Over the past four decades, testicular cancer has equaled - and probably surpassed - Hodgkin's disease as the number one cancer in young men between the ages of 15 and 34. Overall, it is still a rare neoplasm; 1 percent of all male cancers are testicular, with an incidence of two per 100,000 in the adult male population. In teenagers and young men, however, the incidence may be as high as one in 10,000, and it may be slowly increasing. The American Cancer Society estimates by 1999, there will be about 7,400 new cases of testicular cancer that will be diagnosed in the United States, and an estimated 300 men will die of testicular cancer.
Men with undescended testicles are at greatest risk for testicular cancer. About 10 percent of all men with testicular cancer have a history of cryptorchidism or an undescended testicle. Men with undescended testicles have 10 to 40 times the risk of developing a malignancy - one tumor per every 2,000 undescended testes.
For unknown reasons, Caucasians are four times more likely than non-Caucasians to have testicular cancer. The vast majority of testicular cancers in young people are seminomatous. If the tumor is found early and treated by surgical removal of the testis, possibly in combination with radiation, the prognosis is excellent. In fact, with the success rates in early-stage seminomas rapidly approaching 100 percent, oncologists now describe testicular cancer as a curable neoplasm.
The most common types of testicular cancer are seminoma and nonseminoma. Seminomas make up about 40 percent of all cases. These are more sensitive to radiation treatment. Nonseminomas are actually a group of cancers. They include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. Each of these major testicular cancers grow and spread differently and are treated differently.
Ninety-five percent of all primary testicular tumors arise from germinal elements. Nongerminal elements, Sertoli and Leydig cells, account for roughly 5 percent of all primary testicular tumors.
Germinal neoplasms are traditionally divided into seminomas and a variety of other types of germinal neoplasms, known collectively as nonseminomatous germ cell tumors. A number of prognostic classification schemes are in use for metastatic nonseminomatous testicular cancer and primary extragonadal nonseminomatous germ cell cancers treated with chemotherapy.
Testicular cancer can cause a number of symptoms. Men should look for these warning signs:
- lump in either testicle
- 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 the scrotum
- enlargement or tenderness of the breasts.
These symptoms are not sure signs of cancer. They may also be caused by other conditions. However, it is important to see a doctor if any of these symptoms lasts as long as two weeks. Early diagnosis of testicular cancer is especially important, because the sooner cancer is found and treated, the better a man's chances are for complete recovery.
Testicular cancers can be treated with surgery, radiation therapy and chemotherapy. The doctor may use one method or a combination of methods. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.
In most cases, surgery is done to remove the testicle. Sometimes, it may also be necessary to remove lymph nodes in the abdomen. In addition, tumors that may have spread to other parts of the body may be partly or entirely removed by surgery.
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; it affects only the cells in the treated area. Patients usually receive radiation therapy in an outpatient clinic.
Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.
Nonseminomas are not sensitive to radiation. Patients with this type of cancer need other types of treatment.
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 if the doctor suspects that undetected cancer cells may remain in the body after surgery or radiation. The use of anticancer drugs following surgery for an early stage of cancer is known as adjuvant therapy.
Chemotherapy may be given by mouth or by injection into a muscle or 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 doctor's office or at home. Sometimes, the person must be hospitalized for a period of time so that the effects of the treatment can be watched.
What type of testis cancer is it?
Is this case in the good-risk or poor-risk group?
Will nerve-sparing surgery be possible?
Should I consider using a sperm bank?
What are the toxic effects and risks of chemotherapy?
What are the tumor markers? What other tests are needed for follow-up?
What is the chance of cure?