[MOL] Testicular Cancer info [02375] Medicine On Line


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[MOL] Testicular Cancer info



THE TESTICULAR CANCER PRIMER
Let's start off with some quick facts:
Testicular cancer is the most common cancer in young men between the ages of 
15 and 35 years old--but it can strike any male, any time.
Testicular cancer is almost always curable if it is found early.
Most testicular cancers are found by men themselves as a lump on the 
testicle.
The cancer risk for boys with undescended testicles is increased if the 
problem is not corrected in early childhood.
Testicular cancer can be treated with surgery, radiation therapy, 
chemotherapy, surveillance, or a combination of these treatments.
What are the testicles?
The testicles (also called testes or gonads) are the male sex glands. They 
are located behind the penis in a pouch of skin called the scrotum. The 
testicles produce and store sperm, and they are also the body's main source 
of male hormones. These hormones control the development of the reproductive 
organs and other male characteristics, such as body and facial hair, low 
voice, and wide shoulders.

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What is cancer?
Cancer is a group of more than 100 diseases. Although each kind differs from 
the others in many ways, every type of cancer is a disease of some of the 
body's cells.
Healthy cells that make up the body's tissues grow, divide, and replace 
themselves in an orderly way. This process keeps the body in good repair. 
Sometimes, however, some cells lose the ability to limit and direct their 
growth. They grow too rapidly and without any order. Too much tissue is 
produced, and tumors are formed. Tumors can be either benign or malignant.

Benign tumors are not cancer. They do not spread to other parts of the body 
and are seldom a threat to life. Benign tumors can often be removed by 
surgery, and they are not likely to return.

Malignant tumors are cancer. They can invade and destroy nearby healthy 
tissues and organs. Cancerous cells can also spread, or metastasize, to 
other parts of the body and form new tumors.

Cancer that develops in a testicle is called testicular cancer. When 
testicular cancer spreads, the cancer cells are carried by blood or by 
lymph, an almost colorless fluid produced by tissues all over the body. The 
fluid passes through lymph nodes, which filter out bacteria and other 
abnormal substances such as cancer cells. Surgeons often remove the lymph 
nodes deep in the abdomen to learn whether testicular cancer cells have 
spread.


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What is testicular cancer?
Testicular cancer is one of the most common cancers in young men between the 
ages of 15 and 35, but the disease also occurs in other age groups, so all 
men should be aware of its symptoms.
Most testicular cancers are found by men themselves, by accident or when 
doing a testicular self-examination. The testicles are smooth, oval-shaped, 
and rather firm. Men who examine themselves regularly (once a month) become 
familiar with the way their testicles normally feel. Any changes in the way 
they feel from month-to-month should be checked by a doctor, preferably a 
Urologist.

Nearly all testicular tumors stem from germ cells, the special sperm-forming 
cells within the testicles. These tumors fall into one of two types, 
seminomas or nonseminomas. Other forms of testicular cancer can include 
teratoma, and tumors such as sarcomas or lymphomas, which are extremely 
rare.

- Seminomas account for about 40 percent of all testicular cancer and are 
made up of immature germ cells. Usually, seminomas are slow growing and tend 
to stay localized in the testicle for long periods.

- Nonseminomas are a group of cancers that sometimes occur in combination, 
including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. 
Nonseminomas arise from more mature, specialized germ cells and tend to be 
more aggressive than seminomas. According to the American Cancer Society, 60 
to 70 percent of patients with nonseminomas have cancer that has spread to 
the lymph nodes.

There are three stages of testicular cancer:

Stage 1--Cancer confined to the testicle.
Stage 2--Disease spread to retroperitoneal lymph nodes, located in the rear 
of the body below the diaphragm, a muscular wall separating the chest cavity 
from the abdomen.
Stage 3--Cancer spread beyond the lymph nodes to remote sites in the body, 
to include the lungs and brain.

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What are the TC expectations (prognosis)?
The survival rate for men with early stage seminoma is approximately 97%.
The disease-free survival rate for Stage I non-seminomatous cancer is nearly 
99%; for Stage II 87%; and for Stage III 57%.



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What complications can come from TC?
Metastasis (spreading) to other parts of the body may occur with testicular 
cancer. The most common sites include the retroperitoneal abdominal area, 
the abdomen, the spine, the lungs, and the brain. In addition, some rare 
long term side ffects can occur from TC treatments (such as peripheral 
neuropathy - numbness in the extremities, from chemotherapy).

