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Testicular Cancer (Comprehensive)

Most common malignancy in young men, highly curable with stage-adapted multimodal therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Testicular Cancer (Comprehensive)?

Testicular cancer is the most common malignancy in men aged 15-35 years and one of the most curable solid tumors. About 95% are germ cell tumors (GCTs), divided into seminoma (50%) and non-seminomatous germ cell tumors (NSGCT: embryonal carcinoma, yolk sac, choriocarcinoma, teratoma). Stromal tumors (Leydig, Sertoli) and lymphoma are rare. Most present as a painless testicular mass, sometimes with elevated tumor markers (AFP, beta-hCG, LDH).

Diagnosis is made by scrotal ultrasound followed by radical inguinal orchiectomy (never trans-scrotal biopsy due to seeding risk). Staging includes serum tumor markers, chest, abdomen, pelvis CT, and brain MRI in symptomatic or high-risk metastatic cases. AJCC TNMS staging (S category for tumor markers) and IGCCCG risk classification (good, intermediate, poor) guide treatment.

Treatment is highly stage-adapted: stage I seminoma may receive surveillance, single-dose carboplatin, or adjuvant radiation; stage I NSGCT surveillance, BEP x1, or RPLND; stage II seminoma radiation or BEP; stage II-III NSGCT or advanced seminoma BEP x3-4 or EP x4 with consideration of post-chemotherapy retroperitoneal lymphadenectomy. Cure rates exceed 95% in early stage and 80% in metastatic disease. Late effects (cardiovascular, secondary cancers, neuropathy, infertility, hypogonadism) require lifelong surveillance and counseling.

Symptoms

Painless testicular mass or swelling
Heaviness or aching in scrotum
Dull lower abdominal or back pain
Gynecomastia (hCG-secreting tumor)
Cough, dyspnea (lung metastases)
Cervical or supraclavicular lymphadenopathy (advanced)
Weight loss, fatigue (advanced)
Headache, neurologic symptoms (brain metastasis)
Hydrocele or epididymitis-like presentation (atypical)
Acute testicular pain (rare, hemorrhage into tumor)
Infertility evaluation finding

Risk Factors

Cryptorchidism (undescended testis), even after correction
Personal history of testicular cancer (contralateral risk 2-5%)
Family history (father or brother)
Klinefelter syndrome
Down syndrome
Caucasian ethnicity
Age 15-35 years
Infertility
Testicular microlithiasis (modest risk)
HIV infection (germ cell tumors)
Maternal estrogen exposure (DES, historical)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Painless testicular lump or swelling
  • Persistent scrotal heaviness
  • Lower abdominal or back pain
  • Gynecomastia (especially adolescent)
  • Persistent cough or dyspnea
  • Lymph node enlargement
  • Family history with concerning symptoms
  • Self-exam finding

Treatment Methods

01
Scrotal ultrasound: testis-confined hypoechoic mass with internal vascularity
02
Tumor markers: AFP, beta-hCG, LDH (avoid trans-scrotal biopsy)
03
Radical inguinal orchiectomy with high spermatic cord ligation
04
Pathology with WHO classification (seminoma versus NSGCT)
05
Sperm cryopreservation discussion before treatment in fertility-desiring men
06
Staging: chest, abdomen, pelvis CT; tumor markers post-orchiectomy; brain MRI in poor-risk
07
AJCC TNMS staging plus IGCCCG risk for advanced disease
08
Stage I seminoma: active surveillance, single-dose carboplatin AUC 7, or para-aortic radiation 20 Gy
09
Stage I NSGCT: surveillance for low-risk, BEP x1 or RPLND for high-risk
10
Stage IIA seminoma: para-aortic plus ipsilateral iliac radiation 30 Gy or BEP x3
11
Stage IIA-IIB NSGCT: BEP x3, EP x4, or primary RPLND in selected cases
12
Stage IIC-III: BEP x3 (good risk) or BEP x4 (intermediate-poor risk), or EP x4 if bleomycin contraindicated
13
Salvage chemotherapy with TIP, VeIP, or high-dose chemotherapy with autologous stem cell rescue
14
Post-chemotherapy retroperitoneal lymphadenectomy for residual masses 1 cm or larger in NSGCT or persistent seminoma
15
Surveillance schedule: history, exam, tumor markers, imaging at intervals over 5-10 years
16
Manage long-term effects: cardiovascular (atherosclerosis, myocardial infarction), nephrotoxicity, neuropathy, ototoxicity, hypogonadism
17
Annual contralateral testicular self-exam
18
Secondary malignancy surveillance
19
Fertility counseling and assisted reproductive technology
20
Psychosocial support and survivorship clinic

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.