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Testicular cancer

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Overview of testicular cancer

Testicular cancer is a disease in which malignant or cancer cells form in the tissues of one or both testicles. This type of cancer accounts for 1–2% of all neoplasms in men and is the most common malignant tumor in men aged 20–35 years with an annual incidence of 4 per 100,000. The incidence has doubled in the past 40 years and continues to rise, particularly in White men. From 1980 to 2000, death rates from testicular cancer decreased by 50% and the cure rate is currently 99%, if diagnosed early.1,2

Most testicular cancers start in the germ cells. The two main types of testicular germ cell tumors are seminomas and nonseminomas. These two types differ in the way they grow and spread and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation. A testicular tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.3

Signs and Symptoms of testicular cancer

The following are some of the symptoms of testicular cancer. These warrant immediate medical attention.

  • Painless lump or swelling in either testicle.
  • Change in how the testicle, feels normal.
  • Dull ache in the lower abdomen or the groin.
  • Sudden build-up of fluid in the scrotum.
  • Pain or discomfort in a testicle or in the scrotum.

Signs and symptoms of testicular cancer

Causes and Risk Factors for testicular cancer

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Following are the various causes and risk factors for testicular cancer.1,2

Cryptorcidism or undescended testicles:

About 10% of men with testicular cancer have a history of undescended testicles; repair before puberty is associated with two times increased risk, whereas repair after age 12 years increases the risk five times.

Family history:

Having a brother with testicular cancer increases the risk 6–10 times.

White race:

White men are at higher risk than Black men, and a genetic link is being investigated.

Infertility:

Infertility and abnormal semen is an association, and men exposed to diethylstilbestrol in utero are at risk.

Smoking:

The risk is increased two times with a 12-pack-year (pack-year is a multiple of the number of packs of cigarettes smoked per day and the number of years the person has smoked) smoking history even after smoking cessation.

No association has been found with diet and trauma.

Diagnosis of testicular cancer

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Early diagnosis of testicular cancer is crucial since the doubling time of testis tumors is estimated to be 10–30 days.4 While survival rates at all stages are very high, an earlier stage at diagnosis carries a better long-term prognosis. Men are often reluctant to report a swelling or lump in the testicle, resulting in a delay in presentation to a physician. The following tests are used to diagnose testicular cancers.

Scrotal ultrasonography:In any patient with a testicular mass or unexplained scrotal pain or swelling, an ultrasonogram of the scrotum should be obtained. This test is nearly 100% accurate in distinguishing between intratesticular and extratesticular pathology.5 All intratesticular masses are considered cancer until proved otherwise.

Chest radiograph and computed tomographic (CT) scan of the abdomen to rule out metastases.

Serum tumor markers are obtained for staging. A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following three tumor markers are used to detect testicular cancer:

  • Alpha-fetoprotein
  • Beta-human chorionic gonadotropin
  • Lactate dehydrogenase

Radical inguinal orchiectomy is performed for definitive diagnosis. Here the entire testicle is removed through an incision in the groin. This is also the first step in most treatment regimens. Trans-scrotal testicular biopsy is absolutely contraindicated in the diagnosis or management of testicular cancer since it could cause a spread of the cancer to the scrotum and lymph nodes.

Treatment of testicular cancer

Treatment of testicular cancer depends on several factors, including the type and stage of the cancer, overall health and the preferences of the patient. Treatment options may include the following.

Surgery

Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. Surgery might be done to remove the lymph nodes in the groin (retroperitoneal lymph node dissection). In the early stages, surgery may be the only treatment needed. In case of a more advanced testicular cancer, other treatments may be recommended after surgery.

Radiation Therapy

This is a treatment option for the seminoma type of testicular cancer. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Side-effects may include fatigue as well as skin redness and irritation in the abdominal and groin areas. This may result in infertility. However, as the treated area heals, fertility may be regained.

Chemotherapy

Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy may be recommended after surgery before or after lymph node removal. Side-effects of chemotherapy depend on the drugs being used. Common side-effects include fatigue, nausea, hair loss, infertility and an increased risk of infection.

Stem Cell Transplant

This seems to be a promising mode of treatment in cases of testicular cancer. Before a stem cell transplant, drugs that coax the body’s bone marrow stem cells out of the bones into the bloodstream are given. Then, the stem cells are filtered and frozen for later use. After this, high doses of chemotherapy are given to kill any cancer cells, which may also kill bone marrow cells. The stored stem cells are thawed and put back into the body to replenish the bone marrow cells.

Prevention of testicular cancer

Although there are no proven ways to prevent testicular cancer, the following steps may increase the possibility of finding early-stage testicular cancer when it is most likely to be curable.

  • Perform regular testicular self-examinations. Most cases of testicular cancer are discovered during self-examination or by a health professional during a routine physical examination.
  • Any pain or discomfort in the scrotum, pelvis, or lower back may be an indication of testicular cancer and hence warrants immediate medical attention.

References

1.Shaw J. Diagnosis and treatment of testicular cancer. Am Fam Physician. 2008;77(4):469–474.

2.American Academy of Family Physicians. Testicular cancer: What you should know. Am Fam Physician. 2008;77(4):475–476.

3.National Cancer Institutes. US National Institutes of Health. General information about testicular cancer. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/testicular/patient Accessed on 16-06-08

4.Richie JP. Detection and treatment of testicular cancer. CA Cancer J Clin. 1993;43:151–175.

5.Langer JE. Ultrasound of the scrotum. Semin Roentgenol. 1993;28:5–18.