Are you concerned about your testicles? Let's talk about Testicular Cancer without fear!

Today we are going to talk about a slightly sensitive, but very important topic. That is testicular cancer. When you hear this name, you may be a little scared and even worried. However, the most important thing is not to panic, because being properly informed about this can make a big difference.

What is testicular cancer?

Simply put, testicular cancer is the growth of malignant cells in one or, rarely, both of your testicles. As you know, the testicles are two small walnut-sized glands in men. They produce sperm and the hormone testosterone . They are located in a pouch of skin just below the penis, called the scrotum. Like any other cancer, testicular cancer is a serious condition. But fortunately, it is a largely treatable disease. So don't worry, let's talk about it further.

Are there types of this cancer?

Yes, there are several main types of testicular cancer. Most of the time, about 90% of cases, these cancers arise from germ cells inside the testicles. These germ cells are a type of cell that will later become sperm. These cells clump together to form a tumor. There are two main types:

• Seminoma: This is a slow-growing type of cancer . It is most common in men between the ages of 40 and 50.
• Non-seminoma: This type grows faster than seminoma. It mostly affects young people, between the ages of 15 and 30. There are four other subtypes of non-seminoma. Each is named after the type of germ cell that makes up the cancer . Examples include embryonal carcinoma , yolk sac carcinoma , choriocarcinoma , and teratoma .

Sometimes both types of cells (Seminoma and Non-seminoma cells) can be present in the same cancer.

How common is testicular cancer?

Testicular cancer is actually not that common . It affects only about one in 250 men with testicles. However, it is the most common type of cancer in men between the ages of 15 and 35. So it is especially important for those in that age group to be aware of it.

What are the symptoms? What should you do if you see these?

Okay, now let's see what are the symptoms of testicular cancer. If you have one or more of these, don't panic and see a doctor.

• The most common symptom is a painless lump or swelling in the testicle .
• Swelling or sudden accumulation of fluid in the scrotum .
• A lump or swelling in one or both testicles.
• Feeling of heaviness in the scrotum.
• A dull ache in the groin or lower abdomen.
• Pain or discomfort in the scrotum or testicle.
• Testicular Atrophy.

Remember, these symptoms can also occur in other medical conditions. So don't immediately assume that it's cancer. However, it's always wise to see a doctor for a checkup. The later the diagnosis, the greater the chance that the cancer cells will spread, and the more complicated the treatment can be.

Why does this testicular cancer occur?

Researchers still don't know exactly what causes testicular cancer. What happens is this: Cells that normally divide and grow suddenly start dividing at an uncontrollable rate. Eventually, these cells join together to form a tumor. Most of the time , the germ cells we talked about earlier become cancerous.

What are the risk factors? Who is more likely to develop it?

Okay, now let's see who is at higher risk of developing testicular cancer. We call these risk factors ``(Risk Factors)`` . Having these risk factors doesn't mean that you will develop cancer, but the chance of developing it is slightly higher.

• Age: It most commonly occurs in people between the ages of 15 and 35.
• Undescended Testicles: Normally, the testicles develop in the abdomen when a fetus is in the womb. Before birth, they descend into the scrotum. This is the name given to testicles that have not descended. This may require surgery. Men born with this condition are at increased risk of developing testicular cancer later in life, even after surgery.
• Race and ethnicity: This is slightly more common among non-Hispanic whites in the United States and Europe.
• Family history : If someone in your family (father, brother) has had this cancer, you have a small chance of developing it too. Also, some genetic diseases like Klinefelter SyndromeConditions can also increase the risk. If cancer develops in one testicle, the chance of developing it in the other is higher.
• Infertility : Some factors that cause male infertility are thought to be linked to the development of testicular cancer, but more research is needed on this.

How is this disease diagnosed?

