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Testicular Cancer - Symptoms & Treatment

Testicular cancer is an abnormal, rapid, and invasive growth of cancerous (malignant) cells in the testicles (male sex glands adjacent to the penis).

The testicles are located in the membranous pouch below the penis (scrotum) and are suspended from the body by the spermatic cord. They produce male reproductive cells (sperm) and testosterone. Testicular cancer is treated successfully in more than 95% of cases.

Malignant testicular tumors are the most prevalent solid tumors in men ages 20 to 40. Testicular cancer is rare in nonwhite men and accounts for less than 1 % of all male cancer deaths. Rarely, testicular cancer occurs in children.

With few exceptions, testicular tumors originate from germinal cells. About 40% become seminomas. These tumors, which are characterized by uniform, undifferentiated cells, resemble primitive gonadal cells. Other tumors - nonseminomas - show various degrees of differentiation.

Causes

The cause of testicular cancer is unknown. However, men whose testes did not descend into the scrotum by age three are more likely to develop testicular cancer than men whose testes did descend by that age. Normally, the testes move down from inside the abdomen into the scrotum before birth. An undescended testicle is a condition where one or both testes remain inside the abdomen. Higher rates of testicular cancer have also been noted in men with HIV infection.

Signs and Symptoms

The following are the most common symptoms for testicular cancer. However, each individual may experience symptoms differently. The National Cancer Institute suggests that a man see a physician if any of the following symptoms lasts two weeks or longer:

  • lump in either testicle
  • enlargement of a testicle
  • feeling of heaviness in the scrotum
  • dull ache in the lower abdomen or in the groin
  • sudden collection of fluid in the scrotum
  • pain or discomfort in a testicle or in the scrotum
  • enlargement or tenderness of the breasts

The symptoms of testicular cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Diagnostic tests 

Serum analyses may be done to evaluate betasubunit human chorionic gonadotropin (HCG) and alphafetoprotein (AFP) levels. Elevated levels of these proteins (tumor markers) suggest testicular cancer and can differentiate a seminoma from a nonseminoma: elevated HCG and AFP levels point to a nonseminoma; elevated HCG and normal AFP levels indicate a seminoma.

Computed tomography scanning can detect metastases. Chest X-rays may demonstrate pulmonary metastases. Lymphangiography, ultrasonography, and magnetic resonance imaging may disclose additional metastases.

Excretory urography may detect ureteral displacement, which is caused by metastasis to a paraaortic lymph node.

Biopsy can confirm the diagnosis, help stage the disease, and plan treatment.

Treatment

In testicular cancer, treatment includes surgery, radiation therapy, and chemotherapy. Treatment intensity varies with the tumor cell type and stage.

Surgical options include orchiectomy and retroperitoneal node dissection to prevent disease extension and assess its stage. Most surgeons remove just the testis, not the scrotum. The patient may need hormonal replacement therapy after bilateral orchiectomy.

Treatment of seminomas involves postoperative radiation to the retroperitoneal and homolateral iliac nodes. Patients whose disease extends to retroperitoneal structures may be given prophylactic radiation to the mediastinal and supraclavicular nodes. Treatment of nonseminoma includes radiation directed to all cancerous lymph nodes.

Chemotherapy is most effective for late-stage seminomas and most nonseminomas when used for recurrent cancer after orchiectomy and removal of the retroperitoneal lymph nodes.

Autologous bone marrow transplantation is usually reserved for patients who don't respond to standard therapy. It involves giving high-dose chemotherapy, removing and treating the patient's bone marrow to kill remaining cancer cells, and returning the processed bone marrow to the patient.

Prevention

There is no prevention for testicular cancer, but finding it early is important to successful treatment and survival. Young men should learn to perform testicular self-examination (TSE) shortly after puberty. A TSE performed on a monthly basis may play a major role in detecting tumors at earlier stages -- before they spread.



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