What is Tes­tic­u­lar Can­cer?

Wellness Update - - Health Watch MD -

What are the tes­ti­cles? The tes­ti­cles are male sex glands that pro­duce sperm and the hor­mone testos­terone. The tes­ti­cles are two wal­nut-shaped glands in­side the scro­tum. The scro­tum is the sac of skin that lies be­low the pe­nis.

What is tes­tic­u­lar can­cer?

Tes­tic­u­lar can­cer is a dis­ease that oc­curs when can­cer­ous (ma­lig­nant) cells de­velop in the tis­sues of a tes­ti­cle. The de­vel­op­ment of can­cer­ous cells in both tes­ti­cles can oc­cur, but is very rare. Tes­tic­u­lar can­cer is the most com­mon can­cer in men aged 20 to 35. The dis­ease usu­ally is cur­able.

What are the risk fac­tors for de­vel­op­ing tes­tic­u­lar can­cer?

Risk fac­tors for de­vel­op­ing tes­tic­u­lar can­cer in­clude: * Un­de­scended tes­ti­cle(s) — This is when one or both tes­ti­cles do not move down into the scro­tum be­fore birth. * Kline­fel­ter’s syn­drome — This is a dis­or­der in which males are born with an ex­tra X chro­mo­some in all or most of their cells. Cer­tain other ge­netic syn­dromes are also as­so­ci­ated with higher risk. * Race — Non-His­panic, white men are more likely to de­velop this can­cer than are men of other races and eth­nic­i­ties. * Per­sonal or fam­ily his­tory — Men with a brother or fa­ther who had testis can­cer have an in­creased risk of de­vel­op­ing testis can­cer them­selves. Men who have had testis can­cer them­selves in one tes­ti­cle are at in­creased risk of de­vel­op­ing a sec­ond can­cer in the other tes­ti­cle.

What are the symp­toms of tes­tic­u­lar can­cer?

The fol­low­ing symp­toms can be signs of tes­tic­u­lar can­cer or of an­other con­di­tion. Con­sult a doc­tor if you have any of th­ese symp­toms: * Swelling in the scro­tum * Lump or swelling in ei­ther tes­ti­cle * Build-up of fluid on the scro­tum * Dull ache in the groin or lower ab­domen * Pain or dis­com­fort in the scro­tum or a tes­ti­cle * How is tes­tic­u­lar can­cer di­ag­nosed? Testis­cu­lar can­cer is usu­ally di­ag­nosed af­ter the man no­tices a lump or other change in a tes­ti­cle. When an ab­nor­mal­ity is sus­pected, an ul­tra­sound is usu­ally or­dered, which is a pain­less med­i­cal test that helps the doc­tor to see whether there are ab­nor­mal­i­ties in the tes­ti­cle. If the ul­tra­sound shows ev­i­dence of can­cer, then surgery is per­formed to re­move the tes­ti­cle and it is ex­am­ined un­der a mi­cro­scope to see whether can­cer is present and, if so, what type of can­cer. Thus, tes­tic­u­lar can­cer is only di­ag­nosed af­ter the tes­ti­cle is re­moved and ex­am­ined. Biop­sies, which in­volve the re­moval of a small amount of tis­sue us­ing a nee­dle or other med­i­cal tool, are NOT per­formed on tes­ti­cles be­cause pen­e­trat­ing the tes­ti­cle can make it more dif­fi­cult to treat a can­cer if one is dis­cov­ered.

Tests to help di­ag­nose tes­tic­u­lar can­cer can in­clude:

* Ul­tra­sound — This is a pro­ce­dure that uses high-en­ergy sound waves to form pic­tures of body tis­sues. * A phys­i­cal exam and his­tory — A phys­i­cal exam and med­i­cal his­tory can help the doc­tor look for prob­lems that might be re­lated to tes­tic­u­lar can­cer. * A serum tu­mor marker test — This pro­ce­dure ex­am­ines a blood sam­ple to mea­sure the amounts of cer­tain sub­stances linked to spe­cific types of can­cers. Th­ese sub­stances are called tu­mor mark­ers. The tu­mor mark­ers that are of­ten el­e­vated in tes­tic­u­lar can­cer are alpha-fe­to­pro­tein (AFP), hu­man chori­onic go­nadotrophin (HCG or beta-HCG) and lac­tate de­hy­dron­ge­nase (LDH). * In­guinal or­chiec­tomy and biopsy — This pro­ce­dure in­volves the re­moval of the en­tire tes­ti­cle through an in­ci­sion in the groin. A tis­sue sam­ple from the tes­ti­cle is then checked for can­cer cells. * CT scans and X-rays — A CT scan is a med­i­cal test that uses x-rays to form pic­tures of the in­side of the body. When a can­cer is di­ag­nosed or sus­pected, a CT scan (also re­ferred to as a CAT scan) is per­formed to see whether can­cer can be seen else­where in the body. In testis can­cer, a CT scan is per­formed of the ab­domen and pelvis. Im­ages of the chest are taken us­ing ei­ther a CT scan or a reg­u­lar X-ray.

What are the stages of tes­tic­u­lar can­cer?

