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About testicular cancer
Posted Tue, 30 May 2000
Testicular cancer is one of the most treatable cancers. In spite of a slow increase in the number of cases each year, there has been a dramatic decrease in the number of deaths from the cancer thanks to new treatments. In 1977, testicular cancer was the third leading cause of cancer deaths in American men between the ages of 15 and 34. By 1981 the disease was no longer among the top five causes of cancer deaths in the same age group.
Who gets testicular cancer?
This is a disease of young men. Among white men it is the most common cancer between the ages of 20 and 34 years of age, the second most common between 35 and 39 years and the third most common between 15 and 19 years. It is uncommon after the age of 40. A testicular lump in a man over the age of 50 is more likely to be a lymphoma, particularly if both testes are involved.
Testicular cancer is 4.5 times more common among white men than among black men.
Risk factors are:
-
A history of
undescended testes. These men have 3 to 17 times the average risk, which means that one in ten men with undescended testes will develop testicular cancer. Those with testes left in the abdomen have a greater risk than those whose testes have descended as far as the inguinal canal.
- Men with any problems in the development of their testes, for example two conditions called gonadal dysgenesis and Klinefelter's syndrome, have a higher risk of testicular cancers.
- Some reports suggest that HIV infection predisposes men to testicular cancer.
- Men who had mumps orchitis complicating childhood mumps may have a higher risk of developing testicular cancer.
- The presence of cancer in one testis will predispose to the development of cancer in the other testis.
Most testicular cancers are first detected by the patient when they find a lump in one testis. These are generally asymptomatic.
In advanced disease there may be symptoms of spread such as back and abdominal pain, weight loss, shortness of breath due to spread to the lungs, enlarged lymph nodes and urinary obstruction.
How is testicular cancer diagnosed?
Once a testicular cancer is suspected blood samples are taken for tumour markers such as human chorionic gonadotrophin (HCG), alpha fetoprotein (ALP) and lactate dehydrogenase (LDH). These levels are then used for comparison during follow up after treatment.
The definitive diagnosis is made by removing the testis for examination.
A biopsy is never performed since there is a high possibility of then spreading the tumour cells into the scrotal sac and the local lymph nodes, the inguinal nodes.
Types of testicular cancer and their significance for treatment
Testicular cancers are broadly split into seminoma and nonseminoma types. These are important when planning treatment, since seminomas are very sensitive to radiation therapy. Any tumour which shows a mixture of types is regarded as nonseminoma.
Nonseminoma types include embryonal carcinoma, teratoma, yolk sac carcinoma, choriocarcinoma and various combinations of these cell types. The risk of spread of the cancer is lowest for teratoma and highest for choriocarcinoma. The other cell types have an intermediate risk.
Patients with seminoma have an overall cure rate of more than 80%. Those with very early cancers with no spread have an almost 100% cure rate.
Unlike many other cancers even men who have extensive spread of the cancer at diagnosis can still be cured, and should never be treated as terminal.
How is testicular cancer treated?
Before treatment starts it is important to know the stage of the disease, that is whether there is any spread to the surrounding lymph nodes or beyond. The type of testicular cancer will also determine the type of treatment.
Treatment is generally a combination of surgery and/or radiation therapy and chemotherapy depending on the stage and type of cancer.
Obviously men are going to be worried about their sexual and reproductive potential after surgery and chemotherapy. Surgical techniques have now been developed which spare the nerves involved in ejaculation, so allowing a normal sex life. All men will become infertile during chemotherapy, but many recover full sperm production and are able to father children later. There is no evidence that these children have an increased risk of congenital malformations.
Follow up includes physical examination and regular evaluation of the tumour markers HCG, ALP and LDH. Patients are generally followed up monthly for the first year after treatment and then every alternate month for two years. Most tumour recurrences occur in the first two years, although late recurrence has been reported, so long term follow up is recommended.
Men cured of testicular cancer have about a 2 to 5% cumulative risk of developing cancer in the opposite testicle over 25 years after the initial diagnosis. These patients are treated with chemotherapy and sometimes surgery as well, depending on the extent of the disease.
Links
There are many sites dealing with cancers of all types. This list is not meant to be comprehensive but will provide starting points from which further searches can be made. The British site, the Cancer Web Project is worth a look, providing plenty of information on cancer in general and allowing searches for specific types of cancer. Another British site is Cancer Help UK, which provides information specifically for cancer patients and their families. Medicine Net promises state of the art medical information and is an excellent resource. Look up prostate cancer in their Diseases and Treatment section which has an alphabetical listing. Men's health issues cover testicular cancer along with a number of other health topics exclusive to men.
