What is it? Who is affected?
Testicular cancer is a disease that affects men. The testicles, located in the scrotum, are responsible for producing sperm and the male hormone “testosterone.” Although it is rare in men over 50, it primarily affects younger men aged 20-35. Today, if caught early, the chances of curing this disease are around 98%.
How is it Diagnosed?
Patients typically present with swelling in their testicles. Diagnosis is usually made through a physical examination by a surgeon and a “scrotal ultrasonography.”
Initial Steps After Diagnosis
First, blood tests are performed to measure beta HCG, alpha-fetoprotein, and LDH levels, followed by immediate surgery. The surgery, known as radical orchiectomy in urology, involves removing the testicle through a small incision in the groin along with its surrounding sheaths.
Pre- and Post-Surgery
After necessary medical preparations, patients are admitted to the hospital, and the surgery is performed the same day. This surgery takes 15-20 minutes and can be done under general anesthesia or regional anesthesia (spinal). Usually, patients are discharged the same day, and we wait for the pathology results.
Post-Surgery: What is Done? Treatment
After receiving the pathology report, the type of cancer is determined. There are two types of testicular cancer:
1. Seminoma
2. Non-Seminoma (NSGCT = Non-Seminomatous Germ Cell Tumor)
The treatment for these two types is partly the same and partly different. A CT scan is performed to check for the spread of the disease to distant organs (lungs, around the major blood vessels in the abdomen, lymph nodes in the neck).
– Pathology Result Seminoma and No Distant Spread: One or two single doses of Carboplatin (chemotherapy) are administered.
– Pathology Result Non-Seminoma (NSGCT) and No Distant Spread: Usually, short-term chemotherapy referred to as 2 cycles is sufficient treatment.
– Regardless of Cancer Type, If There is Distant Spread: If there is spread to the lungs, lymph tissues around the major blood vessels in the abdomen, or neck lymph nodes, a longer course of chemotherapy consisting of 4 cycles is required.
Post-Chemotherapy Process
After chemotherapy, patients are monitored every 3 months for the first two years, then every 6 months for 5-10 years. The goal of this follow-up is to observe the response of the disease that has spread to distant organs to the chemotherapy.
Evaluating Chemotherapy Response
Response to chemotherapy is assessed with periodic CT scans:
1. If large lymph nodes around the major blood vessels in the abdomen have not disappeared,
2. If they initially shrank but later grew again,
3. If the masses disappeared but blood tests for beta HCG, alpha-fetoprotein remain elevated,
If any of these conditions are present, it indicates a poor or insufficient response to chemotherapy.
Treatment If There is No Response to Chemotherapy
In such cases, the treatment is a surgery called RPLND (Retroperitoneal Lymph Node Dissection).
What is RPLND Surgery? Pre- and Post-Surgery
RPLND is considered one of the largest surgeries in urology and should be performed by an experienced team. Sometimes, the masses around vital blood vessels can be very large, requiring a vascular surgery team to assist the urology team. The goal is to remove the masses without injuring other organs or major blood vessels in the abdomen.
Possible Pathology Results Post-RPLND Surgery and Treatment
Three possible outcomes can emerge from the pathology report:
1. *Live Cancer Tissue: Found in 20% of cases, requiring further chemotherapy.
2. *Teratoma: Found in 40% of cases. Chemotherapy is unnecessary, but regular follow-up is needed. Teratomas are not cancerous but can transform into lethal cancers or grow into large masses compressing vital organs if left in the body.
3. *Necrosis: Found in 20% of cases. Chemotherapy is unnecessary, and regular follow-up is sufficient.