HEALTH - TESTICULAR CANCER (TESTICLE CANCER SYMPTOMS)
What is Testicular Cancer?
Testicular cancer is a disease in which cells in one or both testicles become abnormal and begin to grow uncontrollably. These cancerous cells will eventually form a growth, or tumor, that can spread to other parts of the body. Testicular cancer is typically curable, especially if found early. The three main treatment options are surgery, chemotherapy, and/or radiation therapy.
Testicular cancer is a disease that occurs in the testicles (testes), which are located
inside the scrotum, a loose bag of skin underneath the penis. The
testicles produce male sex hormones and sperm for reproduction. Testicular cancer involve cells in one or both testicles that become abnormal and grow
uncontrollably. These cancerous cells will eventually form a growth, or
tumor, that can spread to other parts of the body. Testicular cancer is
typically curable, especially if found early. The cause of testicular cancer is unknown.
Most cancers of the testicle develop in the sperm-producing cells known as germ cells, and these cancers are referred to as germ cell tumors. Germ cell tumors most commonly start in the testicles but can also develop in other parts of the body, such as the retroperitoneum (the back of the abdomen in front of the spine), the mediastinum (the central portion of the chest between the lungs), the lower spine, and very rarely the pineal gland (a small gland in the brain). There are two types of germ cell tumors that occur in the testicles: seminoma and non-seminoma. Generally, seminoma is relatively slow growing, while non-seminoma tends to grow and metastasize (spread) more quickly.
Compared with other types of cancer, testicular cancer is rare. Testicular cancer accounts for only 1 percent of all cancers in men in the
United States. About 8,000 men are diagnosed with testicular cancer, and about
390 men die of this disease each year. Testicular cancer occurs most often
in men between the ages of 20 and 39, and is the most common form of cancer in American males between the ages of 15 and 34. It is most common in white men, especially
those of Scandinavian descent.
The testicular cancer rate has more than doubled among white men in the past 40 years, but has only recently begun to increase among black men. The reason for the racial differences in incidence is not known.Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.
Health: Risk Factors of Testicular Cancer (Men - Testicle)
Although the cause of testicular cancer is not known, the following factors can raise a man's risk of developing testicular cancer:
Age. Testicular cancer is most commonly found in men between 20 and 45, but it can occur in men of any age. It can occur in older men, and rarely, in younger boys.
Family history. A man who has a relative who has had testicular cancer is at increased risk of developing testicular cancer. The risk for testicular cancer is greater in men whose brother or father has had the disease.
Personal history. Men who have had cancer in one testicle are at increased risk for developing cancer in the other testicle.
Race. Although men of any race can have testicular cancer, white men are more likely than men of other races to be diagnosed with testicular cancer.
Cryptorchidism (undescended testicle). Men with this
health condition, in which one or both testicles do not descend into the
scrotum before birth as they normally should, have an increased risk of
developing testicular cancer. This risk may be lowered if surgery is
performed to correct the condition before the boy reaches puberty.
Some doctors have recommended that cryptorchidism be corrected when a boy is very young, between six and 15 months, in order to reduce the risk of infertility (inability to produce children). The risk remains, even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.
Klinefelter's syndrome. Men with this condition have an extra X chromosome, which results in low levels of male hormones, infertility, breast enlargement, and small testicles; it also increases the risk of developing germ cell tumors that begin in the chest, but this is rare.
Human immunodeficiency virus (HIV) infection. Men infected with HIV, the virus that causes acquired immune deficiency syndrome (AIDS), have a slightly higher risk of developing testicular cancer.
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Health: Symptoms of Testicular Cancer (Men - Testicle)
Most testicular cancers are found by men themselves. Men with testicular cancer may experience the following symptoms. Sometimes, men with testicular cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor or health care provider.
The first sign of testicular cancer may be a small lump on the testicle, which often does not cause any pain. Other symptoms may go unnoticed until the cancer is advanced and has spread to other parts of the body. Regular testicular self-examinations and examinations by doctors can detect the cancer in its early stages, when it is more likely to be successfully treated.
Symptoms of testicular cancer may include:
- Painless lump or swelling on either testicle (If detected early, a testicular tumor may be about the size of a pea, but it can rapidly become the size of a marble or larger.) Any lump or enlargement should be evaluated by a doctor as soon as possible.