Stage 0 — Ab­nor­mal cells have de­vel­oped but are still con­fined within the tubules where sperm cells start to de­velop.

Stage I - This stage con­sists of the stages IA, IB, and IS. In Stage IA, the can­cer is con­fined to the tes­ti­cle and the epi­didymis, and all tu­mor marker lev­els are nor­mal. The can­cer has not spread to the outer layer of the dou­ble mem­brane that sur­rounds the tes­ti­cle and has not grown into the blood or lymph ves­sels. In Stage IB, at least one of the fol­low­ing ap­plies: The can­cer in­vades into the blood ves­sels or lym­phat­ics within the tes­ti­cle; the can­cer has spread to the outer layer of the mem­brane around the tes­ti­cle; and/or the can­cer in­vades into the sper­matic cord or the scro­tum. In stage IB, all tu­mor marker lev­els are nor­mal. In Stage IS, the can­cer is any­where within the tes­ti­cle, sper­matic cord, or scro­tum and one or more of the tu­mor mark­ers is el­e­vated. Stage II - This stage con­sists of Stage IIA, Stage IIB, and Stage IIC and refers to pa­tients whose can­cer has spread to the lymph nodes in the back of the ab­domen (this part of the body is re­ferred to as the retroperi­toneum) but not to any­where else. If pa­tients with can­cer in their lymph nodes have mod­er­ately or highly el­e­vated tu­mor mark­ers, then they are stage III rather than stage II. In Stage IIA, the can­cer has spread to a max­i­mum of five lymph nodes in the ab­domen. None of the lymph nodes is larger than 2 cen­time­ters in size. Tu­mor mark­ers must be ei­ther nor­mal or only mildly el­e­vated. In stage IIB, the can­cer has spread to more than 5 nodes, none of which is larger than 5 cen­time­ters, or the can­cer has spread to 5 or fewer nodes and there is a lymph node mass mea­sur­ing be­tween 2 and 5 cen­time­ters. Tu­mor mark­ers must be ei­ther nor­mal or mildly el­e­vated. In Stage IIC, the can­cer has spread to at least one lymph node in the ab­domen that is larger than 5 cm di­am­e­ter. Tu­mor mark­ers must be ei­ther nor­mal or only mildly el­e­vated. Stage III - This stage is di­vided into Stage IIIA, Stage IIIB, and Stage IIIC and is de­ter­mined af­ter an in­guinal or­chiec­tomy (re­moval of a tes­ti­cle through an in­ci­sion in the groin) is per­formed. In Stage IIIA, the can­cer has spread to lymph nodes be­yond the ab­domen (such as lymph nodes in the chest) and/or to the lungs. Tu­mor mark­ers must be nor­mal or only mildly el­e­vated. In stage IIIB, the can­cer has spread to lymph nodes in the ab­domen or else­where (such as lymph nodes in the chest) and/or to the lungs and the tu­mor mark­ers are mod­er­ately el­e­vated. In stage IIIC, ei­ther the can­cer has spread to an or­gan other than the lungs (such as the liver, the bones, or the brain) or the tu­mor mark­ers are highly el­e­vated and the can­cer has spread to at least one lymph node or or­gan.

How is tes­tic­u­lar can­cer treated at each stage?

Nearly all tes­tic­u­lar can­cers start in the germ cells (those that be­come sperm or eggs). The main types of tes­tic­u­lar germ cell tu­mors are semi­no­mas and non-semi­no­mas. Non-semi­no­mas tend to grow and spread faster than do semi­no­mas. Semi­no­mas are more sen­si­tive to ra­di­a­tion, and both kinds are very sen­si­tive to chemo­ther­apy. If a tes­tic­u­lar tu­mor has both semi­noma and non­semi­noma cells, it is treated as a non-semi­noma. The three main kinds of treat­ment for tes­tic­u­lar can­cer are:

Sur­gi­cal treat­ment - This treat­ment can in­clude re­mov­ing the tes­ti­cle (or­chiec­tomy) and re­mov­ing as­so­ci­ated lymph nodes (lym­phadenec­tomy). Usu­ally, or­chiec­tomy is per­formed for both semi­noma and non-semi­noma tes­tic­u­lar can­cers, whereas lymph node re­moval is used only for non-semi­no­mas. Surgery may also be per­formed in cer­tain sit­u­a­tions to re­move tu­mors from the lungs or liver if they have not dis­ap­peared fol­low­ing chemo­ther­apy.

Ra­di­a­tion ther­apy - This treat­ment uses high­dose X-rays. Ra­di­a­tion might be used af­ter surgery for pa­tients with semi­no­mas to pre­vent the tu­mor from re­turn­ing. Usu­ally, ra­di­a­tion is limited to the treat­ment of semi­no­mas.

Chemo­ther­apy - This treat­ment uses drugs such as cis­platin, bleomycin, and etopo­side to kill can­cer cells. Chemo­ther­apy has im­proved the sur­vival rate for peo­ple with both semi­no­mas and non-semi­no­mas.