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What are the causes of testicular cancer?
To date, no one really knows. Researchers study patterns of cancer in the 
population to discover whether some people are more likely than others to 
develop certain cancers. If they can learn what causes the disease, they may 
be able to suggest ways to prevent it.
Although any man can contract testicular cancer, the disease is relatively 
rare. It accounts for only about 1 percent of all cancers in American men, 
with 7,000-8,000 new cases annually. Although most other cancers affect 
mostly older people, testicular cancer usually occurs in young men and is 
more common in white men than in other races.

Testicular cancer is not contagious: no one can "catch" it from another 
person. Exactly what causes this disease is unknown and seldom can it be 
explained why one person gets it while another doesn't. Research does show 
that some men are more likely than others to develop testicular cancer. For 
example, the risk is higher than average for boys born with their testicles 
in the lower abdomen rather than in the scrotum (called undescended 
testicles or cryptorchidism) . The cancer risk for boys with this condition 
is increased if the problem is not corrected in early childhood. Research 
has also shown that testicular cancer is sometimes linked to certain other 
rare conditions in which the testicles do not develop normally. There is 
even some line of thought that pollutants may be contributing to this 
problem, evidenced by the considerable increase in occurences over the last 
few decades and parallelled with industrial growth and waste. Click HERE for 
an article detailing this hypothesis.

Some men whose mothers took a hormone called DES (diethylstilbestrol) during 
pregnancy to prevent miscarriage have testicular abnormalities. But 
scientists do not know whether prenatal exposure to DES (or any other female 
hormone) increases the risk of testicular cancer.

Some patients with testicular cancer have a history of injury to the 
scrotum. But again, no one knows whether such an injury can actually cause 
cancer. Many doctors think such an injury simply calls attention to a tumor 
that was already growing.


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What are the symptoms of testicular cancer?
Testicular cancer can cause a number of symptoms. Listed below are warning 
signs that men should watch for:
A lump in either testicle; the lump typically is pea-sized, but sometimes it 
might be as big as a marble or even an egg.
Any enlargement of a testicle;
A significant shrinking of a testicle;
A feeling of heaviness in the scrotum;
A dull ache in the lower abdomen or in the groin;
A sudden collection of fluid in the scrotum;
Pain or discomfort in a testicle or in the scrotum;
Enlargement or tenderness of the breasts.
These symptoms are not sure signs of cancer, they can also be caused by 
other conditions. There are numerous other causes of swelling of the testis 
that are harmless, including hydrocele, a collection of fluid in the 
scrotum; epididymal cyst, a fluid-filled swelling of the epididymis (the 
structure behind the testis where sperm mature) which may also cause fever 
and discharge from the penis; and varicocele, varicose veins in the scrotum 
which is described as feeling like "a bag of worms". Inflammation of the 
testis can also be related to bacterial infections. Torsion of the testis 
occurs when a testicle rotates, and the spermatic cord becomes obstructed 
and the blood supply is cut off. This most commonly occurs around puberty 
and causes acute severe pain and swelling of the testis.

However, it is important to see a doctor, preferably a urologist, if any of 
these symptoms occur -- any illness should be diagnosed and treated as soon 
as possible. Early diagnosis of testicular cancer is especially important 
because the sooner cancer is found and treated, the better a man's chance 
for complete recovery and the easier the treatment protocol.


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How is testicular cancer diagnosed?
When a man's symptoms suggest that there might be cancer in a testicle, a 
personal and family medical history is taken and a complete physical 
examination is conducted. In addition to checking general signs of health 
(temperature, pulse, blood pressure, and so on), the scrotum will be 
carefully examined. The patient will usually have a sonogram, a chest x-ray, 
and blood and urine tests. If the physical exam and lab tests do not show an 
infection or another disorder, cancer is suspected because most tumors in 
the testicles are cancerous.
The only sure way to know whether cancer is present is for a pathologist to 
examine a sample of tissue under a microscope. To obtain the tissue, the 
affected testicle is removed through the groin. This operation is called 
inguinal orchiectomy. The surgeon does not cut through the scrotum and does 
not remove just a part of the testicle because, if the problem is cancer, 
cutting through the outer layer of the testicle might cause local spread of 
the disease.


