread to surrounding tissues and organs. Although metastasis is mostly seen in the lung, it can also be seen in the liver and rarely in the brain. It can be said that the treatment of cancer diagnosed at this stage will be quite difficult.

How is Testicular Cancer Diagnosed?

Any mass and swelling in the testicle causes testicular cancer to be suspected. In this case, in addition to physical examination and taking the patient's medical history, laboratory tests and imaging methods are also used.

Ultrasound is the first imaging method used for diagnosis. Ultrasonography can determine whether the swelling felt in the testis is solid or liquid-filled. Solid swellings generally indicate testicular cancer.

In addition, chest X-ray and abdominal scans can be performed to determine the spread of cancerous cells.

What are the Treatment Methods in Testicular Cancer?

Treatment of testicular cancer varies according to the extent of spread of cancerous cells, the type of cancer and the general health status of the patients. It can be said that the main treatment method, especially in cancer diagnosed at an early stage, is surgery. 

Testicular Surgery

In testicular cancer, which is usually diagnosed at an early stage, radical inguinal orchiectomy is performed to remove the testicles. In particular, the presence of cancerous cells only in the testis and the fact that they do not spread increases the probability of success in this surgery.

Operations involving removal of only one testis do not cause any complications in patients. Although some patients think that they will experience infertility or erection problems after the removal of a single testis, this is not the case. However, it should be kept in mind that removing both testicles can cause infertility.

In cases where cancerous cells have spread to the lymph nodes, the lymph nodes can be surgically removed. Erection problems are not seen in men after this surgery, which is performed by opening an incision in the abdomen.

In addition to surgical methods, radiotherapy and chemotherapy can also be applied to patients, especially seminoma type testicular cancer.

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