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Testicular cancer
ICD9 = 186| ICDO = | Image = | Caption = | OMIM = | OMIM_mult = | MedlinePlus = 001288 | eMedicineSubj = med | eMedicineTopic = 2250 | DiseasesDB = 12966 | }} Testicular cancer is a type of cancerthat develops in the testicles, a part of the malereproductive 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). 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 ninety percent; essentially one hundred percent 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 fifty percent.
Symptoms and early detectionBecause testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examinationafter a hot shower, when the scrotum is looser. Men should examine each testicle, first feeling for lumps and then compare the testicles to each other together to see whether one is larger than the other. Symptoms may include one or more of the following:
Men should report any of these to a doctoras soon as possible. The extent of testicular cancer and whether the cancer is present are ascertained by ultrasound(of the testicles), X-rays, and/or CT-scans, which are used to locate tumors. For nonseminomas(see below), a blood test is used to identify and measure tumor indicators that are specific to that type of testicular cancer. PathologyTesticular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm. They are not pathogenic; i.e., they are not to be confused with the "germs" (viruses, bacteria) that cause illness.) In general, the remainder of this article discusses germ-cell testicular cancer. Germ-cell tumors are classified as either seminomas or nonseminomas. Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be localized (i.e., only in the testicles), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more-mature germ cells and spread more quickly. (Nonseminomas are classified as one of three or four subtypes; their rate of spread varies somewhat, but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma. A case of testicular cancer is categorized as being in one of three stages (which have subclassifications). Stage one is that in which the cancer remains localized to the testicle. In stage two, the cancer has spread to the nearest lymph nodes, which are small, bean-shaped structures that produce and store infection-fighting cells, in the abdomen. In stage three, the cancer has spread farther, to locations that may include the kidneys, liver, bones, lungs, or brain. The majority of cases are stage 1 when first identified; stage 3 is relatively rare. TreatmentThe three basic types of treatment are surgery, radiation therapy, and chemotherapy. Surgery (orchiectomy) is performed by urologists; radiation therapy is administered by radiation oncologists; and chemotherapy is the work of general oncologists. SurgeryWhile it is possible, in many cases, to remove testicular cancer tumors from a testicle while leaving the testicle functional, this is rarely done. Since only one testicle is required to maintain virility, hormone production, and other male functions, the afflicted testicle is almost always removed completely (an appropriate exception would be in the case of the second testicle's later developing cancer as well). In the case of nonseminomas that appear to be stage 1, surgery is often done on the lower lymph nodes(in a separate operation) to better determine whether the cancer is in stage 1 or 2. However, this approach, while standard in many places, is also omitted at many cancer centers because of the significant possibility of nerve damage. Surgery can be performed in other parts of the body where (in rare cases) there are tumors for which this is appropriate; this may occur before or after chemotherapy or radiation therapy. Radiation therapyRadiation therapy is not effective on nonseminomas. It can be given to treat stage-2 seminoma cancers, or as preventive (adjuvant or primary) therapy in the case of stage 1 cancers, to minimize the likelihood that tiny, non-detectable tumors exist and will spread. Chemotherapy as an alternative to radiation therapy is increasing, because radiation therapy has more significant long-term side effects (internal scarring, for example). ChemotherapyChemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage 2 or 3). It is also an option for stage-1 nonseminomas, as preventive (adjuvant) therapy, particularly for higher-risk cases. The standard chemotherapy protocolis 3 to 4 rounds of Bleomycin-Etoposide-Cisplatin(BEP). This treatment was developed by Dr. Lawrence Einhorn. While treatment success depends on the stage, the average survival rate after five years is around 95 %, and stage-1 cancers cases (if monitored properly) have essentially a 100-percent survival rate (which is why prompt action, when testicular cancer is a possibility, is so important). Actions after treatmentFor stage-1 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). A man with one remaining testicle can lead a normal life, because the other testicle takes up the load, and will generally have adequate fertility. 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 will certainly be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy is done. A man who loses bothtesticles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and is infertile, but can lead an otherwise normal life. Less than five percent of those who have testicular cancer will have it again in the second testicle. Famous survivors
Famous victimsBrian Piccolo, an American footballplayer in the late 1960swith the Chicago Bears, died of testicular cancer that was not detected until it had metastasized into his lungs. Piccolo would be a major subject of teammate and friend Gale Sayers's autobiography, I Am Third; Sayers's story of their friendship and of Piccolo's struggle with cancer was adapted into the legendary TV movie Brian's Song. Sean Kimerling, born on April 17, 1966, a New York sports anchor for The WB, died of testicular cancer at the age of 37 on September 9, 2003. See also
External links
Understanding Testicular Cancerfrom The Cancer Council of Australia
es:Cáncer de testículo fi:Kivessyöpä fr:Cancer testiculaire simple:Testicular cancer Categories: Andrology| Oncology| Types of cancer
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