CanCer-666: Testis Cancer

Treatment Options for Testicular Cancer

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Treatment Options for Testicular Cancer</h2>
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In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For testicular cancer, this team includes a urologist and medical oncologist, who is a doctor who specializes in treating cancer with medication, and sometimes a radiation oncologist. A radiation oncologist a doctor who specializes in giving radiation therapy to treat cancer.<br />
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Descriptions of the most common types of treatment used for testicular cancer are listed below, followed by treatment options by the cancer’s stage. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the man’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.<br />
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Most often, <b>testicular cancer can be successfully treated with surgery</b>, chemotherapy, and/or radiation therapy. Men with testicular cancer usually have concerns about how their treatment will affect their sexual function, fertility, and quality of life, and each man should discuss these topics with his doctor before treatment begins because there is often more than one treatment option available. The final choice of a treatment plan depends on the patient’s specific situation. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment.<br />
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Depending on the type and stage of the cancer and other factors, treatment options for testicular cancer can include: <br />
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<span style="color: #6aa84f;">Surgery</span></h3>
Surgery is the removal of the tumor and surrounding tissue during an operation. There are different types of surgery used to treat testicular cancer, each is described further below. If a decision is made to perform an orchiectomy, a sample of blood will be collected before surgery to test for levels of serum tumor markers because they are often helpful in planning treatment and follow-up care (see Diagnosis).<br />
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<b>• Radical inguinal orchiectomy</b><br />
Treatment of testicular cancer usually starts with surgery to remove the testicle with cancer, called radical inguinal orchiectomy. This is done through an incision in the groin along the beltline. It is used to diagnose and treat both early-stage and later-stage seminomas and non-seminomas. For later-stage cancer, a radical inguinal orchiectomy may, occasionally, be delayed until after treatment with chemotherapy is finished. <br />
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The removal of one testicle typically does not affect a man’s testosterone level if he still has the other testicle, and it is a normal size. If a man’s testosterone level is reduced, symptoms may include depression or other mood changes, fatigue, decreased sex drive, inability to achieve a normal erection, especially in the morning, and hot flashes, as well as loss of muscle and bone mass in the long term. Orchiectomy is unlikely to make a man unable to father a biological child because the remaining testicle will still produce sperm. However, about 25% of men with testicular cancer are infertile even before being diagnosed with cancer. It appears that the cancer itself may cause some men to become infertile. Sperm counts may improve after the testicle with cancer is removed.<br />
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A man may develop cancer in both testicles either at the same time or at different times. However, this is rare, occurring in about 2% of men with testicular cancer. If the removal of both testicles, called a bilateral orchiectomy, is performed, the man will no longer produce sperm or testosterone and will not be able to biologically produce children. If the doctor recommends removing the testicle in a man with one testicle, semen is usually analyzed twice before surgery to check if the man’s sperm are fully functioning. If the sperm are functional, then sperm banking is usually recommended, so that he will be able to have children later if he wishes. In addition, for men who have had both testicles removed, testosterone hormone replacement therapy will be needed.<br />
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Men can choose to have an artificial or prosthetic testicle implanted in the scrotum that has a weight and texture that is somewhat similar to a normal testicle but not exactly the same. Some men find that a prosthetic testicle is uncomfortable. Each man is encouraged to talk with his doctor about the best timing of this implantation. Some men prefer to wait until after the active treatment period is over to give this option full consideration.<br />
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<b>• Retroperitoneal lymph node dissection (RPLND)</b><br />
Depending on the type and stage of your cancer, some lymph nodes at the back of the abdomen (around the large blood vessels known as the aorta and inferior vena cava) may also be removed at the same time as the orchiectomy or during a second operation. Not all patients with testicular cancer need to have lymph nodes removed, so it’s important to discuss this (and the possible alternatives) with your doctor. This is a complex and long operation. A large incision is typically made down the middle of the abdomen to remove the lymph nodes. It should be done by a surgeon who does this often. Experience counts.<br />
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<b>Laparoscopic surgery:</b> In some cases, the surgeon can remove lymph nodes through very small skin incisions in the abdomen by using a laparoscope (a narrow, lighted tube with a small video camera on the end that lets doctors see inside the abdomen) and other long, thin surgical tools. The surgeon’s hands are not inside the patient’s body during this type of surgery.<br />
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Laparoscopic surgery seems to be a lot easier for the patient, but doctors are not sure if it’s as safe and effective as the standard “open” surgery in removing all of the potentially cancerous lymph nodes. Because of this uncertainty, doctors are more likely to recommend chemotherapy after laparoscopic surgery if cancer is found in the lymph nodes. In laparoscopic surgery, after being put to sleep, the patient is turned onto his side. Several small incisions are made on the abdomen. A laparoscope and long instruments are inserted through the incisions to remove the lymph nodes. The incisions are then closed and the patient is awakened.<br />
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Patients recover much more quickly from this operation than the standard open procedure and are walking soon after surgery. There is usually less pain and patients are eating sooner. This procedure is most often used for patients with early stage non-seminomas to see if the lymph nodes contain cancer. As with the standard open procedure, this is a complex operation that should only be done if the surgeon is very experienced. <br />
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<b>• Possible risks and side effects of surgery</b><br />
The short-term risks of any type of surgery include reactions to anesthesia, excess bleeding, blood clots, and infections. Most men will have at least some pain after the operation, which can usually be helped with pain medicines, if needed.<br />
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<b>Effects of orchiectomy:</b> Losing a testicle usually has no effect on a man’s ability to get an erection and have sex. But if both testicles are removed, sperm cells cannot be produced and a man becomes infertile. Also, without testicles, a man cannot make enough testosterone, which can decrease sex drive and affect his ability to have erections. Other effects could include fatigue, hot flashes, and loss of muscle mass. These side effects can be avoided by taking testosterone supplements, either in the form of a gel, a patch, or a shot. Pills are generally not reliable sources of testosterone. Usually men with testicular cancer are young and may be concerned that their appearance has changed. They may be dating and worry about a partner’s reaction, or they may be athletic and feel embarrassed by the missing testicle when in locker rooms.<br />
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To restore a more natural look, a man can have a testicular prosthesis surgically implanted in his scrotum. The prosthesis approved for use in the United States is filled with saline (salt water) and comes in different sizes to match the remaining testicle. When in place, it can look like a normal testicle. There can be a scar after the operation, but it’s often partly hidden by pubic hair. Some men might want to have a prosthesis, while others might not. You should discuss your wishes with your surgeon before considering this surgery. It could also help to talk with someone who has a testicular prosthesis, to see what their experience has been like.<br />
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<b>Effects of lymph node dissection:</b> Surgery to remove retroperitoneal lymph nodes is a major operation. Serious complications are not common, but they can happen. About 5% to 10% of patients have temporary complications after surgery, such as bowel obstruction or wound infections. The standard approach for an RPLND requires a large incision in the abdomen, which will leave a scar and can take some time to heal. Your ability to get up and around after the operation will be limited for some time. This is less likely to be an issue if you have laparoscopic surgery, which uses smaller incisions.<br />
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This type of surgery does not cause impotence – a man can still have erections and sexual intercourse. But it might damage some of the nerves that control ejaculation. If these nerves are damaged, when a man ejaculates, the semen is not propelled forward through the urethra to exit the body but rather goes backwards into the bladder. This is known as retrograde ejaculation, and it can make it hard to father children. To save the normal ejaculation function, surgeons have developed a type of retroperitoneal lymph node surgery called nerve-sparing surgery that has a very high rate of success in experienced hands. Testicular cancer often affects men at an age when they may be trying to have children. These men may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment). Men with testicular cancer often have lower than normal sperm counts, which can sometimes make it hard to collect a good sperm sample.<br />
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<h3>
Active surveillance for clinical stage I testicular cancer</h3>
After having a radical inguinal orchiectomy, one option for men with clinical stage I seminomas and non-seminomas may be active surveillance. With active surveillance, the patient is monitored closely and active treatment begins only if the cancer recurs. This option involves regular doctor appointments for CT scans, chest x-rays, physical examinations, and blood tests for tumor markers. This approach requires dedication by the doctor and patient to stick to the surveillance schedule so that any recurrence can be detected at an early stage. It is only considered as an option if the serum tumor markers are normal or return to normal after the cancerous testicle is removed.<br />
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The main advantage of active surveillance is that it avoids any further treatment after orchiectomy, such as chemotherapy, radiation therapy, or additional surgery for the 80% of men with seminoma and 70% of men with non-seminoma who do not need more treatment after surgery. For an individual patient, the risk of recurrence may be higher or lower based on certain risk factors determined by the pathologist’s examination of the testicular tumor after the testicle has been removed.<br />
