**7. The importance of early detection of TC and TSE**

The aim of any cancer screening program is to diagnose the disease at an earlier and more easily treatable stage by improving disease-specific survival and minimizing treatment morbidity [70].

As with all cancer cases, when testicular cancer is diagnosed in early stages, the rate of treatment for TC is approximately 96%, significantly affecting survival [71]. Unfortunately, more than 50% of cases are diagnosed after the disease has spread to the primary site, and men must be persuaded to avoid medical treatment as soon as a mass is detected [72]. Once the cancer has expanded over the local nodes (Stage III), the survival rate decreases extremely. This is because approximately every 10–30 days, the tumor doubling times were fast. Therefore, early diagnosis equates with a better long-term overall prognosis [6]. Obviously, for testicular cancer, a potentially lethal disease, early detection and early treatment are very important [6]. Rapid diagnosis of these neoplasms provides the opportunity to treat these patients at the earliest stage of the disease and thus minimize long-term morbidity [70].

Despite the importance of early diagnosis, invisible dangers are common in early and definitive diagnosis of testicular tumors. There are many studies based on delay in the diagnosis of testicular cancer [73–75]. In a comprehensive study on delayed diagnosis (DD) in testicular cancer, DD confirmed that it had a significant effect on survival in TC patients receiving modern treatments, including chemotherapy [76]. On the other hand, Nikzas et al. found no effect on survival in delay between 1980 and 1987 in 232 patients studied in Great Britain [77].

Both patients and health professionals can contribute to delay in diagnosis. Patient-induced delays due to unawareness, embarrassment, fear of cancer, or fear of emasculation are accepted [75, 78–80]. The results of literature reviews suggest that approximately 20–30% of cancer patients delay seeking help for more than 3 months after having experienced possible symptoms of cancer [81].

TC affects young and generally healthy males who do not accept the threat of deadly disease. Moreover, that testicular cancer requires loss of external genitals during a time in the man's life when sexuality is very important is additionally stressful [70]. The physician-mediated delay is most often the misdiagnosis of a testicular tumor as an infection. Unluckily for clinicians, classic painless testicular mass of patients ultimately diagnosed with TC is only half the resulting symptoms [82].

For early diagnosis several organizations, including the American Cancer Society and American Urological Association, recommend that physicians include testicular examination as part of routine control [83].It is also recommended that primary healthcare professionals teach and encourage TSE to males between the ages of 15 and 35 years [84]. At the same time, the American Cancer Society recommends to men, especially who at high risk for TC, TSE as an effective and cost-free method [71]. Studies have shown that men at risk for TC are not educated and do not know how to perform TSE [6]. Moreover, many studies reported that close to all men of the risk group (adult men below age 35) had never performed TSE and very few knew that men who were in the 18- to 50-year-old age group should perform TSE every month [16, 85].

TSE is the cheapest and easiest method for screening firstly taught by the nurses or physicians to the man. The man is taught to perform the TSE when the scrotum is soft and relaxed, usually after a shower. In addition, TSE is recommended to be done at least once a month starting at the onset of puberty [17]. TSE teaching begins when the man becomes familiar with the major structures of the testis, scrotum, testicle, and epididymis [86]. After being familiar with the normal tissue and structures of the testes, the man is better readied to identify normal physiological structures. Any suspicious masses are notified to a healthcare professional as soon

**121**

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

in their testicles even when there is no pain.

**Conflict of interest**

tion of this chapter.

**Thanks**

Kaya.

**8. Conclusions**

positive, can produce sustainable health behavior choices [90].

as possible [86]. However, the role of TSE in screening of testicular cancer is still a matter of debate. In testicular cancer, regular TSE to prove the relationship between life and life US Preventive Services Task Force Some organizations such as the Canadian Task Force are out of the ordinary they do not recommend regular TSE because they can cause anxiety and unnecessary doctor visits [87, 88]. However, self-testis may be useful in increasing the incidence of testicular cancer and in early diagnosis because of the very low number of men participating in preventive healthcare [89]. TSE is a convenient method to detect testicular cancer and contribute to healthier lifestyles for men at risk [71]. Furthermore, TSE, potentially

In conclusion, studies have shown that the incidence of TC is increasing, especially in developed countries, where it is the most commonly diagnosed malignancy in young men. For this reason, young men should be encouraged to be aware of early detection of TC, to raise awareness and to apply to the health institution. In general, with rates of treatment above 95% (80% for metastatic disease), TC is considered to be a curable cancer when diagnosed early. At the same time, contrary to the supposition of men, treatment of TC is generally a type of cancer that does not cause sexual problems and does not affect fertility, and men's masculinity is maintained unless both testicles are affected for a long time. The men that will be given TSE training may need to be present as educators because some men find the discussion of their testicles embarrassing. Furthermore, teaching young men to conduct TSE may result in these men taking increased responsibility for their own healthcare. When men are aware of what is normal for themselves, they are more likely to consult in the absence of false assurances from the absence of a lack of precariousness when they detect any abnormal condition. It is equally important to tell men that the diagnosis of testicular cancer is not death and the rate of treatment is excellent. Efforts should be made to make men aware that there may be a disease

The author declared no potential conflicts of interest with respect to the publica-

Thanks to my students who are Cansu Yasar, Kardelen Ozcoban, and Kezban

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

as possible [86]. However, the role of TSE in screening of testicular cancer is still a matter of debate. In testicular cancer, regular TSE to prove the relationship between life and life US Preventive Services Task Force Some organizations such as the Canadian Task Force are out of the ordinary they do not recommend regular TSE because they can cause anxiety and unnecessary doctor visits [87, 88]. However, self-testis may be useful in increasing the incidence of testicular cancer and in early diagnosis because of the very low number of men participating in preventive healthcare [89]. TSE is a convenient method to detect testicular cancer and contribute to healthier lifestyles for men at risk [71]. Furthermore, TSE, potentially positive, can produce sustainable health behavior choices [90].

