Testicular
Cancer
The information presented
here - on the symptoms,
diagnosis, and treatment
of testicular cancer
and on living with
the disease - is intended
to add to information
from doctors, nurses,
and other members of
the medical team.
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.
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. Also,
cancer cells can
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
the 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.
Symptoms
Testicular
cancer is one of the
most common cancers
in young men between
the ages of 15 and
34. 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 testicular self-examination
(TSE). The testicles
are smooth, oval-shaped,
and rather firm. Men
who examine themselves
regularly become familiar
with the way their
testicles normally
feel. Any changes in
the way they feel from
month to month should
be reported to a doctor.
Testicular cancer
can cause a number
of symptoms. Listed
below a warning signs
that men should watch
out for:
- A lump in either
testicle.
- Any
enlargement of a
testicle.
- A
feeling of heaviness
in the scrotum.
- A dull
ache in the lower
abdomen or 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. However,
it is important to
see a doctor if any
of these symptoms lasts
as long as 2 weeks.
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.
Diagnosing Testicular
Cancer
When a man’s
symptoms suggest there
might be cancer in
a testicle, the doctor
will ask about personal
and family history
and do a complete physical
exam. In addition to
checking for general
signs of health (temperature,
pulse, blood pressure,
and so on), the doctor
will carefully examine
the scrotum. Also,
the patient will usually
have a chest x-ray
and blood and urine
tests. If the physical
exam and lab tests
do not show an infection
or another disorder,
the doctor is likely
to suspect cancer because
most tumors in the
testicles are cancer.
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 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.
The most common types
of testicular cancer
a seminoma and nonseminoma.
- Seminomas make
up about 40 percent
of all cases.
- Nonseminomas are actually a group
of cancers. They
include choriocarcinoma,
embryonal carcinoma,
teratoma, and yolk
sac tumors.
Each
of these two major
types of testicular
cancer grows and spreads
differently—and
they are treated differently.
Treating the Disease
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 have
computed tomography,
also called CT or CAT
scan, which is a series
of x-rays of various
sections of the body.
Some have intravenous
pyelography (IVP),
x-rays used with a
special dye to outline
the urinary system.
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.
Special lab
tests can reveal certain
substances in the blood.
These substances are
called tumor markers
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
the type of testicular
cancer the patient
has.
Surgery may be
recommended to remove
the lymph nodes deep
in the abdomen. A pathologist
then examines the nodes
to see whether they
contain cancer cells.
For patients with nonseminoma,
removing the nodes
helps stop the spread
of their disease. Seminoma
patients do not need
this surgery because
cancer cells in their
lymph nodes can be
destroyed with radiation
therapy.
Planning Treatment
Decisions
about treatment for
testicular cancer are
complex. Sometimes
it is helpful to have
more than one doctor's
advice. Before starting
treatment, the patient
might want a second
opinion about the diagnosis
and treatment plan.
It may take a week
or two to arrange to
see another doctor.
This short delay will
not make treatment
less effective. There
are a number of ways
to find a doctor for
a second opinion:
- The patient’s
doctor may be able
to suggest a doctor
who has a special
interest in testicular
cancer.
- The
Cancer Information
Service, at 1-800-4-CANCER,
can tell callers
about cancer centers
and other NCI-supported
programs in their
area.
- Patients
can get the names
of doctors from their
local medical society,
a nearby hospital,
or a medical school.
Methods
of Treating Testicular
Cancer
Testicular cancer
can be treated with
surgery, radiation
therapy, and chemotherapy.
The doctor may use
just one method or
a combination. Often,
the patient is referred
to medical centers
that specialize in
testicular cancer treatment
Surgery.
In most cases,
surgery is done to
remove the testicle.
Sometimes it also is
necessary to remove
lymph nodes in the
abdomen. In addition,
tumors that have spread
to other parts of the
body may be partly
or entirely removed
by surgery.
Radiation therapy.
In radiation therapy
(also called x-ray
therapy, radiography,
cobalt treatment, or
irradiation), high-energy
rays are used to damage
cancer cells and to
stop growth. Like surgery,
radiation therapy is
a local therapy; it
affects only the cells
in the treated area.
The patient usually
receives radiation
therapy as an outpatient.
Seminomas are highly
sensitive to radiation.
Following surgery,
men with seminomas
generally 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.
Chemotherapy.
The
use of drugs to treat
cancer is called chemotherapy.
Anticancer drugs are
recommended when there
are signs that the
cancer has spread.
Also, chemotherapy
is sometimes used when
the doctor suspects
that undetected cancer
cells remain in the
body after surgery
or irradiation. The
use of anticancer drugs
following surgery for
early stage cancer
is known as adjuvant
therapy.
Chemotherapy may be
given by mouth or by
injection into a muscle
or a blood vessel.
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,
or at home. Sometimes,
however, the person
must be hospitalized
for a time, so the
effects of the treatment
can be watched.
Side Effects of Treatment
The
treatments used against
cancer must be very
powerful. That’s
why 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.
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 interferes with
ejaculation. Some men
recover the ability
to ejaculate without
treatment; other may
be helped by medication.
Patients should talk
with the doctor about
the possibility of
removing the lymph
nodes using a special
surgical technique
that may protect the
ability to ejaculate.
Radiation therapy
affects both normal
and cancerous cells,
but normal cells are
able to recover. Having
treatments 5 days a
week for several weeks
spreads out the total
dose of radiation and
gives the patient weekend
rest breaks. Nevertheless,
the body must work
very hard during radiation
therapy to repair the
tissues injured by
the treatment. Patients
may feel unusually
tired, 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.
Other unpleasant effects
of radiation therapy
include diarrhea, nausea,
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 doctors advise.
Chemotherapy causes
side effects because
it damages not only
cancer cells, but other
rapidly growing cells
as well. Often anticancer
drugs are given in
cycles; treatment periods
alternate 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
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. Patients
may find that they
are less interested
in sexual activity
if they are tired or
feel ill. Doctors try
to plan treatment to
keep problems to a
minimum, and 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.
Follow-up Care
Regular
follow-up exams are
very important for
anyone treated for
testicular cancer.
The doctor will continue
to watch the patient
closely for several
years to be sure
the cancer is completely
gone. If the cancer
does recur, it is
very important for
the doctor to detect
it right away and
start additional
treatment.
Follow-up care may
vary for different
types and stages of
testicular cancer.
Generally, patients
are checked and have
blood tests to measure
tumor marker levels
every month for the
first two years after
treatment. They also
have regular x-rays
and 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
do testicular self-examination
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.
If you would like
more information on
this topic, please
contact
us.
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