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The surveillance schedule for non-seminomas involves testing every one to two months for the first year, every two to three months in the second year, and less often thereafter. The surveillance schedule for seminomas is much less intense, with testing performed every four months for the first two to three years and less often thereafter. Patients generally have follow-up screening for at least ten years after their diagnosis.<br />
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<i> Treatment Options for Testicular Cancer</i><br />
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<h3>
Chemotherapy (chemo)</h3>
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.<br />
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Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.<br />
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The following drugs are used for testicular cancer, usually in the combinations listed further below.<br />
<ul>
<li>Bleomycin (Blenoxane)</li>
<li>Carboplatin (Paraplatin)</li>
<li>Cisplatin (Platinol)</li>
<li>Etoposide (Toposar, VePesid)</li>
<li>Ifosfamide (Ifex)</li>
<li>Paclitaxel (Taxol)</li>
<li>Vinblastine (Velban)</li>
<li>Vinorelbine (Navelbine)</li>
</ul>
The following chemotherapy regimens may be used for testicular cancer.<br />
<ul>
<li>BEP: bleomycin, etoposide, and cisplatin.</li>
<li>EP: etoposide and cisplatin</li>
<li>TIP: paclitaxel, Ifosfamide, and cisplatin</li>
<li>VeIP: vinblastine, ifosfamide, and cisplatin</li>
<li>Vinorelbine (Navelbine), etoposide, and cisplatin</li>
<li>VIP: etoposide, ifosfamide, and cisplatin</li>
</ul>
In general, patients with later-stage disease receive more chemotherapy. The appropriate chemotherapy regimen depends on the stage of the cancer and whether it is a seminoma or a non-seminoma.<br />
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Chemotherapy works very well for testicular cancer but can cause side effects and complications. Most of these side effects usually go away once treatment is finished, but some can show up much later. These are called late effects. Balancing the risks and benefits of chemotherapy is an important issue for men with testicular cancer. However, metastatic testicular cancer (see further below) can generally only be cured with chemotherapy, so for men with metastatic testicular cancer, the benefits of chemotherapy typically outweigh the risks. On the other hand, men with stage I testicular cancer almost never die of the disease regardless of which treatment they receive, so the risks of chemotherapy may outweigh the benefits for these men. <br />
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<u><b>The side effects of chemotherapy</b></u> depend on the individual and the dose used, but they can include the following:<br />
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<b>Fatigue.</b> Tiredness and loss of energy are among the most common side effects of chemotherapy. Almost all men who have chemotherapy for testicular cancer will experience some fatigue, but the severity varies widely from person to person.<br />
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</b> <b>Fertility problems.</b> Chemotherapy can cause lowered sperm counts and increase the risk of infertility. In addition, chemotherapy can temporarily damage sperm.<br />
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<b>Hair loss.</b> For most patients, hair loss occurs after four weeks. However, it grows back about four months after chemotherapy has ended. At times, it may grow back a different texture (such as curly, if it used to be straight) or a different color. However, patients who are balding before chemotherapy do not grow more hair after completing chemotherapy than they had before chemotherapy.<br />
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<b>Hearing loss.</b> Chemotherapy can cause loss of hearing for high-pitch sounds and can cause ringing in the ears, which is called tinnitus. Hearing loss, when it occurs, is usually permanent.<br />
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<b>Kidney damage.</b> Mild reductions in kidney function are common after chemotherapy, but it is unknown whether mild reductions actually cause any medical problems. Rarely, chemotherapy can cause more severe kidney damage that prevents the kidneys from functioning completely.<br />
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<b>Lung damage.</b> Slightly reduced lung function is common after chemotherapy with bleomycin. Rarely, the effects of bleomycin on the lungs can cause death.<br />
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<b>Nausea and vomiting.</b> This is common during each cycle of chemotherapy. Vomiting can often be prevented using the appropriate medications. Drugs that prevent vomiting are given before chemotherapy on each of the days the drug cisplatin is given. There are several drugs and drug combinations that work well to reduce or prevent vomiting, although they do not get rid of all nausea. Learn more about preventing vomiting caused by cancer treatment.<br />
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<b>Numbness and tingling.</b> Chemotherapy for testicular cancer sometimes causes a partial loss of feeling in the hands and/or feet from nerve damage. Numbness and tingling after chemotherapy often improves over time, but it may be permanent.<br />
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</b> <b>Reduction in the number of blood cells.</b> Chemotherapy may cause a reduction in the number of white cells that fight infections, red blood cells that carry oxygen, or platelets, which cause blood to clot. Because lower levels of these cells can interfere with blood clotting and the body’s ability to fight infections, it is important to seek help immediately if you have bleeding, infection, and/or a fever. Infections during chemotherapy can be very serious, and even life-threatening, if they are not treated immediately, and fever is often the only warning of an infection.<br />
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</b> <b>Skin marks.</b> Bleomycin can sometimes leave some brown patches on the skin.<br />
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Chemotherapy may also increase risk of secondary cancers many years after treatment, as well as cardiovascular disease and infectious diseases. Learn more about common side effects. Other side effects that can last for a long time after chemotherapy are described in the After Treatment section. Talk with your doctor about your risk of long-term side effects before starting chemotherapy.<br />
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High-dose chemotherapy and stem cell transplant</h3>
In general, testicular cancers respond well to chemotherapy (chemo), but not all cancers are cured. Even though higher doses of chemo might be more effective, they are not given because they could severely damage the bone marrow, which is where new blood cells are formed. This could lead to life-threatening infections, bleeding, and other problems because of low blood cell counts. A stem cell transplant allows doctors to use higher doses of chemo. Blood-forming stem cells are collected from the bloodstream in the weeks before treatment using a special machine. In the past the stem cells were taken from the bone marrow, but this is done less often now. The stem cells are frozen, and then the patient receives high-doses of chemo.<br />
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After the chemo the patient gets his stem cells back again. This is called a transplant, but it does not involve surgery – the cells are infused into a vein much like a blood transfusion. The stem cells settle in the bone marrow and start making new blood cells over the next few weeks. For testicular cancer, stem cell transplant is most often used to treat cancers that have come back after treatment with chemo. Current studies are exploring whether a stem cell transplant may be valuable in treating some patients with advanced germ cell cancers as part of their first treatment.<br />
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A stem cell transplant is a complex treatment that can cause life-threatening side effects because of the high doses of chemotherapy used. Be sure you understand the possible benefits and risks. If the doctors think you might benefit from a transplant, it should be done at a hospital where the staff has experience with the procedure and with managing the recovery phase. Stem cell transplants often require a lengthy hospital stay and can be very expensive. Even if the transplant is covered by your insurance, your co-pays or other costs could easily amount to tens of thousands of dollars. It is important to find out what your insurer will cover before deciding on a transplant to get an idea of what you might have to pay.<br />
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Radiation therapy</h3>
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. For testicular cancer, the radiation is generally directed at lymph nodes in the abdomen. Often, the radiation is also targeted at lymph nodes on the same side of the pelvis as the testicle where the cancer started.<br />
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Radiation therapy is more effective for treating seminoma than non-seminoma and is used less often than in the past. Active surveillance or, less commonly, carboplatin chemotherapy is used instead of radiation therapy as the preferred treatment of stage I seminomas at many treatment centers because of the risk that radiation therapy may cause other cancers and heart disease. However radiation therapy remains an option for stage I, IIA, and IIB pure seminomas. It is also sometimes used to treat brain metastases from either seminomas or non-seminomas, but testicular cancer rarely spreads to the brain.<br />
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Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, loose bowel movements, and peptic ulcers. Medications may be helpful to prevent or reduce nausea and vomiting during radiation therapy. Most side effects go away soon after treatment is finished. Radiation therapy may cause problems with sperm production, but this is less common now with newer radiation techniques that can help men to preserve fertility. Radiation therapy may increase risk of secondary cancers many years after treatment, as well as cardiovascular disease and gastrointestinal disease. Talk with your doctor about your risk of long-term side effects before starting radiation therapy.<br />
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In some cases, more than one of type of treatment might be used. You may have different types of doctors on your treatment team, depending on the stage of your cancer and your treatment options. These doctors may include:<br />
<ul>
<li>A urologist: a surgeon who specializes in treating diseases of the urinary system and male reproductive system</li>
<li>A radiation oncologist: a doctor who treats cancer with radiation therapy</li>
<li>A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy</li>
</ul>
Many other specialists might be involved in your care as well, including physician assistants, nurse practitioners, nurses, physical therapists, social workers, and other health professionals. It’s important to discuss all of your treatment options as well as their possible side effects with your doctors to help make the decision that best fits your needs. When time permits, getting a second opinion is often a good idea. It can give you more information and help you feel good about the treatment plan you choose. Where you are treated is important. There is no substitute for experience. You have the best chance for a good outcome if you go to a hospital that treats many testicular cancer patients.<br />
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<u>Treatment Options for Testicular Cancer</u></div>
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Treatment Options for Testicular Cancer

