Testicular cancer

Testicular cancer is a rare type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's chance of getting testicular cancer is roughly 1 in 250 (four tenths of one percent, or 0.4%). It is most common among males aged 15-40 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of 90%; essentially 100% if it has not spread. Even for the relatively few cases in which the cancer has spread widely, chemotherapy offers a cure rate of at least 85% today. Not all lumps on the testicles are cancerous and there are many other conditions such as Epididymal cysts, Hydatid of Morgagni, and so on which may be painful but are non-cancerous. It should be emphasized however that all unusual lumps or pain in the testicles should be checked by a doctor immediately.

Symptoms and early detection

Because testicular cancer is curable (stage I can have a success rate of >95%) when detected early, experts recommend regular monthly testicular self-examination after a hot shower or bath, when the scrotum is looser. Men should examine each testicle, feeling for pea-shaped lumps. Symptoms may include one or more of the following:

• a lump in one testis or a hardening of one of the testicles
• pain and tenderness in the testicles
• build-up of fluid in the scrotum
• a dull ache in the lower abdomen or groin
• an increase, or significant decrease, in the size of one testis
• blood in semen [1]

Men should report any of these to a doctor as soon as possible.

The presence and of testicular cancer is ascertained by ultrasound (of the testicles), the extent of the disease is evaluated by CT scans and X-rays, which are used to locate metastases. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum.

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.

[edit] Surgery

[edit] Orchiectomy

While it may be possible, in some cases, to remove testicular cancer tumors from a testis while leaving the testis functional, this is almost never done, as more than 95% of testicular tumors are malignant. Since only one testis is typically required to maintain fertility, hormone production, and other male functions, the afflicted testis is almost always removed completely in a procedure called inguinal orchiectomy. (The testicle is almost never removed through the scrotum; an incision is made beneath the belt line in the inguinal area.) Most notably, since removing the tumor alone does not eliminate the precancerous cells that exist in the testis, it is usually better in the long run to remove the entire testis to prevent another tumor. A plausible exception could be in the case of the second testis later developing cancer as well.

[edit] Retroperitoneal Lymph Node Dissection (RPLND)

In the case of nonseminomas that appear to be stage I, surgery may be done on the retroperitoneal/Paraaortic lymph nodes (in a separate operation) to accurately determine whether the cancer is in stage I or stage II and to reduce the risk that malignant testicular cancer cells that may have metastasized to lymph nodes in the lower abdomen. This surgery is called Retroperitoneal Lymph Node Dissection (RPLND). However, this approach, while standard in many places, especially the United States, is falling out of favor due to costs and the high level of expertise required to perform the surgery.

Many patients are instead choosing surveillance, where no further surgery is performed unless tests indicate that the cancer has returned. This approach maintains a high cure rate because of the growing accuracy of surveillance techniques.

Lymph node surgery may also be performed after chemotherapy to remove masses left behind, particularly in the cases of advanced initial cancer or large nonseminomas.

[edit] 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.

[edit] 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).

(Source : http://en.wikipedia.org/wiki/Testicular_cancer)