- Pain or discomfort (with or without swelling) in a testicle or scrotum. Pain can result from many different conditions, including infections, injury, twisting, and cancer. Infection of the testicle is referred to as orchitis. Infection of the epididymis is called epididymitis. (The epididymis is a small organ that is attached to the testicle that is made up of coiled tubes that carry sperm away from the testicle.) If infection is suspected, a patient may be given a prescription for antibiotics. If antibiotics do not solve the problem, an evaluation for testicular cancer should be performed.
- Enlargement of a testicle or change in the way it feels
- Feeling of heaviness in the scrotum (For example, a testicle that feels very firm or hard may indicate a problem.)
- Dull ache in the lower abdomen or groin
- Sudden buildup of fluid in the scrotum
- Breast tenderness or growth (Although rare, some tumors produce hormones that cause breast tenderness or growth.)
- Unexplained fatigue or a general feeling of not being well
Lower back pain, shortness of breath, chest pain, and bloody sputum (phlegm) can be symptoms of advanced testicular cancer. These symptoms can be caused by cancer or by other health conditions. It is important to see a doctor to determine the cause of any of these symptoms.
Early detection: finding testicular cancer early
Most cases of testicular cancer can be detected at an early stage, and men often find the cancer themselves while performing self-examinations. Some doctors recommend that men ages 15 to 55 perform a monthly self-examination. However, some testicular cancers may not cause symptoms and may go undetected until they reach an advanced stage.
Health: Diagnosis of Testicular Cancer (Men - Testicle) Doctors use many tests to diagnose cancer
and determine if it has metastasized. Some tests may also determine
which treatments may be the most effective. For most types of cancer, a
biopsy is the only way to make a definitive diagnosis of cancer, but
biopsies are rarely used to diagnose testicular cancer. Instead, if a
cancer is suspected in a testicle, the standard procedure is to
surgically remove the testicle. In fact, a biopsy using a needle
through the skin should NOT be performed because this can complicate
future treatment options. When a man develops a testicular lump or something else that raises
a suspicion of cancer, the usual first test that is performed is an
ultrasound (see below) of the testicles. Blood tests may also be done
at the same time. If the ultrasound shows an abnormality that looks
like a tumor, then the testicle will be surgically removed and examined
under a microscope to see whether cancer is present. Imaging tests,
such as x-rays and computed tomography (CT) scans, may be used to find
out whether the cancer has metastasized. Your doctor may consider these
factors when choosing a diagnostic test: If the doctor suspects testicular cancer, he or she will ask about a
man's medical history and general health. The doctor may conduct the
following tests: Physical examination. The doctor will feel the testicles for
any sign of swelling, tenderness, or hardening. The doctor will also
feel the abdomen, neck, upper chest, armpits and groin for evidence of
enlarged lymph nodes, which may indicate that the cancer has spread.
The breasts and nipples will also be examined to look for enlargement. Ultrasound. This imaging test allows doctors to detect
growths in the testicles. The ultrasound machine produces sound waves
and bounces them off tissues in the scrotum. The echoes of the sound
waves produce an image called a sonogram that can help the doctor
detect the presence, size, and solidness of a tumor. Solid tumors are
much more likely to be cancerous. During an ultrasound you lie on your back with your legs
spread. Your doctor then applies a clear gel to your scrotum. A
hand-held probe is moved over your scrotum to make the ultrasound
image. An ultrasound test can help your doctor determine the nature of any
testicular lumps, such as if the lumps are solid or fluid filled.
Ultrasound also tells your doctor whether lumps are inside or outside
of the testicle. Your doctor uses this information to determine whether
a lump is likely to be testicular cancer. Blood tests/tumor markers. A sample of blood may be collected
to test for levels of serum tumor markers, which are substances
produced by a cancerous tumor that can often be found at abnormally
high levels in the blood of a person with that cancer. Results from
these tests depend on whether the cancer is a seminoma or non-seminoma. Tumor markers are substances that occur normally in your
blood, but the levels of these substances may be elevated in certain
situations, including testicular cancer. A high level of a tumor marker
in your blood doesn't mean you have cancer, but it may help your doctor
in determining your diagnosis. Biopsy. A biopsy removes a small amount of tissue for
examination under a microscope. As outlined above, needle biopsies for
testicular cancer are rarely done. Occasionally, a biopsy may be useful
from the lung or the retroperitoneum if it appears that cancer may have
spread there. Pathology tests. In most cases of suspected testicular
cancer, a surgeon will perform a radical inguinal orchiectomy, in which
the entire testicle is removed through an incision in the groin. This
is often all that is required to successfully treat the cancer. Then, a
pathologist (a doctor who specializes in interpreting laboratory tests
and evaluating cells, tissues, and organs to diagnose disease) will
examine the testicle under a microscope to diagnose the type of cancer.