Treatment Options for Testicular Cancer In cancer care, different types of doctors often work together to create a patient’s overall t...

Testicular Cancer Causes

ancorez Testis Cancer 7:07 PM

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Testicular Cancer Causes</h2>
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The exact cause of most testicular cancers is not known. But scientists have found that the disease is linked with a number of other conditions, which are described in the section “<a href="http://cancer-666.blogspot.com/2014/05/testicular-cancer-risk-factors.html" target="_blank">Testicular Cancer Risk Factors</a>” A great deal of research is being done to learn more about the causes.<br />
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<b>The causes of testicular cancer</b> are unknown, but research is going on all the time to try to find out more.<br />
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<i>The causes of testicular cancer</i> are not fully understood. However, we do know about several things which increase your risk of developing the condition.<br />
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It's not clear <u>what causes testicular cancer</u> in most cases. Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren't needed. The accumulating cells form a mass in the testicle.<br />
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Nearly all <a href="http://cancer-666.blogspot.com/search/label/Testis%20Cancer" rel="nofollow" target="_blank">testicular cancers</a> begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known. </div>
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Testicular Cancer Causes

Testicular Cancer Causes The exact cause of most testicular cancers is not known. But scientists have found that the disease is linked...

Testicular Cancer Risk Factors

ancorez Testis Cancer 8:55 PM

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What are the risk factors for testicular cancer?</h2>
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<b>A risk factor</b> is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed. But having a risk factor, or even several, does not mean that you will get the disease. Just as having no risk factors doesn’t mean you won’t get the disease. And some people who get the disease may not have had any known risk factors. Even if a person with testicular cancer has a risk factor, it’s often very hard to know how much that risk factor contributed to the cancer.<br />
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Scientists have found few risk factors that make someone more likely to develop testicular cancer. Even if someone has one or more risk factors for this disease, it’s impossible to know for sure how much that risk factor contributes to developing the cancer. Also, most boys and men with testicular cancer do not have any of the known risk factors. <b>Factors that may increase your risk of testicular cancer</b> include:<br />
<h3>
<span style="color: #6aa84f;">Age</span></h3>
More than half of testicular cancer diagnoses occur in men between the ages of 20 and 45. However, men of any age can develop this disease, including men as young as 15, so it is important that any man with symptoms of testicular cancer visit the doctor.<br />
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<h3>
<span style="color: #6aa84f;">Cryptorchidism</span></h3>
Cryptorchism is an undescended testicle, in which one or both testicles do not move down into the scrotum before birth as they should. Men with this condition have an increased risk of developing testicular cancer. This risk may be lowered if surgery is used to correct the condition before the boy reaches puberty. Some doctors have recommended that cryptorchidism be corrected when a boy is very young, between six and 15 months, in order to reduce the risk of infertility, which is the inability to produce children. Because cryptorchidism is often corrected at a young age, many men may not know if they had the condition.<br />
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<h3>
<span style="color: #6aa84f;">Ethnicity and Race</span></h3>
The risk of testicular cancer among white men is about 4 to 5 times that of black men and more than 3 times that of Asian-American men. The risk for Hispanics/Latinos and American Indians falls between that of Asians and non-Hispanic/Latino whites. The reason for these differences is not known. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among men living in Africa or Asia.<br />
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<h3>
<span style="color: #6aa84f;">Family history</span></h3>
A family history of testicular cancer increases the risk. If a man has the disease, there is an increased risk that one or more of his brothers or sons will also develop it. But only a small number of testicular cancers occur in families. Most men with testicular cancer do not have a family history of the disease.<br />
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<span style="color: #6aa84f;">Oestrogen exposure in utero</span></h3>
<b>• Birth order and number of siblings</b><br />
Testicular cancer risk is 8% higher in firstborns, and risk decreases with increasing birth order, a meta-analysis showed. It is also 25% higher in males with no siblings versus those with 4+ siblings, and risk decreases with increasing number of siblings. Testicular cancer risk is 22-31% higher in males with a twin, meta-analyses have shown. These attributes are associated with higher oestrogen levels in utero, but also with delayed childhood exposure to infections (linked with some other cancers), and parental subfertility, so the root cause remains unclear.<br />
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<b>• Diethylstilbestrol</b><br />
In utero exposure to synthetic oestrogen diethylstilbestrol (DES) is classified by IARC as a possible cause of testicular cancer, based on limited evidence. Testicular cancer risk may be around doubled in males exposed to DES in utero, though in meta-analysis the association was not significant. Cryptorchidism is around twice as common in DES-exposed men, a cohort study showed.<br />
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<b>• Events during pregnancy and at birth</b><br />
Testicular cancer risk is 33% higher in men whose mother had bleeding during pregnancy, a meta-analysis showed. It is 31% higher in men born prematurely, a meta-analysis showed; and may be around fourfold higher in those born extremely prematurely (weeks gestational age), a large cohort study showed.31 But testicular cancer risk is not associated with maternal nausea (though one study suggests an association with severe vomiting during pregnancy), hypertension or pre-eclampsia during pregnancy. Nor is it associated with delivery (breech or caesarean), maternal age or body mass index (BMI). Hormonal factors are implicated in some of these events/conditions.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Other medical conditions</span></h3>
<b>• HIV/AIDS infection</b><br />
Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk. <br />
<br />
<b>• Inguinal hernia</b><br />
Testicular cancer risk is 37-63% higher in males with inguinal hernia (protrusion of part of the bowel through abdominal wall), a meta-analysis and large cohort-study showed.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Other testicular conditions</span></h3>
<b>• Hypospadia</b><br />
Testicular cancer risk is 88-141% higher in males with hypospadia (abnormality of the penis and urethra), a meta-analysis and large cohort study showed.<br />
<br />
<b>• Low fertility</b><br />
<i>Testicular cancer risk</i> is 59% higher in subfertile men (without cryptorchidism), compared with men with normal fertility levels, a meta-analysis showed. However this may be an underestimate, because subfertility was not limited to known male factor subfertility. A study including only men with known male factor subfertility found testicular cancer risk was around threefold increased in this population, but this study did not control for cryptorchidism. It appears that subfertility and testicular cancer may share causes, though subfertility as an early manifestation of testicular cancer (reverse causation) remains a possibility.<br />
<br />
<b>• Testicular dysgenesis syndrome</b><br />
It has been proposed that testicular cancer, cryptorchidism, hypospadia and impaired sperm production/subfertility are all products of disturbed gonadal development in utero, and so should be considered together as testicular dysgenesis syndrome (TDS). There is some evidence that the TDS constituent conditions have similar incidence patterns. However it remains unclear whether they have a shared cause (e.g. in utero exposure to endocrine disruptors), or whether the conditions each affect the risk of one another.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Previous testicular cancer</span></h3>
Testicular cancer risk is 12-18 times higher in men with previous testicular cancer, compared with the general population, large cohort studies show. 2-4% of men with previous testicular cancer will develop cancer in their remaining testicle with 20 years. The risk of second testicular cancer is lower in men whose primary testicular cancer was advanced at diagnosis, probably because cisplatin-based chemotherapy (more like to be used in advanced cases) delays tumour development.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Smoking</span></h3>
Testicular cancer risk may be increased in males whose mother smoked during pregnancy, but evidence is conflicting. Studies which assessed smoking indirectly (population smoking rates or maternal lung cancer) have found an association, while studies using self-report or medical records smoking data found no association.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Testicular carcinoma in situ</span></h3>
This condition does not cause a lump in the testicles or any other symptoms. It isn’t clear how often carcinoma in situ (CIS) in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism. Doctors in Europe are more likely than the doctors in this country to look for CIS. This may be why the numbers for diagnosis and progression of CIS to cancer are lower in the United States than in parts of Europe.<br />
<br />
Since we don’t know how often CIS becomes true (invasive) cancer, it isn’t clear if treating CIS is a good idea. Some experts think that it may be better to wait and see if the disease gets worse or becomes a true cancer. This could allow many men with CIS to avoid the risks and side effects of treatment. When CIS is treated, radiation or surgery (to remove the testicle) is used. <br />
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<h3>
<span style="color: #6aa84f;">Undescended testicle</span></h3>
One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move from the abdomen (belly) into the scrotum before birth. Males with cryptorchidism are several times more likely to get testicular cancer than those with normally descended testicles.<br />
<br />
Normally, the testicles develop inside the abdomen of the fetus and they go down (descend) into the scrotum before birth. In about 3% of boys, however, the testicles do not make it all the way down before the child is born. Sometimes the testicle remains in the abdomen. In other cases, the testicle starts to descend but remains stuck in the groin area. Most of the time, undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably won’t go down on its own. Sometimes a surgical procedure known as orchiopexy is needed to bring the testicle down into the scrotum.<br />
<br />
The risk of testicular cancer may be somewhat higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. If cancer does develop, it is usually in the undescended testicle, but about 1 out of 4 cases occur in the normally descended testicle. Because of this, some doctors conclude that cryptorchidism doesn’t actually cause testicular cancer but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.<br />
<br />
Orchiopexy may reduce the risk of testicular cancer if it is done when a child is younger, but it is not as clear if it is helpful if the child is older. The best time to do this surgery is not clear. Experts in the United States recommend that orchiopexy be done soon after the child’s first birthday for reasons (such as fertility) that are not related to cancer. <br />
<hr />
<h3>
<span style="color: #6aa84f;">Other risk factors</span></h3>
<b>• Asbestos</b><br />
Risk of paratesticular mesothelioma (a rare type of testicular cancer) may be associated with past exposure to asbestos, case series indicate; however, evidence is sparse.<br />
<br />
<b>• Body weight</b><br />
Testicular cancer risk is 8% lower in overweight men (BMI 30+) compared with those of a healthy weight (BMI 25-29.9), a meta-analysis showed.<br />
<br />
<b>• Height</b><br />
Testicular cancer risk is 11-13% higher per 5cm increment in height, a meta-analysis and a pooled analysis of Nordic data showed<br />
<br />
<b>• Late puberty</b><br />
Testicular cancer risk is 16-19% lower in men who started puberty later in comparison with their peers, a meta-analysis showed. No association with early puberty was found.<br />
<hr />
<h3>
<span style="color: #6aa84f;">Factors not shown to be associated with testicular cancer risk</span></h3>
<b>• Illnesses, infections and medications</b><br />
Testicular cancer risk is not increased in males who have had mumps or mumps orchitis (pain and swelling of the testicles), a meta-analysis showed. HPV infection is probably not linked with testicular cancer risk, although evidence is limited. Testicular cancer risk does not appear to be increased in users of antidepressant medications.<br />
<br />
<b>• Microlithiasis</b><br />
Testicular cancer risk is not increased in men with microlithiasis (small calcium deposits in the testes) who are otherwise healthy, meta-analyses have shown. But in men referred for scrotal ultrasound because of other testicular cancer risk factors (e.g. cryptorchidism, relevant cancer history, or low fertility), microlithiasis is associated with an 8.5-fold increased testicular cancer risk.<br />
<br />
<b>• Occupational exposure</b><br />
Despite extensive research, evidence on testicular cancer risk in relation to occupational exposures in adulthood remains insufficient to draw firm conclusions. Testicular cancer risk does not appear to be elevated with occupational exposure to ionising radiation, a systematic review showed. Polychlorinated biphenyls, pesticides and phthalates may affect oestrogen levels and so impact on testicular cancer risk, however evidence remains unclear.<br />
<br />
<b>• Vasectomy and injury</b><br />
<u>Testicular cancer risk</u> is not elevated in men who have had a vasectomy, a large cohort study showed. Any association with testicular injury is thought to reflect recall bias or reverse causality (cancer detected incidentally during investigations for the injury)<br />
<hr />
<h3>
<span style="color: #6aa84f;">Unproven or controversial risk factors</span></h3>
Prior trauma to the testicles and recurrent actions such as horseback riding do not appear to be related to the development of testicular cancer. Most studies have not found that strenuous physical activity increases testicular cancer risk. Being physically active has been linked with a lower risk of several other forms of cancer as well as a lower risk of many other health problems.</div>
</div>

Testicular Cancer Risk Factors

What are the risk factors for testicular cancer? A risk factor is anything that changes your chance of getting a disease such as canc...

