**4. The stages of testicular cancer**

Testicular cancers are classified as seminomas or non-seminomas. The seminomas are most common tumor with 40%. Three histological subtypes are defined. The most common type is classical type seminoma with 85%. Firstly, it makes lenfoj metastasis. It responds to radiotherapy and chemotherapy very well [58]. Nonseminoma tumors account for 4% of all testicular tumors. Leydig cell tumors are the most common and this tumor constitutes 1–2% of all testicular tumors. It has a benign character in children but it is 10% malignant in adults [59].

Staging in TC is useful for determining prognosis and treatment. Patients are classified as Stage I (limited to the testis), Stage II (lymph node involvement), and Stage III (metastasis to visceral organs) [60] (**Table 2**). Among the important factors to be considered when staging are the degree of metastasis, elevation of tumor markers, and histology (seminoma or nonseminoma).


**119**

**6. Fertility issue**

*Information from Ref. [15].*

**Table 3.**

significant gonadal damage in men [64, 65].

*Treatment types for the stages of testicular cancer.*

cussed with the patient before starting the treatment [68, 69].

*Testicular Cancer and the Importance of Early Diagnosis DOI: http://dx.doi.org/10.5772/intechopen.89241*

The primary treatment for testicular tumors is radical inguinal orchiectomy involving the removal of the testis and spermatic cord. After orchiectomy, the type of tumor (seminoma or nonseminoma tumor) and its stage are determined by microscopic diagnosis for further treatment [63]. Treatment options include observation, dissection of the retroperitoneal lymph node, radiation, and chemotherapy [15]. Treatment options for specific stages of disease are summarized in **Table 3**. To determine the success and continuity of treatment, evaluation is made by looking at

Retroperitoneal lymph node dissection or monthly

IB: Take into two courses of chemotherapy IS: The whole-dose chemotherapy if serum tumor marker levels do not drop swiftly after surgery

IIA: Retroperitoneal lymph node dissection, followed by monthly monitoring and frequent lab tests or observation, was made by two courses of

IIB or IIC: If computed tomography still indicates lymph nodes, three or four courses of three-drug chemotherapy followed by retroperitoneal lymph

Three-drug chemotherapy: operating disposal of

High serum tumor marker levels: These patients often do not respond to usual chemotherapy; therefore, more aggressive clinical trials may be

High serum tumor marker levels: These patients frequently do not answer to normal chemotherapy; hence, more aggressive clinical

follow-up observations

chemotherapy, two drugs

node dissection

permanent tumors

trials can be thought

considered

Studies have shown that fertility decreased after treatment in TC patients. In addition, treatment with chemotherapy and radiotherapy was reported to cause

In one study, half of the patients wanted to have children after TC treatment. However, according to the results of the study, fertility rate was lower after treatment than before treatment [66]. In the other study after treating for TC, 13 percent of patients developed hypogonadism [67]. Therefore, since the treatments to be applied to TC patients have a negative effect on fertility, solutions such as sperm banking, testicular tissue freezing, or removal of testicular sperm should be dis-

**5. Treating testicular cancer**

the changes in serum tumor markers [15].

I Usually low-dose radiotherapy as a

II IIA: Radiation therapy of the local lymph

III Three-drug chemotherapy: If there is no

IIB or IIC: Three courses of three-drug

answer, think of the clinical tests of other chemotherapy drugs in combination Have brain metastasis: Treat with brain radiation or operating disposal

preservative

nodes

chemotherapy

**Stage Seminoma Nonseminoma**

### **Table 2.** *Classifications of testicular cancer staging.*