Well, if you have any symptoms, or if you notice something different during a self-exam (we'll talk about that later), how do doctors know for sure if it's testicular cancer? Sometimes it can be detected during a routine medical exam. The main tests that are done are:

• Physical examination and medical history: The doctor will ask you about your symptoms and examine you carefully. He will especially palpate the testicles to check for lumps and swollen lymph nodes (to see if the cancer has spread).
• Ultrasound: If your doctor notices something unusual, they will likely order an ultrasound. This is a painless test that uses high-energy sound waves to take pictures of the tissues inside your body.
• Inguinal Orchiectomy and Biopsy: If the ultrasound shows evidence of cancer, the doctor will make a small incision in the groin and remove the affected testicle. A specialist will then take tissue from the removed testicle and examine it under a microscope to see if there are any cancer cells. This is called a biopsy.

Other tests

In addition to this, other tests can be done:

• Serum Tumor Marker Test: This involves taking a blood sample and measuring the levels of certain substances that may be elevated in the blood in association with certain types of cancer. These substances are called tumor markers . The most common tumor markers that are elevated in testicular cancer are alpha-fetoprotein (AFP) , human chorionic gonadotropin (HCG or beta-HCG) , and lactate dehydrogenase (LDH) . These markers may be elevated in different ways in different types of cancer. For example, in seminoma, HCG may be elevated but AFP may not be elevated. In non-seminoma, AFP may be elevated, but not HCG. Elevated LDH levels can also indicate whether the cancer has spread.
• CT scans/CAT scans, X-rays and MRIs:A CT scan uses X-rays to take pictures of the inside of your body. A CT scan of your abdomen and pelvis can be done to see if the cancer has spread to nearby organs. A CT scan or a regular X-ray can be done to see if the cancer has spread to your lungs. If your doctor suspects that the cancer has spread to your central nervous system (brain and spinal cord), an MRI may be done. An MRI uses magnetic fields and radio waves to take pictures of the inside of your body.

What are the stages of cancer?

Part of diagnosing the disease is determining the stage of the cancer (Cancer Staging) . This stage provides important information, such as the size of the tumor and whether the cancer has spread. It also determines the type of treatment.

• Stage 0: The abnormal cells have grown, but they are still inside the testicles where sperm cells are starting to form. This is also called Germ Cell Neoplasia In Situ (GCNIS) .
• Stage I: The cancer is confined to the testicle. It may have spread to nearby blood or lymph vessels. Tumor markers may or may not be elevated.
• Stage II: The cancer has spread to the lymph nodes in the back of the abdomen (also called the ``Retroperitoneum''), but has not spread anywhere else. However, if the cancer is present in the lymph nodes and the tumor markers are moderately or very high, it is classified as stage III instead of stage II.
• Stage III: The cancer has spread to lymph nodes outside the abdomen or to other organs.

What are the treatments?

Okay, now let's look at the treatments for testicular cancer. Treatment depends on several factors, including your health, your preferences, the stage of the cancer, and the type of cancer. Because seminoma grows slowly and responds well to radiation therapy, it can be treated differently than non-seminoma. However, both types respond well to chemotherapy. If the cancer has cells from both seminoma and non-seminoma, doctors call it non-seminoma. The main treatments are:

Surgery

Surgical removal of the cancerous testicle is the most common treatment . This is done regardless of the stage or type of cancer. In some cases, your doctor may also remove your lymph nodes.

• Radical Inguinal Orchiectomy:This involves removing the testicle that contains the cancer. It is used for both seminoma and non-seminoma. The doctor makes an incision through the groin and removes the testicle that contains the tumor. At the same time, the blood vessels and lymphatic tissue are blocked to stop the cancer from spreading to other parts of the body.
• Retroperitoneal Lymph Node Dissection (RPLND): Depending on the stage and type of cancer, your doctor may perform this surgery. It is most often done for non-seminoma cancers. In this procedure, your doctor makes an incision in your abdomen and removes the lymph nodes behind your abdominal organs. An RPLND can be used to treat cancer and determine the stage of the cancer.

If the cancer has spread to the lungs or liver, surgery may be performed to remove those tumors.

Radiation Therapy

This involves using high-dose X-rays to destroy cancer cells. This treatment can be given after surgery to stop the cancer from coming back. It is usually given most often for seminoma.