Stages of Testicular Cancer

ancorez Testis Cancer 8:03 PM

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<h2>
How is testicular cancer staged?</h2>
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Staging is a way of describing where a cancer has spread. Doctors use diagnostic tests, including CT scans and blood tests, to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and helps predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For testicular cancer, the stage is based on the results of the surgery to diagnose the cancer, blood tests for tumor markers, and imaging tests, all of which are described in the section, “<a href="http://cancer-666.blogspot.com/2014/05/testicular-cancer-test-and-diagnosis.html" target="_blank">Testicular Cancer Test and Diagnosis</a>”.<br />
<hr />
<h3>
The TNM staging system</h3>
A staging system is a standard way for your cancer care team to sum up the extent of your cancer. <b>Testicular cancer is staged</b> using the TNM system created by the American Joint Committee on Cancer (AJCC). It’s based on 4 key pieces of information:<br />
<ul style="text-align: left;">
<li>T refers to how much the main (primary) tumor has spread to tissues next to the testicle.</li>
<li>N describes how much the cancer has spread to regional (nearby) lymph nodes.</li>
<li>M indicates whether the cancer has metastasized (spread to distant lymph nodes or other organs of the body).</li>
<li>S indicates the serum (blood) levels of tumor markers that are made by some testicular cancers.</li>
</ul>
The results are combined to determine the stage of cancer for each person. There are three stages: stages I, II, and III (one, two, and three). The stage provides a common way of describing how advanced the cancer is so that doctors can work together to plan the best treatments. Stage I is the least advanced and stage III is the most advanced. Patients with the least advanced stages are more likely to be cured and often need less aggressive treatment than patients with more advanced stage cancers.   <br />
<br />
There are also two different types of staging in testicular cancer: clinical staging and pathological staging. In clinical staging, the stage is based on a physical examination or x-rays, CT scans, and other imaging tests. In pathological staging, the stage is based on evaluating tissue under a microscope after it has been removed during surgery. For example, clinical stage II testicular cancer means that the retroperitoneal lymph nodes are enlarged when viewed with a CT or MRI scan. Whereas, pathological stage II testicular cancer means that cancer has been found when tissue removed from the retroperitoneal lymph nodes is examined under a microscope. Pathological staging is more accurate than clinical staging, but it is not always necessary.<br />
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Here are more details on each part of the TNM system for testicular cancer:<br />
<br />
<span style="color: #6aa84f;"><b>• Primary tumor (T)</b></span><br />
Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. For testicular cancer, the T stage can only be determined when tissue removed during surgery is examined under a microscope. This means that the T stage is only determined after the testicle is removed, and the T stage is always a pathological stage and never a clinical stage. The “p” before the T stage indicates that it is a pathological stage. Specific tumor stage information is below.<br />
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<b>↠ TX: </b>The primary tumor cannot be assessed<br />
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<b>↠ T0: </b>There is no evidence of primary tumor<br />
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<b>↠ Tis: </b>Carcinoma in situ (non-invasive cancer cells)<br />
<br />
<b>↠ T1: </b>The tumor has not spread beyond the testicle and epididymis (the tubes next to the testicles where sperm mature). The cancer has not reached nearby blood vessels or lymph vessels. The cancer might have grown through the inner layer surrounding the testicle (tunica albuginea), but it has not reached the outer layer covering the testicle (tunica vaginalis).<br />
<br />
<b>↠ T2: </b>Similar to T1 except that the cancer has spread to blood or lymph vessels near the tumor, or the tunica vaginalis<br />
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<b>↠ T3: </b>The tumor is growing into the spermatic cord (which contains blood vessels, lymph vessels, nerves, and the vas deferens)<br />
<br />
<b>↠ T4: </b>The tumor is growing into the skin surrounding the testicles (scrotum)<br />
<br />
<span style="color: #6aa84f;"><b>• Regional lymph nodes (N)</b></span><br />
The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph is a fluid that flows from the different tissues and organs of the body and eventually drains into the blood stream. It passes through specialized tubes called lymphatic vessels and is filtered along the way by the lymph nodes. Cancer cells often buildup and grow in lymph nodes before they spread to other parts of the body. The first place the lymphatic fluid from the testicles drains is the retroperitoneal lymph nodes located in the retroperitoneum. These are called the regional lymph nodes for testicular cancer. Lymph nodes in the pelvis, chest, or other parts of the body are called distant lymph nodes.<br />
<br />
In men with testicular cancer, lymph nodes usually are not biopsied or removed. Instead, the “N” stage is most often estimated by using CT scans. Lymph node stage (N stage) that is based on CT scans is the clinical stage and N stage based on a biopsy or removal of the lymph nodes is the pathological stage. When a stage has been determined pathologically, the letter “p” is added as the first letter of the stage (for example pN1).<br />
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<b>↠ NX:</b> Regional (nearby) lymph nodes cannot be assessed<br />
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<b>↠ N0:</b> No spread to regional lymph nodes is seen on imaging tests<br />
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<b>↠ N1: </b>There is spread to at least one lymph node, but no lymph node is larger than 2 cm (about ¾ inch) across<br />
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<b>↠ N2: </b>There is spread to at least one lymph node that is larger than 2 cm but is not bigger than 5 cm (2 inches) across<br />
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<b>↠ N3: </b>There is spread to at least one lymph node that is larger than 5 cm across<br />
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If the lymph nodes were taken out during surgery, there is a slightly different classification:<br />
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<b>↠ pNX: </b>Regional (nearby) lymph nodes cannot be assessed<br />
<br />
<b>↠ pN0: </b>There is no spread to regional lymph nodes<br />
<br />
<b>↠ pN1: </b>There is spread to 1 to 5 lymph nodes, with no lymph node larger than 2 cm (about ¾ inch) across<br />
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<b>↠ pN2: </b>There is spread to at least one lymph node that is bigger than 2 cm but not larger than 5 cm across; OR spread to more than 5 lymph nodes that aren’t bigger than 5 cm; OR the cancer is growing out the side of a lymph node<br />
<br />
