Testicular cancer
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| Testicular cancer | ||
| OMIM | 273300 | |
|---|---|---|
| DiseasesDB | 12966 | |
| MeSH | C04.588.322.762 | |
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Testicular cancer Microchapters |
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Diagnosis |
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American Roentgen Ray Society Images of Testicular cancer |
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Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Testicular cancer
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
Symptoms and early detection
The nature of any palpated lump in the scrotum is evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by CT scans, which are used to locate metastases. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. The diagnosis is made by performing an orchiectomy, surgical excision of the entire testis along with attached structures epididymis and spermatic cord; the resected specimen is evaluated by a pathologist. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum. A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.
Classification
Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors. Most of the remaining 5% derive from Leydig cells or Sertoli cells. Thus, the focus of diagnosis is on determining which germ cell tumor is present. Correct diagnosis is necessary to ensure the most effective and least harmful treatment. To some extent, this can be done via blood tests for tumor markers, but differential diagnosis requires examination of the histology of a specimen by a pathologist.
Histology
After removal, a testicular tumor is classified by a pathologist according to its histology.
Germ cell tumors of the testis, by frequency
- 40% mixed (usually teratoma plus another)
- 35% seminoma (germinoma of the testis)
- 20% embryonal carcinoma
- 5% teratoma (pure)
- <1% choriocarcinoma
- Gonadoblastoma
Also: Intratubular germ cell neoplasms (the in-situ stage of germ cell tumors)
Non-germ cell tumors of the testis
- Sertoli-Leydig cell tumor (usually benign)
- Gonadoblastomas [3]
Secondary tumors of the testis
- Lymphoma
- Leukemic infiltration of the testis
- Metastatic tumors [4]
Treatment
The three basic types of treatment are surgery, radiation therapy, and chemotherapy.
Surgery is performed by urologists; radiation therapy is administered by radiation oncologists; and chemotherapy is the work of medical oncologists.
Radiation therapy
Radiation may be used to treat stage II seminoma cancers, or as adjuvant (preventative) therapy in the case of stage I seminomas, to minimize the likelihood that tiny, non-detectable tumors exist and will spread (in the inguinal and para-aortic lymph nodes). Radiation is never used as a primary therapy for nonseminoma because a much higher dose is required and chemotherapy is far more effective in that setting.
Chemotherapy
As an adjuvant treatment, use of chemotherapy as an alternative to radiation therapy is increasing, because radiation therapy appears to have more significant long-term side effects (for example, internal scarring, increased risks of secondary malignancies, etc.). Two doses of carboplatin, typically delivered three weeks apart, is proving to be a successful adjuvant treatment, with recurrence rates in the same ranges as those of radiotherapy.
Chemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage II or III). The standard chemotherapy protocol is three to four rounds of Bleomycin-Etoposide-Cisplatin (BEP). This treatment was developed by Dr. Lawrence Einhorn at Indiana University. An alternative, equally effective treatment involves the use of four cycles of Etoposide-Cisplatin (EP).
While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage I cancers cases (if monitored properly) have essentially a 100% survival rate (which is why prompt action, when testicular cancer is a possibility, is extremely important).
Actions after treatment
Surveillance
For stage I cancers that have not had any adjuvant (preventive) therapy, close monitoring for at least a year is important, and should include blood tests (in cases of nonseminomas) and CT-scans (in all cases), to ascertain whether the cancer has metastasized (spread to other parts of the body). For other stages, and for those cases in which radiation therapy or chemotherapy was administered, the extent of monitoring (tests) will vary on the basis of the circumstances, but normally should be done for five years (with decreasing intensity).
Fertility
A man with one remaining testis can lead a normal life, because the remaining testis takes up the burden of testosterone production and will generally have adequate fertility.[5] However, it is worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm banking may be appropriate for younger men who still plan to have children, since fertility may be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy and/or radiotherapy is done.
Less than five percent of those who have testicular cancer will have it again in the remaining testis. A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and will be infertile, but can lead an otherwise normal life.
Famous survivors
- Decorated cyclist Lance Armstrong
- In 1997, figure-skater Scott Hamilton
- Mike Lowell, Boston Red Sox third baseman was diagnosed during spring training of his rookie year.
- Christopher Arena, National Basketball Association and co-founder of ArenaTilton Golf
- Hockey player Phil Kessel of the Boston Bruins, diagnosed during his rookie season in 2006-07
References
External links
- Beth Israel Deaconess Medical Center: Testicular cancer
- UK testicular cancer support forums
- Testicular Cancer Resource Center
- National Institute of Health information and links
- Understanding Testicular Cancer from The Cancer Council Australia
- Images of scans for testicular cancer
- checkemlads.com Testicular cancer support and awareness, run by survivors
- checkyourballs Support and Awareness site, created by a survivor.
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