Testicular Cancer Surgery in Turkey

Testicular cancer surgery is the primary treatment method involving the surgical removal of malignant testicular tissue and is generally performed as a radical inguinal orchiectomy. This procedure is accepted as the standard approach for both diagnosis and treatment depending on the stage of the disease.

In response to the question of how testicular cancer surgery is performed, the surgical intervention is carried out through an incision made in the groin region, and the testis is removed together with the spermatic cord. This method reduces the risk of tumor spread while providing a reliable sample for pathological examination.

The recovery process after testicular cancer surgery varies depending on the patient’s general health condition and the stage of the disease. Mild pain and tenderness may be observed in the early postoperative period, but most patients can return to their daily activities in a short time.

The risks and complications of testicular cancer surgery include infection, bleeding, and rarely lymphatic spread. Additionally, since fertility and hormonal balance may be affected, protective measures such as sperm freezing can be considered before treatment.

What is testicular cancer and who does it affect in society?

Testicular cancer accounts for only about one to two percent of all cancers in men. However, this low percentage should not be misleading, as the epidemiological characteristics of this disease are quite striking. It is the most common solid organ tumor in young adult men between the ages of fifteen and thirty-five, which is the most active and reproductively productive period of life. Its tendency to affect young individuals makes it not only a medical issue but also a condition with significant psychological, social, and familial implications. Detailed analysis of global and national health data shows that its incidence ranges between two to three cases per one hundred thousand men. In recent years, there has also been a slow but steady increase in the number of diagnosed cases.

The lifetime risk of developing testicular cancer for a man is approximately two per thousand. When examining age distribution, three distinct peaks can be observed. The first peak occurs in childhood under the age of ten, involving tumors with different biological behavior. The second and most common peak is between the ages of twenty and forty. The third, less frequent peak appears in men over sixty years of age. Tumors in this older group differ biologically from those seen in younger individuals and are often associated with cellular aging or immune system changes.

What are the prominent risk factors in the development of testicular cancer?

Although the exact reason why cells suddenly undergo genetic changes and become cancerous is not always known, there are well-established and strong risk factors that trigger the development of testicular cancer. The most important of these is a condition known medically as cryptorchidism, or undescended testis. During fetal development, the testicles form in the abdominal cavity and gradually descend into the scrotum before birth. If this descent is interrupted and the testis remains in the abdomen or groin canal, the risk of cancer increases by five to fifteen times compared to normal individuals. The higher internal body temperature in the abdomen can gradually damage these cells.

Another interesting point is that in individuals with only one undescended testis, cancer may develop not only in the undescended testis but also in the normally descended one. This suggests that the disease is not solely related to temperature but may also involve developmental genetic factors affecting both testicles. Familial genetic predisposition also plays a significant role. Individuals with a first-degree relative affected by this disease have a higher lifetime risk. Additionally, a history of severe infections leading to testicular atrophy may also increase the risk by disrupting cellular structure.

The main risk factors are as follows:

• Cryptorchidism
• Family history of testicular cancer
• Contralateral testicular tumor
• Testicular atrophy
• Intratubular germ cell neoplasia

How is testicular cancer classified at the cellular level?

The testis is like a complex factory composed of sperm-producing tubules, supporting tissues, and hormone-secreting cells. However, about ninety-five percent of cancer cases originate from germinal tissue, which produces sperm. These tumors are divided into two main groups based on their growth rate, spread pattern, and response to treatment: seminomas and non-seminomas.

Seminomas make up about half of all cases and tend to grow more slowly, typically appearing in patients around the age of thirty-five. One of their greatest advantages is their high sensitivity to radiotherapy and standard chemotherapy treatments. Tumors that do not belong to this group are called non-seminomas. These consist of more aggressive and biologically diverse cells, usually appearing at younger ages, often in the early twenties, and have a high potential to spread rapidly through the bloodstream.

The subtypes of non-seminomas include:

• Embryonal carcinoma
• Yolk sac tumor
• Teratoma
• Choriocarcinoma

What symptoms do testicular cancer patients usually present with?

This disease can progress silently, but for individuals who are aware of their bodies, it often provides clear warning signs. Most patients notice a mass in the scrotum by chance during daily life, often while showering. This mass is typically the size of a chickpea or hazelnut, feels very hard, and has an irregular surface. The most misleading aspect is that this hardness is usually painless, which often delays medical consultation.