<b>↠ pN3: </b>There is spread to at least one lymph node that is bigger than 5 cm across<br />
<span style="color: #6aa84f;"><b><br />
</b></span> <span style="color: #6aa84f;"><b>• Distant metastasis (M)</b></span><br />
The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. When testicular cancer spreads, it most commonly spreads to the lung and the lymph nodes of the chest, pelvis, and the base of the neck. More advanced stages may have spread to the liver and bones. Testicular cancer rarely spreads to the brain unless the primary tumor is a choriocarcinoma.<br />
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<b>↠ M0: </b>There is no distant metastasis (no spread to lymph nodes outside the area of the tumor or other organs, such as the lungs)<br />
<br />
<b>↠ M1: </b>Distant metastasis is present<br />
<ul>
<li><b>M1a: </b>The tumor has metastasized to distant lymph nodes or to the lung</li>
<li><b>M1b: </b>The tumor has metastasized to other organs, such as the liver, brain, or bone</li>
</ul>
<b><span style="color: #6aa84f;">• Serum tumor markers (S)</span></b><br />
Serum tumor markers also help to stage testicular cancer. As noted in the Diagnosis section, blood tests for tumor markers will be done before and after surgical removal of the testicle(s). Tumor markers usually decrease after the surgery. Generally, the levels need to be tested until they stop decreasing or begin to rise to determine the correct S stage. For patients who will receive chemotherapy, the tumor marker levels on the first day of chemotherapy are used to determine the patient’s risk group.<br />
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<b>↠ SX: </b>Tumor marker levels are not available, or the tests have not been done.<br />
<br />
<b>↠ S0: </b>Tumor marker levels are normal.<br />
<br />
<b>↠ S1: </b>At least one tumor marker level is above normal. This means that LDH is less than 1.5 times the upper limit of the normal range, beta-hCG is less than 5,000 mIu/mL, and AFP is less than 1,000 ng/mL.<br />
<br />
<b>↠ S2: </b>At least one tumor marker level is substantially above normal. This means that LDH is 1.5 to 10 times the upper limit of the normal range, beta-hCG is 5,000 to 50,000 mIu/mL, or AFP is 1,000 to 10,000 ng/mL, and none of the tumor markers is elevated high enough to qualify as S3 (see below).<br />
<br />
<b>↠ S3: </b>One or more tumor marker level is very highly elevated. This means that LDH is more than 10 times the upper limit of the normal range, beta-hCG is more than 50,000 mIu/mL, or AFP is more than 10,000 ng/mL.<br />
<hr />
<h3>
Testicular Cancer Stage Grouping</h3>
Doctors assign <i>the stage of the testis cancer</i> by combining the T, N, and M classifications and the S level information.<br />
<br />
<span style="color: #6aa84f;"><b>• Stage 0 (Carcinoma in Situ)</b></span>: In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called carcinoma in situ.<br />
<br />
<span style="color: #6aa84f;"><b>• Stage I:</b></span> Cancer is at any T level, and there is no evidence of spread to either lymph nodes or other organs. Serum tumor marker levels have not been done or are not available (any T, N0, M0, SX).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IA:</b></span> Cancer is in the testicle and may have grown into the rete testis and the epididymis, but it has not grown into the lymphatic or blood vessels in the testis or spread to lymph nodes or distant sites. The tumor in the testis may have grown into the inner membrane surrounding the testis, called the tunica albuginea, but not the outer membrane, called the tunica vaginalis. Serum markers are normal (pT1, N0, M0, S0).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IB:</b></span> The testicular tumor has grown into the tunica vaginalis, the blood or lymphatic vessels within the testicle, the spermatic cord, or the scrotum. The cancer has not spread to lymph nodes or distant sites. Serum markers are normal (pT2, pT3, or pT4, and N0, M0, S0).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IS:</b></span> Cancer is of any T stage and has not spread to lymph nodes or distant sites. Serum markers remain above normal levels after the cancerous testicle has been removed (any T, N0, M0, and S1-3). Stage IS non-seminoma testicular cancer is treated the same as stage III testicular cancer.<br />
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<span style="color: #6aa84f;"><b>• Stage II:</b></span> The cancer has spread to any number of regional lymph nodes but not to lymph nodes in other parts of the body or distant organs. Serum markers are unavailable (any T, N1-3, M0, SX).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IIA: </b></span>Cancer has spread to retroperitoneal lymph nodes, either clinical or pathological stage N1, but none is larger than 2 cm and, if a lymph node dissection has been done, no more than five lymph nodes contain cancer. In addition, serum tumor markers are at normal levels or slightly high, and there are no signs of cancer having spread anywhere other than the retroperitoneum (any T, N1, M0, S0 or S1).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IIB:</b></span> Cancer has spread to lymph nodes in the retroperitoneum, at least one of which is bigger than 2 cm but not bigger than 5 cm; or, if a lymph node dissection has been done, cancer has spread to at least one lymph node (or lymph node mass) between 2 cm and 5 cm or to more than five lymph nodes, none more than 5 cm. Serum markers are at normal levels or slightly high, and there is no evidence of cancer having spread anywhere other than the retroperitoneum (any T, N2, M0, S0 or S1).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IIC:</b></span> Cancer has spread to at least one lymph node (or lymph node mass) that is larger than 5 cm. Serum markers are at normal levels or slightly high and there is no evidence of cancer having spread anywhere other than the retroperitoneum (any T, N3, M0, S0 or S1).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage III:</b></span> Cancer has spread to distant lymph nodes or to any organ, and serum tumor marker levels are unknown (any T, N0-3, M1, SX).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IIIA:</b></span> Cancer has spread to distant lymph nodes or the lungs. Serum markers are at normal levels or slightly high (any T, N0-3, M1a, S0 or S1).<br />
<br />
<span style="color: #6aa84f;"><b>• Stage IIIB:</b></span> Cancer has spread to any lymph nodes and/or the lungs but not to any other organs. Serum markers are at substantially and persistently high levels (any T, N1-3, M0, S2; or any T, N0-3, M1a, S2).<br />
<br />
<b><span style="color: #6aa84f;">• Stage IIIC:</span></b> Either or both of the following:<br />
<ul>
<li>Serum marker levels are highly high, and the cancer has spread to at least one lymph node or organ (any T, N1-3, M0, S3; or any T, N0-3, M1a, S3).</li>
<li>The cancer has spread to an organ other than the lungs (any T, any N, M1b, any S).</li>
</ul>
<hr />
<br />
<span style="color: #6aa84f;"><b>Recurrent:</b></span> Recurrent cancer means that the cancer has come back (recurred) after treatment. Testicular cancer can recur in the testicle (if it was not removed during surgery) or in another part of the body. If there is a recurrence, <u>the testicular cancer may need to be staged</u> again (called re-staging).</div>
</div>