Treat­ment by stage for tes­tic­u­lar can­cer

In Stage I, the treat­ment is usu­ally surgery to re­move the tes­ti­cle. For stage I semi­no­mas, the stan­dard treat­ment is ob­ser­va­tion, car­bo­platin chemo­ther­apy, or ra­di­a­tion to the lymph nodes in the ab­domen. For non-semi­no­mas, man­age­ment con­sists of ob­ser­va­tion, chemo­ther­apy with bleomycin, etopo­side, and cis­platin, or surgery to re­move lymph nodes in the ab­domen. In Stage II, semi­noma tu­mors are di­vided into bulky and non-bulky dis­ease. Bulky dis­ease is gen­er­ally de­fined as tu­mors greater than 5 cen­time­ters. For non-bulky dis­ease, the treat­ment of stage II semi­no­mas in­cludes surgery to re­move the tes­ti­cle, fol­lowed by ra­di­a­tion to the lymph nodes or chemo­ther­apy us­ing nine weeks (three 21-day cy­cles) of bleomycin, etopo­side, and cis­platin, or 12 weeks (four 21-day cy­cles) of etopo­side and cis­platin. . In cases of bulky dis­ease, the treat­ment in­volves surgery to re­move the tes­ti­cle, fol­lowed by chemo­ther­apy us­ing nine weeks (three 21-day cy­cles) of bleomycin, etopo­side, and cis­platin, or 12 weeks (four 21-day cy­cles) of etopo­side and cis­platin with­out bleomycin.

The treat­ment of Stage II non-semi­no­mas is sim­i­larly di­vided into bulky and non­bulky dis­ease, but the cut­off is lower at 2 cen­time­ters. For non­bulky dis­ease, treat­ment is usu­ally surgery to re­move the tes­ti­cle fol­lowed by ei­ther sur­veil­lance with CT scans or surgery to re­move the lymph nodes in the back of the ab­domen (the retroperi­toneum). If can­cer is found in the lymph nodes that are re­moved, then six weeks of chemo­ther­apy us­ing cis­platin and etopo­side (ei­ther with or with­out bleomycin) is of­ten rec­om­mended. For bulky dis­ease, surgery is per­formed to re­move the tes­ti­cle, fol­lowed by chemo­ther­apy (the same chemo­ther­apy as de­fined above for semi­noma). Af­ter chemo­ther­apy, surgery should be per­formed to re­move the lymph nodes in the back of the ab­domen if there are any re­main­ing en­larged nodes. In Stage III, the treat­ment is surgery to re­move the tes­ti­cle fol­lowed by multi-drug chemo­ther­apy. Treat­ment is the same for Stage III semi­no­mas and non-semi­no­mas, ex­cept that af­ter chemo­ther­apy, surgery is of­ten per­formed to re­move any resid­ual tu­mors in non-semi­no­mas. In semi­no­mas, resid­ual tu­mors usu­ally do not re­quire any ad­di­tional treat­ment. Chemo­ther­apy typ­i­cally con­sists of nine weeks of bleomycin, etopo­side, and cis­platin, or 12 weeks of etopo­side plus cis­platin for pa­tients with fa­vor­able risk fac­tors and 12 weeks of bleomycin, etopo­side, and cis­platin for pa­tients with un­fa­vor­able risk fac­tors. Un­fa­vor­able risk fac­tors in­clude highly el­e­vated tu­mor mark­ers in the blood and tu­mors in or­gans other than the lungs, such as the liver, bones, or brain. If the can­cer is a re­cur­rence of a pre­vi­ous tes­tic­u­lar can­cer, the treat­ment usu­ally con­sists of chemo­ther­apy us­ing com­bi­na­tions of dif­fer­ent medicines, such as ifos­famide, cis­platin, etopo­side, vin­blas­tine, or pa­cli­taxel. This treat­ment some­times is fol­lowed by an au­tol­o­gous bone mar­row or pe­riph­eral stem-cell trans­plant. Re­cur­rences oc­cur­ring more than two years af­ter ini­tial treat­ment are usu­ally treated sur­gi­cally.

What is the prog­no­sis (chance of re­cov­ery) for men with tes­tic­u­lar can­cer?

The prog­no­sis is good for most men with tes­tic­u­lar can­cer. This form of can­cer is treated suc­cess­fully in more than 95 per­cent of cases. Even men with un­fa­vor­able risk fac­tors have, on aver­age, a 50 per­cent chance of be­ing cured.

Can tes­tic­u­lar can­cer be pre­vented?

There is no way to pre­vent tes­tic­u­lar can­cer, but early de­tec­tion is im­por­tant. Men should per­form tes­tic­u­lar self-ex­am­i­na­tion (TSE) on a monthly ba­sis. If you are a male over 15 years old who has not been in­formed about how to per­form TSE, ask your doc­tor to show you how to do this. If a man no­tices any change in his tes­ti­cles (lumps or nod­ules, hard­ness, per­sis­tent pain, or a tes­ti­cle be­com­ing big­ger or smaller), he should no­tify his doc­tor right away so that the tes­ti­cles can be eval­u­ated. -This in­for­ma­tion pro­vided courtesy of Cleve­land Clinic

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