WHAT YOU NEED TO KNOW ABOUT TESTİS TESTIS TUMORS
Although testicular tumors are rare, they are the most common malignant tumor in men aged 15-35 years. It covers 1-2% of all malignant tumors in men. The overall incidence of testicular tumors is reported to be 2-3 per 100,000, but it tends to increase, albeit slowly. The incidence of testicular tumors in men during their lifetime is 0.2%. 90-95% of tumors originate from the germinal tissue. Germ cell tumors of the testis are classified as pure seminoma and nonseminomatous germ cell tumors. Seminomas are extremely sensitive to radiotherapy. Nonseminomatous germ cell tumors (NSGCT) respond particularly well to chemotherapy combinations containing platinum. In recent years, overall survival rates have been increasing with the use of advanced imaging methods and tumor markers together, changes in surgical techniques and the use of multi-drug chemotherapy protocols. While mortality rates were close to 50% in the 1950s, today this rate has fallen below 10%.
Etiology Although there is no known definite cause of testicular tumors, it is known that both congenital and acquired factors are important in the etiology of germ cell tumors. Among these factors, cryptorchidism (undescended testis) shows the strongest relationship. 7-10% of patients with testicular tumors have a history of cryptorchidism. Those with cryptorchidism, on the other hand, have a 5-15 times higher risk of developing testicular tumors. In patients with unilateral cryptorchidism and testicular tumor, 5 – 15% tumor can be seen in the contralateral testis. Seminoma is common in these patients. The risk of malignancy is highest in the intra-abdominal testis (1/20) and the lowest (1/80) in the inguinal testis. Lowering the undescended testis into the scrotum (orchiopexy) facilitates examination and tumor identification, but does not change the malignancy potential.
The use of diethylstilbestrol or estrogen-containing oral contraceptives during pregnancy increases the relative incidence of testicular tumors by 2.8%-5.3%. Acquired factors such as testicular atrophy or trauma associated with nonspecific infection or mumps infection are thought to cause malignant transformation by causing local hormonal imbalances.
The incidence of testicular tumor varies according to race, country and socioeconomic level. It is most common in Scandinavian countries, and the rarest in Africa and Asia. It is the most common solid tumor between the ages of 20-40. They also make a small peak after the age of 60 and under the age of 10. The most common histological type of seminoma is between 35 and 39 years old. Embryonal carcinoma and teratocarcinoma are most common between the ages of 25-35, and choriocarcinoma between the ages of 20-30. Although yolk sac tumors and pure benign teratomas are common in early childhood, these two histological types are seen in combination with other histological types at later ages. Malignant testicular lymphomas are more common after the age of 50. It is slightly more common in the right testis than in the left, paralleling the high incidence of cryptoorchidism.
Primary testicular tumors are approximately 2-3% bilateral-bilateral and they may occur simultaneously or in different time periods. Approximately 50% of these tumors have a history of unilateral or bilateral undescended testis. The most common bilateral testicular tumors; The germ cell tumor is seminoma. However, the most common bilateral tumor is malignant lymphoma.
All germinal cell tumors in adults should be considered malignant and treated. Spontaneous regression is very rare in this disease, and the majority of disease-related deaths occur within 3 years of diagnosis.
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