For a cancer to be considered a seminoma, it must be pure seminoma. Non-seminoma is diagnosed if any of the following are found in the
pathology specimen: choriocarcinoma, embryonal cell carcinoma, yolk sac
tumor, or teratoma. Each of these can occur alone or in any
combination. Sometimes, seminoma cancer can be found as a part of
non-seminoma at any percentage level. For instance, a tumor that is 99%
seminoma and 1% yolk sac is still diagnosed and treated as
non-seminoma. If the man has one testicle to begin with or the
diagnosis is uncertain, the surgeon may remove only a small sample of
tissue from the testicle. The testicle may still need to be removed if
there is evidence of cancerous cells. If cancer is found, other tests may be required to determine the
stage of the cancer and whether it has spread to other areas of the
body. X-ray. An x-ray is a picture of the inside of the body. For
instance, a chest x-ray can help doctors determine if the cancer has
spread to the lungs. Computed tomography (CT or CAT) scan. A CT scan creates a
three-dimensional picture of the inside of the body with an x-ray
machine. A computer then combines these images into a detailed,
cross-sectional view that shows any abnormalities or tumors. Surgery to remove a testicle.
If your doctor determines the lump on your testicle may be cancerous,
he or she may recommend surgery to remove the testicle. Your testicle
will be analyzed in a laboratory to determine if the lump is cancerous
and, if so, what type of cancer. The type of testicular cancer you have
determines your treatment and your prognosis.
Health: Staging of Testicular Cancer (testicle)
Once your doctor confirms your diagnosis, the next step is to determine the extent (stage) of the cancer. Staging is a way of describing how advanced a cancer is. The stage of a cancer is determined by how much it has grown and if or where it has spread. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). To determine whether cancer has spread outside of your testicle, you may undergo:
- Computerized tomography (CT). CT scans take a series of X-ray images of your abdomen. Your doctor uses CT scans to look for signs of cancer in your abdominal lymph nodes.
- X-ray. An X-ray of your chest may determine whether cancer has spread to your lungs.
- Blood tests. Blood tests to look for elevated tumor markers can help your doctor understand whether cancer likely remains in your body after your testicle is removed.
After these tests, your doctor assigns your testicular cancer a stage. The stage helps determine what treatments are best for you. The stages of testicular cancer are:
- Stage I. Cancer has not spread beyond the testicle.
- Stage II. Cancer has spread to the lymph nodes in the abdomen.
- Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.
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Natural Alternative Treatment Option: NATURAL CANCER TREATMENT
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Health: Conventional Treatment of Testicular Cancer (Men - Testicle)
Treatments and side effects of testicular cancer:
The treatment of testicular cancer depends on the size and location of the tumor, whether the cancer has spread, and the person's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan, including a urologist (a doctor who specializes in urinary tract problems), surgeon, medical oncologist, and radiation oncologist.
Most cases of testicular cancer can be successfully treated with
surgery, and/or radiation therapy, and/or chemotherapy. Men with
testicular cancer may have concerns about how their treatment will
affect their sexual function and fertility, and these topics should be
discussed with their doctor before treatment begins. Sometimes, more
than one treatment option is available.
Testicular cancer treatment can cause infertility. Whether you'll experience infertility after cancer treatment depends on the extent of your cancer and what treatments you undergo. Many men with testicular cancer have decreased sperm production even before cancer treatment begins. The final decision is often made depending on the patient's unique situation.
The main treatment options are explained below:
Surgery
Radical inguinal orchiectomy. Treatment of testicular cancer usually starts with surgery to remove the affected testicle, called radical inguinal orchiectomy. This is done through an incision in the groin. It is used to diagnose and treat both early-stage and later-stage testicular cancer, regardless of the type of tumor.
The removal of one testicle typically does not affect a man's
ability to achieve a normal erection. It also is unlikely to make him
sterile (unable to produce children) because the remaining testicle
will still produce sperm. However, men with testicular cancer are more
likely to be infertile than other men, even before being diagnosed with
cancer. It appears that the cancer itself may cause some men to become
infertile, and sperm counts usually improve after the testicle with
cancer is removed.
Men can choose to have an artificial testicle implanted in the scrotum that has a weight and texture similar to a normal testicle. A man may develop cancer in both testicles either at the same time or at different times, but this is rare (about 2% of patients with testicular cancer). If a bilateral orchiectomy (removal of both testicles) is performed, the man will no longer produce sperm or testosterone and will not be able to biologically produce children. A patient may want to consider storing sperm in a sperm bank prior to surgery, so that he will be able to produce children later if he wishes. In addition, if both testicles are removed, then testosterone replacement therapy will be needed.