Stages of Testicular Cancer

How is testicular cancer staged? Staging is a way of describing where a cancer has spread. Doctors use diagnostic tests, including CT ...

Signs and Symptoms of Testicular Cancer

ancorez Testis Cancer 7:11 PM

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<h2>
Signs and Symptoms of Testicular Cancer</h2>
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Men with testicular cancer may experience a variety of <b>symptoms or signs</b>. Sometimes, men with testicular cancer do not show any of these symptoms. In addition, these symptoms can be caused by another condition that is not cancer.<br />
<br />
<b>The first sign of testicular cancer</b> is often enlargement of the testicle or a small lump or area of hardness on the testicle, but an increase in size or a lump may also be caused by the following noncancerous conditions:<br />
<ul style="text-align: left;">
<li>A cyst called a spermatocele that develops in the epididymis. The epididymis is a small organ attached to the testicle that is made up of coiled tubes that carry sperm away from the testicle.</li>
<li>An enlargement of the blood vessels from the testicle called a varicocele.</li>
<li>A buildup of fluid in the membrane around the testicle called a hydrocele.</li>
<li>An opening in the abdominal muscle called a hernia.</li>
</ul>
Other symptoms of testicular cancer may go unnoticed until the cancer has spread to other parts of the body. Monthly testicular self-examinations, performed after a warm shower, can help detect the cancer at an early stage, when it is more likely to be successfully treated.<br />
<br />
<i>Symptoms of testicular cancer</i> may include:<br />
<ul style="text-align: left;">
<li>Breast tenderness or growth. Although rare, some testicular tumors produce hormones that cause breast tenderness or growth of breast tissue, a condition called gynecomastia.</li>
<li>Change in the way a testicle feels or a feeling of heaviness in the scrotum. For example, one testicle may become more firm than the other testicle. Or, testicular cancer may cause the testicle to grow bigger or to become smaller.</li>
<li>Dull ache in the lower abdomen or groin</li>
<li>Lower back pain, shortness of breath, chest pain, and bloody sputum or phlegm can be symptoms of later-stage testicular cancer, but many other diseases can also cause these symptoms.</li>
<li>Pain or discomfort, with or without swelling, in a testicle or the scrotum. Pain can be caused by many different conditions, including an infection, injury, twisting, and cancer. Infection of the testicle is called orchitis. Infection of the epididymis is called epididymitis. If infection is suspected, a patient may be given a prescription for antibiotics. If antibiotics do not solve the problem, tests for testicular cancer are often needed.</li>
<li>Painless lump or swelling on either testicle. Most often, the first symptom of testicular cancer is a lump on the testicle, or the testicle becomes swollen or larger. (It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other.) Some testicular tumors might cause pain, but most of the time they do not. Men with testicular cancer can also have a feeling of heaviness or aching in the lower abdomen or scrotum. </li>
<li>Sudden buildup of fluid in the scrotum</li>
<li>Swelling of one or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. A blood clot in a large vein is called deep venous thrombosis or DVT. A blood clot in an artery in the lung is called a pulmonary embolism and causes shortness of breath. For some young or middle-aged men, developing a blood clot may be the first sign of testicular cancer.</li>
</ul>
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<h3 style="text-align: left;">
<span style="color: #6aa84f;">Symptoms of advanced testicular cancers</span></h3>
Even if testicular cancer has spread to other parts of the body, many men might not have symptoms right away. Lower back pain can be a sign that the cancer has spread to the lymph nodes in the abdomen. Cancer that has spread to the lungs can cause trouble breathing (shortness of breath), chest pain, or a cough (sometimes with blood). Some cancers might cause abdominal pain, either from enlarged lymph nodes or metastasis (spread) to the liver. In rare cases, testicular cancer spreads to the brain and can cause headaches.<br />
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Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes imaging tests done to find the cause of infertility can uncover a small testicular cancer. A number of non-cancerous conditions, such as testicle injury or inflammation, can cause symptoms similar to those of testicular cancer. Inflammation of the testicle (known as orchitis) and inflammation of the epididymis (epididymitis) can cause swelling and pain of the testicle. Both of these also can be caused by viral or bacterial infections.<br />
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<h3 style="text-align: left;">
<span style="color: #6aa84f;">Early signs of puberty in boys</span></h3>
Some Leydig cell tumors can make androgens (male sex hormones). Androgen-producing tumors may not cause any specific symptoms in men, but in boys they can cause signs of puberty at an abnormally early age, such as a deepening of the voice and the growth of facial and body hair.<br />
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<h3 style="text-align: left;">
<span style="color: #6aa84f;">Finding testicular cancer early</span></h3>
Most often, testicular cancer can be detected at an early stage, and men often find the cancer themselves while performing self-examinations. Some doctors recommend that men ages 15 to 55 perform a monthly self-examination to identify any changes. However, some testicular cancers may not cause symptoms and may go undetected until they have spread to other parts of the body. Men who notice a lump, hardness, enlargement, pain, or any other change in one or both of their testicles should visit their doctor immediately.<br />
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If you are concerned about one or more of the symptoms or signs on the list above, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a <a href="http://cancer-666.blogspot.com/2014/05/testicular-cancer-test-and-diagnosis.html" target="_blank">diagnosis</a>.<br />
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If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, <u>including any new symptoms or a change in symptoms</u>.</div>
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Signs and Symptoms of Testicular Cancer

Signs and Symptoms of Testicular Cancer Men with testicular cancer may experience a variety of symptoms or signs . Sometimes, men with...