Chemotherapy

This uses drugs such as Cisplatin, Bleomycin, and Etoposide to kill cancer cells. Chemotherapy has greatly improved the survival rates of both seminoma and non-seminoma patients. Depending on the type of cancer, chemotherapy may be given instead of surgery. It may be given before a radical inguinal orchiectomy (RPLND) or after a radical inguinal orchiectomy (Radical Inguinal Orchiectomy). Chemotherapy is also used if the cancer has recurred after treatment.

Can testicular cancer be prevented? (Testicular Self-Examination - TSE)

There is no way to completely prevent testicular cancer. However, you can do a testicular self-exam (TSE) to check for any changes in your testicles. If you notice any changes, tell your doctor right away. If you notice any lumps, bumps, or hardness in your testicles, or if you notice any changes in your testicles, tell your doctor. Most doctors recommend doing this self-exam at least once a month .

How do you perform a testicular self-examination (TSE)?

Okay, so how do you properly perform a testicular self-examination (TSE)? It only takes about two minutes. Follow these steps:

• Do this test after a hot shower or bath. The heat will loosen the skin of the scrotum, making it easier to feel anything unusual.
• Use both hands to examine one testicle. Place your index and middle fingers under the testicle and your thumb on top.
• Feel each testicle by rolling it between your thumb and two other fingers.
• Get familiar with what you normally feel. When you touch each testicle, you will feel something like a string on top and behind it. This is called the epididymis . This is where sperm is stored and transported. Don't confuse this with a lump. It is also normal for the two testicles to be slightly different in size. Although the left and right testicles may differ in size, each testicle should generally be the same size.
• Look for any lumps. Lumps can be anywhere from the size of a pea to larger, and most of the time they are painless. If you find a lump, see a doctor immediately.

If you notice a change in the size of your testicles, or if you feel a lump, see a doctor immediately. It's also a good idea to have a physical exam at least once a year.

What is the prognosis?

What is the prognosis for testicular cancer? It is actually very good . This type of cancer can be successfully treated in more than 95% of cases. Even for those with unfavorable risk factors, there is usually a 50% chance of recovery. So, this is really good news .

Can testicular cancer be cured?

Yes, testicular cancer is a curable disease . While being diagnosed with cancer is always a scary thing, the good news about testicular cancer is that it can be successfully treated in 95% of cases. If detected early and treated, the cure rate increases to 98%.

Could this be fatal?

Testicular cancer can be fatal, but it is very rare . However, early detection of the disease has a big impact on your chances of recovery . The sooner you see a doctor and get a diagnosis, the better your chances of living cancer-free.

What happens after treatment? (Sex life, fertility)

Many people wonder what happens to their sex drive and fertility after having a testicle removed. Usually, having one testicle is enough to keep your hormone levels healthy and maintain your sex drive. You should be able to have sex (erection) and ejaculate. In some cases, men who have had their penis removed may still have erections, but they may still have difficulty ejaculating. Talk to your doctor about any risks that may arise from treatment. If you are concerned about your fertility, sperm banking , which is storing your sperm for later use, may be a good option.

The most important thing is, if you notice any changes in one or both of your testicles, don't delay seeing a doctor. Many people try to avoid or postpone their genital exams. But when it comes to cancer, time is of the essence. Depending on the type of cancer you have, testicular cancer can be completely cured if treatment is started early.

Finally, the most important thing (Take-Home Message)

Okay, from what we've just talked about, the most important things you need to remember are these:

• Testicular cancer is a disease that can be largely cured if detected early.
• It is very important to perform a monthly testicular self-examination (TSE). If you notice any lumps, swelling, pain, or changes in size, don't be afraid or embarrassed, see a doctor immediately.
• Even if there are symptoms, not all of them will be cancer. But it is essential to confirm.
• There are treatments available, and the cure rate is high.
• You are not alone. Talk openly with your doctors about this. They will provide you with the support and information you need.

So, I hope this information is helpful to you. Taking care of your body is the best thing you can do to stay healthy!