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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