Testicular Cancer Test and Diagnosis

ancorez Testis Cancer 6:46 PM

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<b>How is testicular cancer diagnosed?</b><br />
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Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam. Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective.<br />
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When a man develops a testicular lump or something else that could be testicular cancer, it is important that he see his primary doctor, who may send him to a urologist. A urologist is a doctor who specializes in treating testicular cancer. A physical examination and an ultrasound of the testicles are usually the first tests performed. If these tests show an abnormality that appears to be a tumor, then blood tests are done. The testicle may need to be surgically removed to look for signs of cancer. Imaging tests, such as computed tomography (CT or CAT) scans and x-rays, may also be used to find out whether the cancer has spread.<br />
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This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:<br />
<ul style="text-align: left;">
<li>Age and medical condition</li>
<li>Previous test results</li>
<li>Signs and symptoms</li>
<li>Type of cancer suspected</li>
</ul>
If the doctor suspects testicular cancer, he or she will ask about a man's medical history and general health. The following tests may be used to <i>diagnose testicular cancer</i>:<br />
<h3 style="text-align: justfy;">
<span style="color: #6aa84f;">Biopsy</span></h3>
A biopsy is the removal of a small amount of tissue for examination under a microscope. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer, but a biopsy of a testicle is almost never used to diagnose testicular cancer. Instead, if cancer is suspected in a testicle, the standard procedure is to surgically remove the entire testicle in a procedure called an orchiectomy. In fact, a biopsy of the testicle using a needle through the skin of the scrotum should NOT be performed because this can complicate future treatment options. Occasionally, a biopsy may be taken from the lung, retroperitoneum, or other location in the body if it appears that cancer may have spread.<br />
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<h3 style="text-align: justfy;">
<span style="color: #6aa84f;">Blood tests for tumor markers</span></h3>
The levels of serum tumor markers are measured before surgery to remove a testicle. Tumor markers are substances made by a cancer that are found at abnormally high levels in the blood of some people with cancer. For testicular cancer, serum tumor marker levels are used to find out the cancer’s stage and confirm whether a tumor is a pure seminoma. Different types of cancer make different tumor markers. High levels of any one of three tumor markers may indicate testicular cancer. However, it is also possible to have this type of cancer and have normal tumor marker levels.<br />
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The following tumor markers are used to help stage and plan treatment for testicular cancer:<br />
<ul style="text-align: left;">
<li><b>Alpha-fetoprotein (AFP)</b> is not made by seminomas, so an elevated level of AFP indicates the tumor is not a pure seminoma, even if it looks like a pure seminoma when examined by a pathologist. However, AFP levels are normal for many men with non-seminomas.</li>
<li><b>Beta human chorionic gonadotropin (beta-hCG)</b> can be high from either seminoma or non-seminoma. However, beta-hCG is normal for many men with non-seminomas or seminomas.</li>
<li><b>Lactate dehydrogenase (LDH)</b> can be elevated in any type of testicular cancer, as well as in many other cancers and non-cancerous diseases, such as liver disease or heart disease.</li>
<li><b>Placental alkaline phosphatase (PLAP)</b> is another tumor marker doctors may test for, although it is not commonly measured.</li>
</ul>
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<span style="color: #6aa84f;">Imaging tests</span></h3>
If cancer is found, other tests will be needed to determine the stage of the cancer and whether it has spread to other parts of the body. Usually, doctors recommend imaging tests of the abdomen, pelvis and chest. Images of the brain or bones are not as common, but images of the brain may be need for patients who have choriocarcinoma. Imaging tests may include:<br />
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<b>• Bone scan</b><br />
A bone scan can help show if a cancer has spread to the bones. It might be done if there is reason to think the cancer might have spread to the bones (because of symptoms such as bone pain) and other test results aren’t clear. For this test, a small amount of low-level radioactive material is injected into a vein (IV). The substance settles in areas of bone changes throughout the entire skeleton over the course of a couple of hours. You then lie on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of your skeleton.<br />
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Areas of active bone changes attract the radioactivity and show up as “hot spots.” These areas may suggest metastatic cancer, but arthritis or other bone diseases can also cause the same pattern. To distinguish among these conditions, your cancer care team may use other imaging tests such as plain x-rays or MRI scans to get a better look at the areas that light up, or they may even take biopsy samples of the bone.<br />
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<b>• Chest x-ray</b><br />
A plain x-ray of your chest can be done to see if the cancer has spread to your lungs or the lymph nodes in the middle area of the chest known as the mediastinum. If the x-ray is normal, you probably don’t have cancer in your lungs. But most doctors feel a computed tomography (CT) scan can better judge whether the cancer has spread to the chest.<br />
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<b>• Computed tomography (CT) scan</b><br />
CT scans can be used to help determine the stage (extent) of the cancer by showing if it has spread to the lymph nodes, lungs, liver, or other organs. The CT scan uses x-rays to produce detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures of the part of your body being studied as it rotates around you. A computer then combines these pictures into an image of a slice of your body. Before the test, you might be asked to drink a contrast solution and/or get an intravenous (IV) injection of a contrast dye that helps better outline structures in the body. You may need an IV line to inject the contrast dye. The injection can cause some flushing (redness and warm feeling that may last hours to days). Some people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medicine can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have any allergies or if you have ever reacted to any contrast material used for x-rays.<br />
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A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. You need to lie still on the table while the scan is being done. CT scans take longer that regular x-rays, and you might feel a bit confined by the ring you have to lie in while the pictures are being taken.<br />
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<i>CT guided needle biopsy:</i> CT scans are sometimes used to guide a biopsy needle precisely into a suspected area of cancer spread. For this procedure, you stay on the CT scanning table while a doctor advances a biopsy needle through the skin toward the mass. CT scans are repeated until the doctor can see that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue) is then removed and examined under a microscope.<br />
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<b>• Magnetic resonance imaging (MRI) scan</b><br />
MRI scans are particularly helpful in looking at the brain and spinal cord. They are not usually done for testicular cancer unless your doctor has reason to think the cancer might have spread there. Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material might be injected just as with CT scans but is used less often. MRI scans take longer than CT scans – often up to an hour – and are a little more uncomfortable. You lie on a table that slides inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special, more open MRI machines can help with this if needed, but the images may not be as sharp in some cases. The MRI machine makes buzzing and clicking noises, so some places will provide earplugs to help block this out. <br />
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<b>• Positron emission tomography (PET) scan</b><br />
A PET scan can help spot small collections of cancer cells in the body. It is sometimes useful for looking at enlarged lymph nodes that remain after chemotherapy. A PET scan may help the doctor decide if they contain scar tissue or active tumor (in which case more treatment would be needed). PET scans are often more useful for seminomas than for non-seminomas, so they are less often used in patients with non-seminoma.<br />
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For this test, a form of radioactive sugar (known as fluorodeoxyglucose or FDG) is injected into a vein (IV). (The amount of radioactivity is very low and will pass out of the body over the next day or so.) Because cancer cells in the body grow rapidly, they absorb more of the radioactive sugar. After about an hour, you will be moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it can provide helpful information about your whole body. Many centers have special machines that can do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed appearance of that area on the CT.<br />
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<b>• Other imaging tests</b><br />
Other imaging tests may be done for a number of reasons after a testicular cancer diagnosis, including:<br />
<ul>
<li>To learn how far cancer might have spread</li>
<li>To help determine if treatment has been effective</li>
<li>To look for possible signs of cancer coming back after treatment </li>
</ul>
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<span style="color: #6aa84f;">Medical history and physical exam</span></h3>
If you have signs or symptoms that may suggest testicular cancer, your doctor will want to take a complete medical history to check for risk factors and to learn more about your symptoms. The doctor will feel the testicles for any sign of swelling, tenderness, or hardening. The doctor will also feel the abdomen, neck, upper chest, armpits and groin for evidence of enlarged lymph nodes, which may indicate that the cancer has spread. The breasts and nipples will also be examined to look for enlargement.<br />
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During a physical exam, the doctor will feel the testicles for swelling or tenderness and for the size and location of any lumps. The doctor will also examine your abdomen, lymph nodes, and other parts of your body carefully, looking for any possible signs of cancer spread. Often the results of the exam are normal aside from the testicles.<br />
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<span style="color: #6aa84f;">Surgery to diagnose testicular cancer</span></h3>
For most types of cancer, the diagnosis is made by removing a small piece of the tumor and looking at it under a microscope for cancer cells. This is known as a biopsy. But a biopsy is rarely done for a testicular lump because it might risk spreading the cancer and because the doctor can often get a good idea of whether it is cancer based on the ultrasound and blood tumor marker tests. Instead, if the doctor sees a solid tumor on ultrasound, he or she will very likely recommend surgery to remove it as soon as possible, especially if tumor marker levels are also elevated.<br />
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The surgeon will try to remove the entire tumor along with the testicle and spermatic cord. The spermatic cord contains part of the vas deferens, as well as blood and lymph vessels that could act as pathways for testicular cancer to spread to the rest of the body. To lessen the chance that cancer cells will spread, these vessels are tied off early in the operation. This is best done by operating through an incision (cut) just above the pubic area. This operation is called a radical inguinal orchiectomy.<br />
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The entire specimen is sent to the lab, where a pathologist (a doctor specializing in laboratory diagnosis of diseases) looks at pieces of the tumor under a microscope. If cancer cells are found, the pathologist sends back a report describing the type and extent of the cancer.<br />
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In rare cases, when a diagnosis of testicular cancer is uncertain, the doctor may biopsy the testicle before removing it. This is done in the operating room. The surgeon makes a cut above the pubic area, withdraws the testicle from the scrotum, and examines it without cutting the spermatic cord. If a suspicious area is seen, a portion of it is removed and looked at right away by the pathologist. If cancer is found, the testicle and spermatic cord are then removed. If the tissue is not cancerous, the testicle can often be returned to the scrotum, and treatment will be surgery to remove only the tumor or the use of appropriate medicines. If testicular cancer is found, your doctor will order imaging tests of other parts of your body to check for spread outside of the testicle.<br />
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<span style="color: #6aa84f;">Ultrasound of the testicles</span></h3>
An ultrasound is often the first test done if the doctor thinks you might have testicular cancer. This test uses sound waves to produce images of internal organs. A transducer (wand-like instrument) gives off sound waves and picks up the echoes as they bounce off the organs. A computer processes the pattern of echoes to create an image on a monitor.<br />
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This is an easy test to have and it uses no radiation, which is why it is often used to look at developing fetuses. You simply lie on your back on a table as the technician moves the transducer along the skin of the scrotum. Usually, the skin is first lubricated with gel.<br />
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The pattern of echoes can be used to distinguish certain benign conditions (like hydrocele or varicocele), from a solid tumor that could be a cancer. If the lump is solid, then it’s more likely to be a cancer, so the doctor will recommend further tests or even surgery to remove the testicle.<br />
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<u>Testicular Cancer Test and Diagnosis</u></div>
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Testicular Cancer Test and Diagnosis

