Testicular Cancer
Screening
and diagnosis
Most
men discover testicular cancer themselves, either unintentionally
or while doing a testicular self-examination to check for
lumps.
If
you bring signs and symptoms of testicular cancer to your
doctor's attention, or your doctor discovers a lump during
a routine office visit, your doctor will likely do a physical
exam and order lab tests to see if an infection or something
else is the cause. You may also undergo an ultrasound examination.
This painless test passes sound waves through your scrotum
to make an image of your testicles.
The
testicles contain several types of cells, and each may develop
into several types of cancer. Each type grows and spreads
differently. Treatment and prognosis also vary according
to type.
Classifying
the cancer
Doctors classify testicular cancer as one of two types:
* Seminoma. This type of testicular cancer usually occurs
in men between their late 30s and early 50s. If it's discovered
and treated early, nearly all men recover from this type
of cancer.
* Nonseminoma. This group of cancers includes choriocarcinoma,
embryonal carcinoma, teratoma and yolk sac tumors. These
types of testicular cancer tend to develop earlier in life
than seminomas, usually occurring in men between their late
teens and early 40s.
If
you have a testicular lump and an ultrasound examination
doesn't rule out cancer, a biopsy must be performed to determine
the presence of cancer. A testicular biopsy should be done
through a small incision in the groin (inguinal incision).
A biopsy taken from the scrotum with a needle may spread
the cancer to a new area.
Once
tissue has been obtained, a pathologist can check the tissue
taken from the affected testicle to see if cancer cells
are present. If the lump is noncancerous, there's usually
no need to remove the testicle. If the lump is a cancerous
(malignant) tumor, the entire testicle should be removed.
The pathologist will then determine what type or types of
cancer cells are present in the testicle.
After
the type of cancer has been established, you'll need blood
tests, X-rays, computerized tomography (CT) or magnetic
resonance imaging (MRI) scans, and other tests to determine
if the cancer has spread to other parts of your body.
Staging
the cancer
With these test results, your doctor classifies the cancer
according to its stage. These include:
* Stage I. Testicular cancer is confined to the testicle.
* Stage II. Testicular cancer has spread to the lymph nodes
in the abdomen.
* Stage III. Testicular cancer has spread beyond the lymph
nodes to other regions of your body, such as your lungs
or liver.
If
cancer is confirmed, your surgeon will remove the entire
affected testicle through a surgical incision in your groin.
Treatment
Generally,
doctors use four kinds of treatments for testicular cancer.
They are:
* Radical inguinal orchiectomy. This surgical procedure
involves removing one or both testicles through a cut in
the groin. Lymph nodes in the abdomen also may be removed
(lymph node dissection). If just one cancerous testicle
is removed, there's a small chance that the other will become
cancerous at some point. As a result, your doctor will likely
recommend regular follow-up exams with a urologist.
* External beam radiation therapy. This treatment uses high-dose
X-rays or other high-energy radiation to kill cancer cells.
Seminomas are highly sensitive to radiation therapy, but
nonseminomas are not.
* Chemotherapy. Chemotherapy is used to kill cancer cells
outside the testicle. This drug therapy is usually given
by infusions into your veins (intravenous), typically done
on an outpatient basis.
* Bone marrow transplant. In this procedure, bone marrow
is taken from you, treated with drugs to kill any cancer
cells and then frozen. You then undergo chemotherapy, with
or without radiation, to destroy the remaining cancer cells
in your body. The chemotherapy also destroys your remaining
bone marrow. The frozen marrow is then thawed and injected
back into you through a needle in a vein. This relatively
new treatment for testicular cancer has shown some promising
initial results. Yet doctors don't routinely recommend it
because traditional chemotherapy treatments are typically
very successful. Bone marrow transplant is used only in
rare cases of the disease.
Surgery
may be in combination with radiation therapy or chemotherapy
or both. It depends on the type and the stage of your cancer.
Your age and overall health also are factors in choosing
treatment options.
Post-treatment
implications
You may wonder how treatment for testicular cancer will
affect your appearance and sex life. Keep the following
in mind:
* Artificial implants. After the surgical removal of a testicle,
you can have an artificial testicle (prosthesis) placed
inside your scrotum. The artificial implant has the weight
and feel of a normal testicle.
* Surgery and your sex life. The surgical removal of lymph
nodes won't affect your ability to achieve an erection or
an orgasm. However, this surgery may cause sterility by
interfering with ejaculation. Some men recover the ability
to ejaculate without treatment; medication may help others.
If you undergo surgery, ask about special techniques that
may protect your ability to ejaculate.
* Radiation therapy and your sex life. Radiation therapy
probably won't change your ability to have sex. However,
radiation does interfere with sperm production. The effect
is usually temporary, and most men regain their fertility
within a few months. As a precaution, many men store sperm
at a special facility (sperm bank) before treatment, where
it can be preserved for later use.
* Chemotherapy and your sex life. Chemotherapy doesn't have
to interfere with a normal sex life. The fatigue caused
by chemotherapy, however, may decrease your interest in
sexual activity during the months of treatment. Some anti-cancer
drugs affect sperm production. Although the effect can be
permanent, many men regain their fertility later. Men concerned
about their fertility can have their sperm frozen and preserved
(cryopreserved) before beginning chemotherapy.
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The information on this page has been extracted from http://www.mayoclinic.com/health/testicular-cancer/DS00046/DSECTION=5