In addition to the physical mass, some patients report a dull, dragging discomfort in the lower abdomen, groin, or directly in the scrotum, as if carrying a weight. Sudden, severe pain is rare and usually occurs due to bleeding داخل the tumor or inflammation of surrounding tissues. In some cases, patients may not notice any testicular symptoms but instead present with complaints such as persistent back pain or dry cough due to metastasis to the lungs or abdominal lymph nodes.

Common symptoms include:

• Painless hard mass
• Diffuse enlargement of the testis
• Dull scrotal pain
• Heaviness radiating to the anal region
• Acute scrotal pain

How does the diagnostic process proceed in suspected testicular cancer?

After listening to the patient’s complaints, the most critical step is the physical examination. The presence of a hard area within the normally soft testicular tissue is a strong diagnostic clue. While older methods included transillumination with light, modern diagnosis relies on imaging techniques. The first and most preferred method is scrotal ultrasonography, which provides highly detailed images of testicular structure without radiation. It allows precise identification of abnormal cell clusters, vascularization, and size.

If a suspicious lesion is detected, it is considered malignant until proven otherwise, and further imaging such as CT scans is performed to assess spread to lymph nodes or other organs.

Which tumor markers are measured in blood for testicular cancer diagnosis?

Cancer cells leave chemical traces in the body, known as tumor markers. These markers, measured in blood tests, provide valuable information about tumor burden, type, and treatment response. In most testicular cancer patients, at least one marker is elevated.

The main markers are:

• Alpha-fetoprotein (AFP)
• Beta-hCG
• Lactate dehydrogenase (LDH)
• MicroRNA tests

How is radical surgery performed in the treatment of testicular cancer?

When testicular cancer is strongly suspected, the standard surgical step is radical inguinal orchiectomy. The key oncological principle is performing the surgery through a groin incision rather than the scrotum to prevent tumor spread. During surgery, blood vessels are controlled before the testis is manipulated, and the entire structure is removed safely.

A silicone prosthesis may be placed during surgery for cosmetic purposes. The removed tissue is sent for pathological examination.

In which cases is testis-sparing surgery possible?

Although standard treatment involves complete removal, testis-sparing surgery may be considered in selected cases, such as bilateral tumors or a single remaining testis. The goal is to remove only the tumor while preserving healthy tissue. Intraoperative pathological evaluation determines whether preservation is safe. Additional radiotherapy may be required afterward.

Indications include:

• Bilateral tumors
• Tumor in a solitary testis
• Tumor size under 25 mm
• Less than 30% tumor volume
• Normal preoperative testosterone levels

How is staging and risk classification done in testicular cancer?

After surgery and pathology, staging is performed using the TNM system along with tumor marker levels. The extent of tumor invasion, lymph node involvement, and distant metastasis are evaluated. Patients are classified into good, intermediate, or poor risk groups based on spread and marker levels, which directly guides treatment decisions.

What are the management and follow-up strategies in stage 1 testicular cancer?

In stage 1 disease, surgery alone is often sufficient. However, due to the risk of microscopic spread, patients may undergo active surveillance or receive preventive chemotherapy depending on risk factors. This approach significantly reduces recurrence rates.

What major surgeries are performed when testicular cancer spreads to lymph nodes?

When cancer spreads to retroperitoneal lymph nodes, retroperitoneal lymph node dissection (RPLND) is performed. This complex surgery removes lymphatic tissue around major vessels. Modern nerve-sparing techniques help preserve fertility and ejaculation function.

What are chemotherapy treatments and their side effects in advanced testicular cancer?

Systemic chemotherapy is the main treatment in advanced stages. It uses combinations of drugs that stop cell division. However, it may cause side effects such as kidney toxicity, lung toxicity, bone marrow suppression, and hemorrhagic cystitis.

How is fertility preserved before testicular cancer treatment?

Since the disease affects young men, preserving fertility is critical. Sperm cryopreservation is recommended before treatment. Additional techniques such as MicroTESE and hormone replacement therapy may also be used when necessary.

What kind of follow-up process awaits patients after testicular cancer treatment?

Even after successful treatment, long-term follow-up is essential due to the risk of recurrence. The first two years are critical, requiring frequent monitoring with tumor markers and imaging. Follow-up continues for life to detect late recurrences and long-term treatment effects.