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Home :: Testicular Cancer

Testicular Cancer - Symptoms & Treatment

Malignant testicular tumors primarily affect young to middle-aged men and are the most common solid tumor in this group. (In children, testicular tumors are rare.) Most testicular tumors originate in gonadal cells. About 40% are seminomas - uniform, undifferentiated cells resembling primitive gonadal cells. The rest are nonseminomas ­tumor cells showing various degrees of differentiation.

The prognosis varies with the cell type and disease stage. When treated with surgery and radiation, almost all patients with localized disease survive beyond 5 years.

Testicular cancer is highly treatable when diagnosed early. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify dangerous growths early, when the chance for successful treatment of testicular cancer is highest.

Causes

The cause of testicular cancer is unknown. However, men whose testes did not descend into the scrotum by age three are more likely to develop testicular cancer than men whose testes did descend by that age. Normally, the testes move down from inside the abdomen into the scrotum before birth. An undescended testicle is a condition where one or both testes remain inside the abdomen. This condition can be surgically corrected, but the man still carries an increased risk of testicular cancer. Higher rates of testicular cancer have also been noted in men with HIV infection.

Signs and symptoms

The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness. When such a tumor causes chorionic gonadotropin or estrogen production, gynecomastia and nipple tenderness may result.

In advanced stages, signs and symptoms include ureteral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor, and lethargy.

Diagnosis

A physical examination typically reveals a firm, non-tender testicular mass that does not "trans-illuminate" (light from a flashlight held to the scrotum does not pass through the mass).

Other tests include:

  • Scrotal ultrasound is used to confirm solid mass.
  • Blood tests for tumor markers: alpha-fetoprotein (AFP), human chorionic gonadotrophin (beta HCG), and lactic dehydrogenase (LDH). Approximately 85% of non-seminomas will have elevations of either AFP or beta HCG. Seminomas will have elevations only in beta HCG or LDH. These tests can also be used to monitor the response to treatment.
  • A chest X-ray is done to look for potential metastasis (spreading of cancer) to the lungs.
  • An abdominal CT scan may be done to look for potential metastasis.

Tissue biopsy is usually by surgical removal of the testicle. After the testicle is removed, the tissue is examined.

Treatment

The extent of surgery, radiation, and chemotherapy varies with tumor cell type and stage.

Surgery

Surgical procedures include orchiectomy and retroperitoneal node dissection. Most surgeons remove the testis, not the scrotum (to allow for a prosthetic implant). Hormone replacement therapy may be needed after bilateral orchiectomy.

Radiation

The retroperitoneal and homolateral iliac nodes may receive mediation after removal of a seminoma. All positive nodes receive mediation after removal of a nonseminoma. Patients with retroperitoneal extension receive prophylactic radiation to the mediastinal and supraclavicular nodes.

Chemotherapy

Essential for tumors beyond Stage 0, chemotherapy combinations include bleomycin, etoposide, and cisplatin; cisplatin, vindesine, and bleomycin; cisplatin, vinblastine, and bleomycin; and cisplatin, vincristine, methotrexate, bleomycin, and leucovorin.

Chemothempy and radiation followed by autologous bone marrow transplantation may help unresponsive patients.

Prevention

Currently, there is not a method for preventing the disease because:

  • currently, there is not a known cause for the disease.
  • many of the suggested risk factors are those that cannot be changed.
  • many men with testicular cancer do not have the suggested risk factors.

However, testicular self-examination can improve the chances of finding a cancerous tumor early.



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