According to the National Cancer
Institute, the estimated new cases of testicular cancer were 8,590 and the
deaths were 360 in 2012. This cancer is considered to be the most common cancer
in the males of age groups of 20-39 years. The good thing about this cancer is
that there is almost 90% cure rate for this cancer.
Testicular cancer is commonly seen in patients who belong from the
Caucasian region and is rarest amongst those in Africa. It is also rarely found
in Asia and there have been highest rates of occurrence of cancer in New
Zealand, Germany and Scandinavia. There are many risk factors for the
development of this cancer, the most common being un-descended testis (also
known as cryptorchidism), mumps, inguinal hernias and sometimes, Klinefelters
Syndrome.
Testicular cancers have many subtypes. The most common of these cancers
are Germ Cell Tumors which account for 95% of all the tumors. The other common
subtypes are Sex-cord Gonadal Stromal Tumors. These are derived from the Leydig
Cells or Sertoli Cells in testis.
Testicular cancer often presents with the cardinal symptom of
feeling a “lump” in the testis. Additionally, it may also present with symptoms
of a dull or sharp pain in the lower abdomen, feeling of something sagging or
heavy in the scrotum and sometimes of lower back pain. In rare cases, it may
metastasize to other organs (most commonly the lung) where it may present
symptoms such as shortness of breath and cough sometimes with bloody sputum.
While discussing the symptoms of cancer,
we must also know that there are some testicular cancers which secrete the
hormone β- hCG because of which
gynecomastia (enlargement of breast tissue) in males can be seen.
Diagnosis of this cancer is extremely vital as wrong diagnosis may miss
it altogether. If a young adult or someone in the late adolescent group comes with
a unilateral mass in testis then a suspicion of testicular cancer should be
kept in mind. An ultrasound is necessary to determine exact location, size and
it is highly sensitive in determining the characteristics of the lump such as
cystic/solid and whether its borders are sharply defined or not. Additionally,
serial CT scans are important in determining if the cancer has spread to any
other parts of the body.
Diagnosis of testicular cancer also involves biopsy of the testicular mass
and the estimation of blood levels of some hormones namely alpha-feto protein
(AFP), β- hCG and LDH. Presence of
any of these determines the specific sub-type of testicular cancer.
Once the testicular cancer is diagnosed and staged, the next step is of
treatment. There are three basic types of treatments that are instituted for
the removal of testicular cancer:
1.
Surgery:
Usually performed by uro-surgeons, the surgery is involved to remove the entire
testicle. This procedure is known as orchiectomy. It must be known that only
one testicle is required for fertility so removing one testis does not affect
the fertility of the individual. In Stage I cancer where there is involvement
of some retro-peritoneal lymph nodes also, surgery is performed to remove these
nodes.
2.
Chemotherapy
and 3. Radiation Therapy: Are instituted where the cancer has overcome the
boundaries of the scrotum and has spread to many other regions of the body. In
non-seminomas, BEP (Bleomycin-Etoposide-Cisplatin) Therapy is used. In the case
of seminomas, carboplatins are used.
Success of Modern Medicine: This is what is defined as the prognosis of
testicular cancer by the New England Journal of Medicine. Regardless of
whatever stage the patient is suffering from of testicular cancer, the average
success rate is still around 90%.
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