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What is testicular cancer? |
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The testes (located under the penis in the scrotum) are
male sex glands. There role is to produce sperm and male hormones (called Testosterone).
Testicular cancer is the development of cancer in one or both testes.
Cancer of the testis occurs most often in men between the ages of 20 and 39, and
is the most common form of cancer in men between the ages of 15 and 34.
How is testicular cancer detected? What are symptoms of testicular cancer?
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Most testicular cancers are found by men themselves. Also,
doctors generally examine the testicles during routine physical exams. Between regular
checkups, if a man notices anything unusual about his testicles, he should talk
with his doctor. Men should see a doctor if they notice any of the following symptoms:
- a painless lump or swelling
in a testis
- pain or discomfort in a
testis or in the scrotum
- any enlargement of a testis
or change in the way it feels
- a feeling of heaviness
in the scrotum
- a dull ache in the lower
abdomen, back, or groin
- a sudden collection of
fluid in the scrotum
These symptoms can be caused by cancer or by other conditions. It is important to
see a doctor to determine the cause of any of these symptoms.
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How to perform a testicular self examination? |
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Monthly testicular self examinations (TSE) are the most
effective way to detect a tumor early. Testicular examination is best done after
a warm bath or shower when the skin of the scrotum is relaxed. You should feel for
any change in size and check for any lumps in testis by rolling it between the fingers
and thumbs of both the hands. While many lumps are non cancerous, a high percentage
of testicular masses are cancerous. It is important to consult a specialist about
any change in the testis. |
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What are the risk factors for testicular cancer? |
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Undescended testis (Cryptorchidism): During the early development (before
birth), the testes develop inside the abdomen and subsequently descend into the
scrotum. In some individuals, one or both of the testes do not move down into the
scrotum and stays inside the abdomen. This is known as Cryptorchidism or Undescended
testes. In such cases the testes is not palpable and the scrotal sac is empty on
one or both the sides. The risk of testicular cancer is increased in males in whom
the testis does not move down into the scrotum. This risk does not change even after
surgery to reposition the testicle into the scrotum therefore a regular self examination
is recommended. However, after repositioning the testes into scrotal sac, it becomes
easier to examine and detect early testicular cancers.
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History of testicular cancer: Men who have had testicular cancer are at
increased risk of developing cancer in the other testis.
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Family history of testicular cancer: The risk for testicular cancer is
greater in men whose brother or father has had the disease.
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How is testicular cancer diagnosed? |
In case of suspicion of testicular cancer on examination
or history, the doctor performs certain laboratory and imaging tests to confirm
the diagnosis. These tests include:
- Tumor Markers:
Tumor markers are substances often found in higher-than normal amounts when cancer
is present. The type of tumor marker ordered by doctor will vary depending upon
the kind of suspected cancer. In case of testicular cancer, tumor markers such as
alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (ßHCG), and lactate dehydrogenase
(LDH) in the blood are ordered. Abnormal level of tumor markers may suggest the
presence of a testicular tumor, even if the tumor is too small to be detected by
physical exams or imaging tests.
- Ultrasound
Ultrasonography uses high-energy sound waves to produce images of the internal organs.
It is generally not uncomfortable and usually no preparation is needed for this
test. Ultrasound of the scrotum can show the presence and size of a mass in the
testicle. It is also helpful in ruling out other conditions, such as swelling due
to infection or a collection of fluid unrelated to cancer.
- Biopsy
(microscopic examination of testicular tissue by a pathologist) to determine whether
cancer is present. In nearly all cases of suspected cancer, the entire affected
testicle is removed through an incision in the groin. This procedure is called radical
inguinal orchiectomy. In rare cases (for example, when a man has only one testicle),
the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle
through an incision in the groin and proceeding with orchiectomy only if the pathologist
finds cancer cells.
If testicular cancer is found, more tests are needed to find out if the cancer has
spread from the testicle to other parts of the body (Staging). Determining the stage
(extent) of the disease helps the doctor to plan appropriate treatment.
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What are different types of Testicular cancer?
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Based on the type of the cell in the tumor, testicular
cancers are classified into two most common kind i.e seminomas or nonseminomas.
Rarely, other types of cancer arise in the testes such as lymphoma, endocrine tumors
etc.
The preferred treatment modality may vary with the type of testicular cancer.
Seminomas may be one of three types: classic, anaplastic, or spermatocytic. Types
of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk
sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells. |
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How is testicular cancer treated? What are the
side effects of treatment? |
Most men with testicular cancer can be cured with surgery,
radiation therapy, and/or chemotherapy. Treatment is often provided by a team of
specialists, which may include a surgeon, a medical oncologist, and a radiation
oncologist.