How is testicular cancer diagnosed? Most men discover testicular cancer themselves, either unintentionally or while doing a testicular...

Definition and Description of Testis Cancer

ancorez Testis Cancer 4:27 AM

<div dir="ltr" style="text-align: left;" trbidi="on"><h1 style="text-align: justify;">Definition</h1><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3-px5Y5_wf1EijSzdOClw7K7wYaL2mFkD6MaNRkrlBFSyZerkomFG0svqgWKryhv3CO5F7DZdoR4pw3CkuVbGLIP5dWhBgYsN4h2OB06JX-PSle_Ks0fSkgeOvZ5DbkLSksYKibNIlh0/s1600/definition+and+description+of+Testis+Cancer.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="141" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3-px5Y5_wf1EijSzdOClw7K7wYaL2mFkD6MaNRkrlBFSyZerkomFG0svqgWKryhv3CO5F7DZdoR4pw3CkuVbGLIP5dWhBgYsN4h2OB06JX-PSle_Ks0fSkgeOvZ5DbkLSksYKibNIlh0/s200/definition+and+description+of+Testis+Cancer.jpeg" width="200" /></a></div><b>Testicular cancer</b> is a disease in which <a href="http://cancer-666.blogspot.com/">cancer</a> cells are discovered in one or both testicles. The testicles, also known as testes or gonads, are located in a pouch beneath the penis called the scrotum.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><i>Testicular cancer</i>, also known as cancer of the testes, occurs when germ cells (the cells that become sperm) experience abnormal growth. Germ cells, like stem cells, have the potential to form any cell in the body. Normally this ability is dormant until the sperm fertilizes an egg. When germ cells become cancerous, they multiply unchecked, forming a mass of cells called a tumor, and invade normal tissue.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Testicular cancer can metastasize, meaning that it can spread to other parts of the body. During metastasis cells leave the original tumor and migrate to other parts of the body through blood and lymph vessels, forming a new tumor. Testicular cancer metastasis most often involves the abdomen, lungs and brain. Testicular cancer can spread rapidly and is deadly if left untreated. </div><div style="text-align: justify;"><br />
</div><h2 style="text-align: justify;">Description</h2><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The testicles make up one portion of the male reproductive system. Normally, they are each somewhat smaller than a golf ball in size and are contained within the scrotum. The testicles are a man's primary source of male hormones, particularly testosterone. They also produce sperm.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">There are several types of cells contained in the testicles, and any of these may develop into one or more types of cancer. Over 90% of all testicular cancers begin in cells called germ cells. There are two main types of germ cell tumors in men: seminomas and nonseminomas. Seminomas make up about 40% of all testicular germ cell tumors. Nonseminomas make up a group of cancers, which include choriocarcinoma, yolk sac tumors, embryonal carcinoma, and teratoma.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Although <u>testicular cancer</u> accounts for less then 2% of all cancers in men, it is the most commonly seen cancer in young men aged 15 to 35. It is also one of the most curable.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The American Cancer Society estimates that approximately 8,980 new cases of testicular cancer will be diagnosed in American men in 2004. In addition, about 360 men will die of the disease during that year. Although the incidence of testicular cancer is rising, having doubled since 1975, it is still rare. Scandinavian countries have the highest rate in the world. Germany and New Zealand also have high rates. The lowest incidences of testicular cancer are in Asia and Africa.</div></div>

Definition and Description of Testis Cancer

Definition Testicular cancer is a disease in which cancer cells are discovered in one or both testicles. The testicles, also known as tes...

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