Testicular Cancer
What is Testicular Cancer?
The testes comprise primitive cells that mature to become cells that make spermatozoa or sperm that are important in sexual reproduction. There are also supporting cells that make enzymes and other fluid that bathe the sperm. The primitive cells can sometimes become cancers called germ cell cancers.
How common is Testicular Cancer?
Testicular cancer represents about 1% of all cancers in males. However, it is one of the most common cancers in young adult males. Germ cell cancers are also found in females from primitive cells in the ovary that eventually make eggs. Appears to be more common in male.
Age of Onset
It occurs predominantly in males aged 18 - 35 years.
Risks and Causes
Males who have a history of undescended testes (testes that did not descend to lie in the scrotum during development before birth) have a much higher chance of developing testicular cancer.
Symptoms and Signs of Testicular Cancer
Typically, there are no early symptoms. Most patients are diagnosed because of the presence of a painless lump in one or both testes. Occasionally, there is a heavy or aching sensation in the testes.
Diagnostic Tests
The presence of a solid painless testicular lump is cause for concern. Other findings may include the presence of breasts in a male or a lump in the tummy from enlarged lymph nodes. Ultrasonography of the testes will locate and delineate the size of the testicular lump.
Blood should be sent for alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (HCG), markers that may be produced by the cancer. These same markers may be found in females. Computerised scans (CT) of the abdomen, chest and occasionally, the brain, may be required to stage the cancer.
Once staging examination is completed, usually the entire testis is removed for biopsy and histology. The removal of only a small piece of testis through the skin is not encouraged as that may cause the cancer to spread into skin and other areas.
Treatment of Testicular Cancer
Testicular cancers may be seminomas or non-seminomatous germ cell tumour, depending on what cell type is found at examination of the cancer under the microscope.
Patients with seminomas usually have normal blood AFP levels. After surgery to remove the affected testis, radiotherapy to the surrounding regional lymph nodes may be required in patients with early stage tumour. Radiotherapy is given over 4 to 6 weeks and may have associated side-effects such as lowering of the white blood counts, redness of skin, diarrhoea, nausea and vomiting, and loss of appetite during treatment. Certain patients with early stage non-seminomatous germ cell tumour may not need additonal therapy following surgery.
Chemotherapy is used if there is advanced cancer involving other organs such as the lungs or liver.
Prognosis of Testicular Cancer
Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of germ cell or seminoma or dysgerminoma cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with germ cell or seminoma or dysgerminoma cancer is excellent.
With appropriate treatment, cure rates of up to 80% have been reported even for patients with advanced seminoma. Patients with early stage seminoma cancer have reported cure rates of 90% with appropriate treatment.
For germ cell cancer, chemotherapy has succeeded in pushing cure rates close to 70 to 90%, depending on the stage of the disease. Even in patients not requiring chemotherapy, close monitoring of blood markers can diagnose early recurrence of the cancer and cure achieved by further therapy.
Frequently Asked Questions about Testicular Cancer
1. I have had a lump in my testis for a while. It is not painful.
Testicular cancer is usually not painful. If there is a lump seek early medical attention. Although it may not be cancerous, it is better to have it checked.
2. I have only one testis.
During development within a mother's uterus, two testes develop within the male baby's body. These two testes descend before birth to lie in the scrotum. Occasionally one or both testes do not descend. Because of the high chance of cancer developing in undescended testes, seek early medical attention. Surgery is usually required to bring the testis back into the scrotum.
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