### **8. Conclusions**

*Male Reproductive Health*

ing treatment morbidity [70].

**7. The importance of early detection of TC and TSE**

and 1987 in 232 patients studied in Great Britain [77].

The aim of any cancer screening program is to diagnose the disease at an earlier and more easily treatable stage by improving disease-specific survival and minimiz-

As with all cancer cases, when testicular cancer is diagnosed in early stages, the rate of treatment for TC is approximately 96%, significantly affecting survival [71]. Unfortunately, more than 50% of cases are diagnosed after the disease has spread to the primary site, and men must be persuaded to avoid medical treatment as soon as a mass is detected [72]. Once the cancer has expanded over the local nodes (Stage III), the survival rate decreases extremely. This is because approximately every 10–30 days, the tumor doubling times were fast. Therefore, early diagnosis equates with a better long-term overall prognosis [6]. Obviously, for testicular cancer, a potentially lethal disease, early detection and early treatment are very important [6]. Rapid diagnosis of these neoplasms provides the opportunity to treat these patients at the earliest stage of the disease and thus minimize long-term morbidity [70].

Despite the importance of early diagnosis, invisible dangers are common in early and definitive diagnosis of testicular tumors. There are many studies based on delay in the diagnosis of testicular cancer [73–75]. In a comprehensive study on delayed diagnosis (DD) in testicular cancer, DD confirmed that it had a significant effect on survival in TC patients receiving modern treatments, including chemotherapy [76]. On the other hand, Nikzas et al. found no effect on survival in delay between 1980

Both patients and health professionals can contribute to delay in diagnosis. Patient-induced delays due to unawareness, embarrassment, fear of cancer, or fear of emasculation are accepted [75, 78–80]. The results of literature reviews suggest that approximately 20–30% of cancer patients delay seeking help for more than

TC affects young and generally healthy males who do not accept the threat of deadly disease. Moreover, that testicular cancer requires loss of external genitals during a time in the man's life when sexuality is very important is additionally stressful [70]. The physician-mediated delay is most often the misdiagnosis of a testicular tumor as an infection. Unluckily for clinicians, classic painless testicular mass of patients ultimately diagnosed with TC is only half the resulting symptoms [82]. For early diagnosis several organizations, including the American Cancer Society and American Urological Association, recommend that physicians include testicular examination as part of routine control [83].It is also recommended that primary healthcare professionals teach and encourage TSE to males between the ages of 15 and 35 years [84]. At the same time, the American Cancer Society recommends to men, especially who at high risk for TC, TSE as an effective and cost-free method [71]. Studies have shown that men at risk for TC are not educated and do not know how to perform TSE [6]. Moreover, many studies reported that close to all men of the risk group (adult men below age 35) had never performed TSE and very few knew that men who were in the 18- to 50-year-old age group should perform

TSE is the cheapest and easiest method for screening firstly taught by the nurses or physicians to the man. The man is taught to perform the TSE when the scrotum is soft and relaxed, usually after a shower. In addition, TSE is recommended to be done at least once a month starting at the onset of puberty [17]. TSE teaching begins when the man becomes familiar with the major structures of the testis, scrotum, testicle, and epididymis [86]. After being familiar with the normal tissue and structures of the testes, the man is better readied to identify normal physiological structures. Any suspicious masses are notified to a healthcare professional as soon

3 months after having experienced possible symptoms of cancer [81].

**120**

TSE every month [16, 85].

In conclusion, studies have shown that the incidence of TC is increasing, especially in developed countries, where it is the most commonly diagnosed malignancy in young men. For this reason, young men should be encouraged to be aware of early detection of TC, to raise awareness and to apply to the health institution. In general, with rates of treatment above 95% (80% for metastatic disease), TC is considered to be a curable cancer when diagnosed early. At the same time, contrary to the supposition of men, treatment of TC is generally a type of cancer that does not cause sexual problems and does not affect fertility, and men's masculinity is maintained unless both testicles are affected for a long time. The men that will be given TSE training may need to be present as educators because some men find the discussion of their testicles embarrassing. Furthermore, teaching young men to conduct TSE may result in these men taking increased responsibility for their own healthcare. When men are aware of what is normal for themselves, they are more likely to consult in the absence of false assurances from the absence of a lack of precariousness when they detect any abnormal condition. It is equally important to tell men that the diagnosis of testicular cancer is not death and the rate of treatment is excellent. Efforts should be made to make men aware that there may be a disease in their testicles even when there is no pain.

### **Conflict of interest**

The author declared no potential conflicts of interest with respect to the publication of this chapter.

### **Thanks**

Thanks to my students who are Cansu Yasar, Kardelen Ozcoban, and Kezban Kaya.

*Male Reproductive Health*