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How is testicular cancer treated?
Testicular cancer is almost always curable if it is found early. This 
disease responds well to treatment, even if it has spread to other parts of 
the body.
STAGING
If a man has testicular cancer, it is important to find out the extent, or 
stage, of the disease (whether it has spread from the testicle to other 
parts of the body). Staging procedures include a thorough physical exam, 
blood tests, x-rays and scans, and, in some cases, additional surgery.

Most patients will have a Computed Tomography, also called CT or CAT scan, 
which is a series of x-rays of various sections of the body. Some patients 
may have intravenous pyelography (IVP), x-rays used with a special dye to 
outline the urinary system. Although not as prevalent as before, some 
doctors recommend lymphangiography, x-rays taken with a special dye that 
outlines the lymph system in the abdomen. Ultrasonography, which creates a 
picture from the echoes of high-frequency sound waves bounced off internal 
organs, also may be useful. PET scans are the newest test available, with 
their ability to check for "life" in a tumor - but it is still experimental.

Special lab tests can also reveal certain substances in the blood. These 
substances are called tumor markers (and proteins) because they often are 
found in abnormal amounts in patients with some types of cancer. The levels 
of specific tumor markers in the blood can help the doctor determine what 
type of testicular cancer the patient has and to what extent.

Surgery may be recommended to remove the lymph nodes deep in the abdomen 
(called RPLND surgery). A pathologist then examines the nodes to determine 
whether they contain cancer cells. For patients with nonseminoma, removing 
the nodes can also help stop the spread of their disease. Seminoma patients 
do not usualy need this surgery because cancer cells in their lymph nodes 
can be destroyed with radiation therapy.

METHODS OF TREATING TESTICULAR CANCER
Testicular cancer can be treated with surgery, radiation therapy, 
chemotherapy, and surveillance. One method or a combination of methods may 
used. Often, the patient is referred to medical centers that specialize in 
testicular cancer treatment.

SURGERY
In most cases, surgery is initially performed to remove the testicle (called 
an Inguinal Orchiectomy). Sometimes it is also necessary to remove lymph 
nodes in the abdomen (called RPLND surgery). Additionally, tumors that have 
spread to other parts of the body may be partly or entirely removed by 
surgery. *** While the nation's blood supply is arguably the safest it's 
ever been, you may want to discuss banking your own blood for your use with 
your doctor, if surgery's in your future.

RADIATION THERAPY
In radiation therapy (also called x-ray therapy, radiotherapy, cobalt 
treatment, or irradiation), high-energy rays are used to damage cancer cells 
and stop their growth. Like surgery, radiation therapy is a local treatment 
and affects only the cells in the treated area. The patient usually receives 
radiation therapy on an outpatient basis.

Seminomas are highly sensitive to radiation. Following surgery, men with 
seminomas often have radiation therapy to their abdominal lymph nodes.

Nonseminomas are somewhat less sensitive to radiation. Patients with this 
type of cancer usually have other types of treatment, such as surgery and/or 
chemotherapy.

CHEMOTHERAPY
The use of drugs to treat cancer is called chemotherapy. Anticancer drugs 
are recommended when there are signs that the cancer has spread and the type 
of tumor is responsive to this treatment. Chemotherapy is also sometimes 
used when the doctor suspects that undetected cancer cells remain in the 
body after surgery or irradiation --this is known as "adjuvant therapy".

Chemotherapy may be given by mouth or injected into a muscle or a blood 
vessel via an IV. Chemotherapy is a systemic treatment--the drugs enter the 
bloodstream and reach cells all over the body. Depending on the specific 
drugs and the patient's general condition, chemotherapy may be taken: as an 
outpatient at the hospital, at the doctor's office, at home, but for many 
patients they must be hospitalized for a time so that effects of the 
treatment can be monitored.

The Food and Drug Administration has approved several drugs to treat 
testicular cancer, including Ifex (ifosamide), Vepesid (etoposide), Velban 
(vinblastine sulfate), Blenoxane (bleomycin sulfate), and Platinol 
(cisplatin).

Many medical professionals regard Platinol as the "magic bullet" for 
treating certain forms of testicular cancer. The FDA approved the 
platinum-based drug for use after surgery or radiation. Platinol almost 
always is used in combination with other chemotherapy drugs.

SURVEILLANCE
In some forms of TC (ex: seminoma Stage I) waiting and regular testing, 
called surveillance, is recommended. Then, if the cancer recurs, additional 
treatments can then be used to stop the spread of the disease. It can NOT be 
stressed enough that men under surveillance must follow the exact directions 
of their medical team to ensure that the disease is maintained as best 
possible!


