**5. Treating testicular cancer**

*Male Reproductive Health*

testicular cancer [15].

cyst, and tunica albuginea cyst [55].

**4. The stages of testicular cancer**

In men showing with testicular mass, unexplained scrotal pain or signs, ultrasonography should be regarded an appendage of the physical examination due to being broadly existing, cheap, and noninvasive [54]. After Physical examination, for revealing a mass in the testicle and the first radiological evaluation was Ultrasonography [55]. First of all intratesticular mass or the extratesticular location is examined. The intratesticular masses tend to be malignant, and the extratesticular masses tend to be benign. The nature of the detected masses (solid or cystic) is determined by Ultrasonografi (US). Solid masses suggest more malignancy, whereas cystic masses are often benign, such as rete testis ectasia, simple

Tumor markers are also an important part of the diagnostic workup. Betahuman chorionic gonadotropin (Bhcg), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH) levels are checked for the diagnosis of testicular tumors [56]. At the same time, these marker levels should be acquired after orchiectomy and to monitor chemotherapy treatment [39]. At the beginning of cancer, levels of these markers tend to be in the normal level. LDH levels are often elevated metastatic

A biopsy can damage the testicles and spread the cancer into scrotum, so biopsy is not recommended [57]. But if suspected of having testicular tumor, one should

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

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

Stage I The tumor is in the testis. No evidence of metastasis was found in any of the testis

undergo a radical inguinal orchiectomy for pathologic evaluation [39].

benign character in children but it is 10% malignant in adults [59].

markers, and histology (seminoma or nonseminoma).

Stage IM After orchiectomy tumor markers in height is observed

Stage III Supradiaphragmatic lymphadenopathies are present

Stage II Retroperitoneal lymphadenopathy is present

IIA Lymphadenopathy <2 cm across

Stage IV Organ metastasis/hematogenous spread

IIB = 2–5 cm across IIC >5 cm across

*Classifications of testicular cancer staging.*

*Information from Refs. [61, 62].*

**118**

**Table 2.**

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 the changes in serum tumor markers [15].


### **Table 3.**

*Treatment types for the stages of testicular cancer.*