Retroperitoneal lymph node dissection (RPLND). This is surgery to remove the retroperitoneal lymph nodes, involving an incision (usually made down the middle of the abdomen) and removal of the lymph nodes that lie at the back of the abdomen. RPLNDs are performed in two different situations: (1) clinical stage I nonseminomas and (2) men with residual retroperitoneal masses after completing chemotherapy for advanced stage disease. Residual masses after chemotherapy are almost always removed in men with non-seminomas, but in men with pure seminomas, such masses are often left in place and observed with CT scans.
RPLND for stage I non-seminomas
About 30% of patients with clinical stage I non-seminoma who have an RPLND are found to have lymph nodes with cancer; in other words, the surgery reveals that they have stage II disease. If the lymph node involvement is minimal (pN1), about 90% are successfully treated with this surgery alone. If a greater amount of cancer is found (pN2 or pN3), about 50% of patients are successfully treated with surgery alone, while the other 50% will have a relapse (return of cancer after treatment). The advantage of the RPLND is that it can cure most patients with small lymph node metastases, provide a more accurate assessment of the extent of disease, and avoid the need for frequent CT scans of the abdomen during follow-up care. It also reduces the chance that a man with early-stage (stage I) testicular cancer will ever need chemotherapy.
It is important to remember that the RPLND is a complex operation requiring substantial experience and technical skill in order to remove all of the appropriate lymph nodes and to minimize the side effects of the operation. RPLND should only be done by a surgeon who is highly experienced with this operation.
Some patients may experience temporary complications from RPLND, such as bowel obstruction or wound infections. This procedure should not affect a man's ability to have an erection or orgasm, but it may cause infertility because it may interfere with nerves that control the ejaculation of sperm. There are surgical techniques that are usually successful at sparing the nerves involved with ejaculation, and it is recommended that a man discuss this with his surgeon. The main disadvantage of this surgery is that 70% of patients are cured by removal of the testicle alone and for these men, an RPLND is of no benefit except, possibly, peace of mind.
Also, despite the surgery, about 10% of testicular cancers recur even if the lymph nodes were not found to have cancer. If the RPLND finds that the lymph nodes have cancer, then a decision needs to be made whether to give two courses of chemotherapy (see below) to decrease the chance of recurrence to about 1%. However, it is equally reasonable to "watch and wait" (also called surveillance, see below) and begin treatment with chemotherapy only if the cancer recurs. This is because this type of cancer has a greater than 95% chance of being eradicated (removed) with three cycles of chemotherapy if the recurrence is diagnosed early through regular surveillance.
RPLND to remove residual tumors after chemotherapy
RPLND performed after chemotherapy is a more complex operation and is more likely to result in infertility (due to failure to ejaculate) and other complications. However, the surgical removal of any residual masses after chemotherapy for non-seminomas is believed to be an essential part of treating the disease when such an operation can be safely completed. About half of men going through such surgery will be found to have a residual mass that contains either teratoma (about 40%) or one of the other germ cell cancers (10%). No tumor will be found in the other half. In men found to have teratoma, no additional treatment is given after RPLND. In men found to have one of the other germ cell cancers (seminoma, embryonal carcinoma, yolk sac tumor, or choriocarcinoma), then additional chemotherapy is usually given after RPLND.
Surveillance
As described above, after having a radical inguinal orchiectomy, one treatment option for clinical stage I seminomas and non-seminomas may be surveillance to watch for signs of cancer recurrence. A doctor may recommend this approach (also called active surveillance, watchful waiting, and watch and wait), in which the patient is monitored closely and treatment begins only if the cancer reappears. This option involves regular doctor appointments for CT scans, chest x-rays, physical examinations, and blood tests for tumor markers. This approach requires dedication by the doctor and patient to stick to the surveillance schedule so that any recurrence can be detected at an early stage. The main advantage of this approach is that it avoids any further treatment after orchiectomy (such as chemotherapy, radiation therapy, or additional surgery) in the 80% of patients with seminoma and 70% of patients with non-seminoma who do not require further treatment.
It is worth noting that while the surveillance schedule for non-seminomas involves testing every one to two months for the first two years and less often thereafter. The surveillance schedule for seminomas is much less intense, with testing performed every four months for the first three years and less often thereafter.
