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Facts about Testicular Cancer and Its Treatment Options

National Cancer Institute, Testicular cancer, symptoms, cancer, Facts, Testicular, Treatment

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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