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What are the side effects of treatment for testicular cancer?
The treatments used against cancer must be very powerful, and that is why 
some patients may have some unpleasant side effects.
Many men worry that losing one testicle will affect their ability to have 
sexual intercourse or make them sterile. But a man with one healthy testicle 
can still have a normal erection and produce sperm. Therefore, an operation 
to remove just one testicle does not make a patient impotent and seldom 
interferes with fertility.

Men can also have an artificial testicle, called a prosthesis, placed in the 
scrotum. The implant has the weight and feel of a normal testicle. Note that 
finding a source for this implant in the USA is very hard. Recent legal 
problems involving silicone breast implants have made most chemical 
manufacturers and medical resources very reluctant to provide these 
resources - check with your doctor and here at TCRC for the latest word in 
availability.

Surgery to remove the lymph nodes does not change a man's ability to have an 
erection or an orgasm, but the operation can cause sterility because it may 
interfere with the nerves involved in ejaculation. Some men may have 
temporary stoppage then recover the ability to ejaculate without treatment; 
others may be helped by medication - for some it will b permanent. Patients 
should talk with their doctor about the possibility of removing the lymph 
nodes using a special surgical technique that may protect the ability to 
ejaculate. This may not be possible in every given case.

Radiation therapy affects both normal and cancerous cells, but normal cells 
are able to recover, and recent updates in rad therapy have greatly reduced 
the amount of colateral "scatter". Having treatments 5 days a week, for 
several weeks, spreads out the total dose of radiation and gives the patient 
weekend rest breaks to recover. Nevertheless, the body must work very hard 
during radiation therapy to repair the tissues injured by the treatment. 
Patients may feel unusually tired with periods of nausea, and they should 
try to rest as much as possible. Radiation therapy does not change the 
ability to have sex. Radiation therapy does, however, interfere with sperm 
production. Usually the effect is temporary, and most patients regain their 
fertility within a matter of months. Some other unpleasant effects of 
radiation therapy include diarrhea and vomiting. These problems can usually 
be controlled with medication. Also, there may be skin reactions in the area 
being treated, and it is important to treat the skin gently. Lotions and 
creams should not be used on these areas without the doctor's advice.

Chemotherapy causes side effects because it damages not only cancer cells, 
but other rapidly growing cells as well, such as hair and gum tissue. Often 
anticancer drugs are given in cycles, with treatment periods alternating 
with rest periods. The side effects of chemotherapy depend on the specific 
drugs that are given and the response of the individual patient. These drugs 
commonly affect hair cells, blood-forming cells, and cells that line the 
digestive tract. As a result, they may cause various problems, including 
hair loss, lowered resistance to infection, loss of appetite, nausea and 
vomiting, and mouth sores. Most men who receive chemotherapy for testicular 
cancer can continue to function sexually, although some anticancer drugs 
interfere with sperm production. Although this effect is permanent for some 
patients, many recover their fertility later on.

Loss of appetite can be a serious problem for patients receiving either 
radiation therapy or chemotherapy. Researchers are learning that patients 
who eat well are better able to withstand the side effects of their 
treatment. Therefore, good nutrition is important. Eating well means getting 
enough calories to prevent weight loss and having enough protein to build 
and repair skin, hair, muscles, and organs. Many patients find that having 
several small meals and snacks throughout the day is easier than trying to 
eat three large meals.

The side effects of cancer therapy vary from person to person and may even 
be different from one treatment to the next in the same patient. Patients 
may find that they are less interested in sexual activity if they are tired 
or feel ill. Attempts are made to plan treatment to minimize problems. 
Fortunately, most side effects are temporary. Doctors, nurses, and 
dietitians can explain the side effects of cancer treatment and suggest ways 
to deal with them.


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What happens after patients are treated for testicular cancer?
Regular follow-up exams are very important for anyone treated for testicular 
cancer. A patient who has had testicular cancer should be closely monitored 
for several years to be sure the cancer is completely gone. If the cancer 
does recur, early detection is very important so that additional treatment 
can be started and the disease contained quickly.
Follow-up care regimens does vary for the different types and stages of 
testicular cancer. Generally, patients are checked and have blood tests to 
measure tumor marker levels every month or two for the first 2 years after 
treatment. They also have regular x-rays and CT scans. After that, checkups 
may be needed just once or twice a year. Testicular cancer seldom recurs 
after a patient has been free of the disease for 3 years.