Seminomas and nonseminomas grow and spread differently and are treated differently.
Treatment also depends on the stage of the cancer, the patient's age and general
health, and other factors. Treatment is more likely to be successful when testicular
cancer is found early. In addition, in early stages, the treatment can often be
less aggressive and may cause fewer side effects.
The side effects depend on the type of treatment and may be different for each person. |
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The three types of standard treatment are: |
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Surgery to remove the testicle through an incision in the
groin is called a radical inguinal orchiectomy. Men may be concerned that losing
a testicle will affect their ability to have sexual intercourse or make them sterile
(unable to produce children). However, a man with one healthy testicle can still
have a normal erection and produce sperm. Therefore, an operation to remove one
testicle does not make a man impotent (unable to have an erection) and seldom interferes
with fertility (the ability to produce children). For cosmetic purposes, men can
have a prosthesis (an artificial testicle) placed in the scrotum at the time of
their orchiectomy or at any time afterward.
More aggressive tumors (decided on the basis of pathologic examination of the testis)
may require surgical removal of the lymphnodes in the abdomen (Retroperitoneal lymph
node dissection). This type of surgery does not usually change a man's ability to
have an erection or an orgasm, but it can cause problems with fertility if it interferes
with ejaculation. Robot Assisted Retroperitoneal lymphnode dissection (Robotic RPLND)
is an alternative to open surgery which gives equivalent results while minimizing
the morbidity of the procedure. |
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Radiation
therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells and shrink tumors. Seminoma tumors are responsive to radiation therefore
external beam radiation (radiation from source outside the body), aimed at the lymph
nodes in the abdomen are used to treat seminomas. It is usually given after the
surgery. It is a local therapy, meaning that it affects cancer cells only in the
treated areas. Radiation therapy affects normal as well as cancerous cells. The
side effects of radiation therapy depend mainly on the treatment the radiation dose
and the area exposed. Common side effects include fatigue, skin changes at the site
where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation
therapy interferes with the sperm production, but many patients regain their fertility
over a period of 1 to 2 years.
Because nonseminomas are less sensitive to radiation, men with this type of cancer
usually do not undergo radiation therapy. Non seminomatous tumors are treated by
surgery or chemotherapy.
Chemotherapy is the use of anticancer drugs
to kill cancer cells. When chemotherapy is given to testicular cancer patients,
it is usually given as adjuvant therapy (after surgery) to destroy cancerous cells
that may remain in the body. Chemotherapy may also be the initial treatment if the
cancer is advanced; that is, if it has spread outside the testicle at the time of
the diagnosis. Most anticancer drugs are given by injection into a vein.
Chemotherapy is a systemic therapy (as opposed to local therapy), meaning drugs
travel through the bloodstream and affect normal as well as cancerous cells throughout
the body. The side effects depend largely on the specific drug used and their doses.
Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever,
chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects
include dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer
drugs also interfere with sperm production. Although the reduction in sperm count
is permanent for some patients, many others recover their fertility.
Some men with advanced or recurrent testicular cancer may undergo treatment with
very high doses of chemotherapy. These high doses of chemotherapy kill cancer cells,
but they also destroy the bone marrow (which makes and stores blood cells). Such
treatment can be given only if patients can undergo a bone marrow transplant. In
a transplant, bone marrow stem cells are removed from the patient before chemotherapy
is administered. These cells are frozen temporarily and then thawed and returned
to the patient through a needle (like a blood transfusion) after the high-dose chemotherapy
has been administered.
Men with testicular cancer should discuss their concerns about sexual function and
fertility with their doctor. It is important to know that men with testicular cancer
often have fertility problems even before their cancer is treated. If a man has
pre-existing fertility problems, or if he is to have treatment that might lead to
infertility, he may want to ask the doctor about sperm banking (freezing sperm before
treatment for use in the future). This procedure allows some men to have children
even if the treatment causes loss of fertility. |
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Is follow-up treatment necessary? What does it
involve? |
Regular follow-up exams are extremely important for men
who have been treated for testicular cancer. Like all cancers, testicular cancer
can recur (come back). Men who have had testicular cancer should see their doctor
regularly and should report any unusual symptoms right away. Follow-up varies for
different types and stages of testicular cancer. Generally, patients are checked
frequently by their doctor and have regular blood tests to measure tumor marker
levels. They also have regular x-rays and computed tomography, also called CT scans.
Men who have had testicular cancer have an increased likelihood of developing cancer
in the remaining testicle. Patients treated with chemotherapy may have an increased
risk of certain types of leukemia, as well as other types of cancer. Regular follow-up
care ensures that changes in health are discussed and that problems are treated
as soon as possible. |
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