Radiation therapy is the use of high-energy x-rays or other radioactive particles to kill cancer cells. For testicular cancer, the most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. The radiation is generally directed at lymph nodes in the abdomen. Radiation therapy is more effective with seminoma than non-seminoma. The only common use of radiation therapy in testicular cancer is for stage I, IIA, or IIB pure seminomas.
Side effects from radiation therapy include mild skin reactions, nausea and vomiting, peptic ulcers, heartburn, loose bowel movements, and fatigue. Medications may be helpful in preventing or reducing nausea and vomiting during radiation therapy. Radiation therapy can also cause problems with sperm production and the remaining testicle needs to be shielded if the man wishes to try to preserve fertility. Radiation therapy has been shown to result in an increased risk of second cancers many years after treatment and has also been linked to an increased risk of cardiovascular disease and gastrointestinal disease.
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. There are different options to consider when a doctor prescribes chemotherapy in testicular cancer, depending on the stage of the disease. Your doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection.
The side effects of chemotherapy depend on the individual and the dose used, but can include the items listed below. Most of these side effects usually go away once treatment is finished.
Nausea and vomiting. This is common during each cycle of chemotherapy. Vomiting can often be prevented using the appropriate medications. Drugs that prevent nausea and vomiting are given before chemotherapy on each of the days the cisplatin is given. These drugs are very effective. One of these antinausea drugs is a cortisone-like steroid called dexamethasone (Decadron). Another class of drugs, called serotonin antagonists, blocks a chemical called serotonin from entering the brain and triggering the vomiting center. The combination of these drugs almost completely prevents vomiting in a majority of patients, although they do not eliminate all nausea. A third active drug is metoclopramide (Reglan). The combination of metoclopramide, dexamethasone, and a serotonin antagonist has been shown to be highly effective at preventing vomiting and reducing nausea in patients receiving chemotherapy regimens like BEP. However, if nausea and/or vomiting occur, other drugs such as prochlorperazine (Compazine), promethazine (Phenergan), or lorazepam (Ativan) may be helpful. Another class of drugs called NK-1 inhibitors are sometimes used to prevent nausea and vomiting that may occur a few days after the last dose of cisplatin.
Fatigue. Tiredness and loss of energy are among the most common side effects of chemotherapy. Almost all men undergoing chemotherapy for testicular cancer will experience some degree of fatigue, but the extent varies widely from person to person.
Reduction in the number of white cells (cells that fight infections), red blood cells (cells that carry oxygen), or platelets (cells that cause blood to clot). The most important issue is to make sure to seek help if bleeding and/or infection and/or fever occurs.
Loss of hair. In most patients, hair loss occurs after four weeks. However, it grows back about four months after completion of the chemotherapy. At times, it may grow back a different texture (such as curly, if it used to be straight) or a different color. However, patients who are balding before chemotherapy do not grow more hair after completing chemotherapy than they had before chemotherapy.
Numbness and tingling. The chemotherapy used for testicular cancer sometimes causes nerve damage that results in a partial loss of sensation in the hands and/or feet. Numbness and tingling after chemotherapy often improves over time but may be permanent.
Hearing loss. Chemotherapy can cause loss of hearing for high-pitch sounds and can cause ringing in the ears, which is referred to as tinnitus. Hearing loss, when it occurs, is usually permanent.
Kidney damage. Studies of kidney function before and after chemotherapy for testicular cancer have shown that mild reductions in kidney function are common after chemotherapy, but it is unknown whether mild reductions actually cause any medical problems. Rarely, chemotherapy can cause more severe kidney damage that compromises the kidneys' capacity to function adequately.
Skin marks. Bleomycin can sometimes leave some brown patches on the skin.
Health: Prevention of Testicular Cancer (Men - Testicle)
There's no sure way to prevent testicular cancer. However, regularly self-examination may improve your chances of finding a tumor at its earliest stage. Beginning in your midteenage years, and continuing throughout your life, examine your testicles at least once a month.
A good time to examine your testicles is after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to find anything unusual.
To do this examination, follow these steps:
- Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
- Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.
- Gently roll the testicle between the thumbs and the fingers. Remember that the testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other. Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum. By regularly performing this exam, you will become more familiar with your testicles and aware of any changes that might be of concern.
- If you find a lump, call your doctor as soon as possible. Testicular cancer is highly treatable, especially when identified early.
Your doctor should also examine your testicles whenever you have a physical. If you have an undescended testicle, be sure to tell your doctor, who may refer you to a urologist for treatment or a more specialized exam.
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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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