Patients who have been treated for cancer in one testicle have about a 1 
percent chance of developing cancer in the remaining one. If cancer does 
arise in the second testicle, it is nearly always a new disease rather than 
a metastasis from the first tumor. Patients should be checked regularly by 
their doctor and should continue to perform testicular self-examinations 
every month. Any unusual symptoms should be reported to the doctor without 
delay. As with the patient's first cancer, the earlier a new tumor is 
detected and treated, the greater the chance of cure - which is also very 
good, even in secondary TCs.


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How can patients and their families cope with testicular cancer?
When people have cancer, life can change--for them and for the people who 
care about them. These changes in daily life can be difficult to handle. 
When a man learns that he has testicular cancer, it is natural to have many 
different and sometimes confusing emotions. At times, patients and family 
members may be frightened, angry, or depressed. Their feelings may vary from 
hope to despair or from courage to fear. Patients are usually better able to 
handle these feelings if they talk about their illness and share their 
feelings with family members and friends.
Concerns about the future--as well as about medical tests and treatments, 
hospital stays, medical bills, and sexuality--are common. Talking with 
doctors, nurses, or other members of the health care team may help ease fear 
and confusion. Patients should ask questions about their disease and its 
treatment and take an active part in decisions about their medical care. 
Patients and family members often find it helpful to write down questions as 
they think of them to prepare for the next visit to the doctor. Taking notes 
during talks with the doctor can be a useful aid to memory. Patients should 
ask the doctor to repeat or explain anything that is not clear.

Most people want to know what kind of cancer they have, how it can be 
treated, and how successful the treatment is likely to be. The patient's 
doctor is the best person to answer questions and give advice about working 
or other activities. If it is difficult to talk with the doctor about 
feelings and other very personal matters, patients may find it helpful to 
talk with others facing similar problems. This kind of help is available 
through support groups, such as those described in the next section. If the 
patient or his family finds that emotional problems become too hard to 
handle, a mental health counselor may be able to help.

We here at TCRC also offer TC-NET, an email support network of several 
hundred TC patients, medical professionals, family, and friends.

Adapting to the changes that are brought about by having cancer is easier 
for patients and those who care about them when they have helpful 
information and support services. Often, the social service office at the 
hospital or clinic can suggest local and national agencies that will help 
with emotional support, financial aid, transportation, home care, or 
rehabilitation.


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What does the future hold for testicular cancer?
More than 8 million Americans living today have had some type of cancer -- 
the outlook for men with testicular cancer is excellent. Because researchers 
have found better ways to diagnose and treat this disease, the chance of 
recovering completely has improved dramatically. Today, a large majority of 
testicular cancer patients are cured by their initial treatment, while most 
of those who have a recurrence can be cured too.
Scientists at hospitals and medical centers throughout the United States are 
studying testicular cancer. They are working toward a better understanding 
of its causes, prevention, diagnosis, and treatment. Researchers are looking 
for additional tumor markers that may be present in abnormal amounts in the 
blood or urine of a person with very early testicular cancer. If such 
markers are found, it might be possible to detect testicular cancer even 
before any symptoms are noticed. Several such markers have been studied, and 
research is continuing. Researchers are also looking for treatment methods 
that are more effective and easier for patients to tolerate. They are 
studying new drugs and drug combinations, varied doses, and different 
treatment schedules.

RESOURCES
General information about cancer is widely available. Some helpful resources 
and publications are listed below. Others may be available at a local 
library or from support groups in the community.

NCI's CANCER INFORMATION SERVICE: 1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, 
provides a nationwide telephone service for cancer patients and their 
families and friends, the public, and health care professionals. The staff 
can answer questions and can send booklets about cancer. They also know 
about local resources and services. One toll-free number, 1-800-4-CANCER 
(1-800-422-6237), connects callers with the office that services their area. 
Spanish-speaking staff members are available.

The AMERICAN CANCER SOCIETY
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345


The American Cancer Society is a voluntary organization with a national 
office (at the above address) and local units all over the country. It 
supports research, conducts educational programs, and offers many services 
to patients and their families. It also provides free booklets on testicular 
cancer and on sexuality. To request booklets or to learn about services and 
activities in local areas, call the Society's toll-free number, 
1-800-ACS-2345 (1-800-227-2345), or the number listed under American Cancer 
Society in the white pages of the telephone book.

Further Internet links for TC and other cancer / medical info can be found 
HERE

Click on this to go back to the TCRC main page:



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