Testicular Cancer

Testicular-CancerTesticular cancer is a disease in which cells in one or both testicles become cancerous or malignant.

Depending on the characteristics of the cells present in the tumor, testicular cancers are broadly segragated as seminomas or nonseminomas. Seminomas may be one of these three types: Classic, Anaplastic, or Spermatocytic. The various types of nonseminomas include Choriocarcinoma, Embryonal carcinoma, Teratoma, and yolk sac tumors. Testicular tumors may comprise both seminoma and nonseminoma cells.

According to estimates, about 8,000 men are diagnosed with testicular cancer each year in the United States and approximately 390 men die of this disease annually. Testicular cancer occurs mostly in men between the ages of 20 and 39.

Causes:

  • Undescended testicle or cryptorchidism: Cryptorchidism is a condition in which the testicle does not move down or pass into the scrotum. The risk of testicular cancer significantly increases in males suffering from this condition.
  • Congenital abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia
  • Family history of testicular cancer

Symptoms:

  • Painless lump or inflammation in a testicle
  • Pain or a sense of discomfort in a testicle or in the scrotum
  • Enlargement of a testicle
  • Feeling of heaviness in the scrotum
  • Dull ache in the lower abdomen, back, or groin
  • Sudden accumulation of fluid in the scrotum

Diagnosis

Some of the diagnostic tests for testicular cancer include:

  • Blood tests: Tumor markers are certain substances markers such as Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) that are found in higher-than-normal amounts when cancer cells are present.
  • Ultrasound: Ultrasound of the scrotum can help to reveal the presence and size of the lump or mass in the testicle. It is also helpful in ruling out certain other conditions, such as inflammation due to infection or accumulation of fluid which may be unrelated to cancer.
  • Biopsy: A biopsy of a sample of testicular tissue helps to determine the presence of cancer. Through a surgical process known as Radical Inguinal Orchiectomy, the whole of the affected testicle is removed by making an incision in the groin. In certain cases, for e.g. when a person has only one testicle, the surgeon performs an inguinal biopsy, removing only a sample of the tissue from the testicle by making an incision in the groin. Orchiectomy is done only if the pathologist detects cancer cells.

If testicular cancer is diagnosed, more tests are required to find out the extent of the disease. This helps the doctor to plan the treatment which is appropriate for the patient.

Treatment

Most people affected with testicular cancer can be cured with surgery, radiation therapy, and/or chemotherapy.

Seminomas and nonseminomas develop, grow and spread differently and are treated using different methods. While nonseminomas tend to grow and spread more rapidly; seminomas are highly sensitive to radiation. In case the tumor consists of both seminoma and nonseminoma cells, it is treated as a nonseminoma. Treatment also largely depends on the stage of the cancer, the age of the patient, general physical health, and various other factors.

The three types of standard treatment are:

The surgical procedure used for removing the testicle through an incision in the groin is known as a Radical Inguinal Orchiectomy. Lymph node dissection or removal of some of the lymph nodes located deep in the abdomen is also part of the surgery. This type of surgery does not generally affect a man’s ability to have an erection or an orgasm. However, it can result in fertility problems if it interferes with ejaculation.

Radiation therapy or Radiotherapy makes use of high-energy rays to kill cancer cells and reduce tumors. For treating seminomas, external radiation is aimed at the lymph nodes in the abdomen and is generally administered after surgery. On the contrary, as nonseminomas are comparatively less sensitive to radiation, men affected by this type of cancer do not undergo radiation therapy. Radiation therapy affects both the normal as well as cancerous cells. The major side effects of radiation therapy include fatigue, changes in the skin in the region where the treatment is given, loss of appetite, nausea, and diarrhea.

Chemotherapy is administered to testicular cancer patients as adjuvant therapy (post-surgery) to eliminate the cancerous cells that may remain in the body.

Chemotherapy may be recommended if the cancer is in its advanced stage. It affects normal as well as cancerous cells present throughout the body. Some of the common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, shortness of breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, or difficulty in hearing. Men affected by testicular cancer should discuss their concerns regarding sexual function and fertility with their doctor.

Follow-up care

Regular follow-up exams are very important for people who have been treated for testicular cancer. Patients treated with chemotherapy may have the likelihood of developing certain types of leukemia, as well as some types of cancer. Like all other cancers, testicular cancer has the tendency to recur. Patients have to undergo regular blood tests in order to measure tumor marker levels. In addition, they also have to take regular x-rays and CT scans so that the problems are diagnosed and treated as soon as possible.