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Testicular Cancer

Testicular Cancer

What is testicular cancer?

Testicular carcinoma is a kind of cancer that affects the testicles.
When cancerous (malignant) cells form in the tissues of a testicle, it is known as testicular cancer. Cancerous cells may form in both testicles, although this is very uncommon. In males aged 20 to 35, testicular cancer is the most frequent malignancy. The condition is frequently treatable.

What forms of testicular cancer are there?


Seminoma and non-seminoma are the two main kinds of testicular cancer. Seminoma is a kind of cancer that develops from youthful germ cells, grows slowly, and is largely stationary. Seminomas account for between 30% and 40% of testicular malignancies. More developed germ cells give rise to non-seminoma. These tumors are usually more aggressive. Testicular malignancies that are a mix of seminoma and non-seminoma are also known.

Who is at risk for testicular cancer?


Men between the ages of 20 and 35 are most likely to get testicular cancer. Some men may be at a greater risk if they had a physical problem of the testicles when they were younger. Testicular cancer, on the other hand, is uncommon.

Is testicular cancer curable?


Testicular carcinoma is a very treatable disease. While a cancer diagnosis is always frightening, the good news is that testicular cancer is effectively treated in 95% of instances. The cure rate jumps to 98 percent if treated early. Although a man's likelihood of obtaining HIV is 1 in 263, he only has a 1 in 5,000 chance of dying from it.

What are the elements that increase your chances of getting testicular cancer?


Testicular cancer may be caused by a number of conditions, including:

 

  • Undescended testicle(s): When one or both testicles do not descend into the scrotum before birth, this is known as undescended testicle(s).
  • Non-Hispanic white males are more likely than men of other races and ethnicities to acquire this malignancy.
  • Personal or family history: Men who have had a brother or father who has had testicular cancer are more likely to get the disease themselves. Men who have had cancer in one of their testicles are more likely to acquire cancer in the other testicle.
  • Infertility: Men who are infertile are more likely to acquire testicular cancer. Some of the same variables that cause infertility may also contribute to the development of testicular cancer, however the link is not well understood.

 

What are the common symptoms of testicular cancer ?

 

The symptoms listed below might indicate testicular cancer or another illness. If you experience any of the following symptoms, see a doctor:

 

  • Swelling or an unexpected accumulation of fluid in the scrotum
  • Heavy sensation in the scrotum
  • Either testicle has a bump or swelling.
  • Fluid accumulation on the scrotum
  • A dull discomfort in the lower abdomen or groin
  • In the scrotum or a testicle, there is pain or discomfort.
  • A testicle that is shrinking

 

 

How can you know if you have testicular cancer?


A lump or other alteration in a man's testicle is generally the first sign of testicular cancer. When a testicular anomaly is detected, a doctor will generally prescribe an ultrasound, which is a painless medical examination that allows the doctor to examine whether the testicle has any abnormalities. If the ultrasound reveals cancer, the testicle is removed and inspected under a microscope to determine if cancer is present and, if so, what sort of cancer it is. After the testicle is removed and inspected, testicular cancer is detected. Biopsies are not conducted on testicles because entering the testicle might make it more difficult to treat cancer if it is identified.

What are the main diagnostic methods used for testicular cancer?

 

  • Ultrasound is a process that creates images of bodily tissues using high-energy sound waves.
  • A physical examination and a medical history: A doctor may use a physical exam and medical history to check for abnormalities that might be connected to testicular cancer.
  • A serum tumor marker test looks at a blood sample to see how much of particular chemicals associated to certain tumors are present. Tumor markers are the name for these compounds. The tumor markers alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG or beta-HCG), and lactate dehydrogenase are often increased in testicular cancer (LDH).
  • The whole testicle is removed via an incision in the groin during an inguinal orchiectomy and biopsy operation. A testicular tissue sample is then examined for cancer cells.
  • CT scans and X-rays: A CT scan is a medical procedure that involves the use of X-rays to create images of the interior of the body. When cancer is diagnosed or suspected, a CT scan (also known as a CAT scan) is used to detect whether cancer has spread to other parts of the body. A CT scan of the abdomen and pelvis is used to diagnose testicular cancer. A CT scan or a standard X-ray are used to get images of the chest.

What are the stages of testicular cancer ?

 

  • Stage 0: Abnormal cells have formed, but they are still contained inside the tubules where sperm cells begin to form.

 

  • Stage I: The stages IA, IB, and IS make up this stage.

    The malignancy is limited to the testicle and epididymis in Stage IA, and all tumor marker values are normal. The cancer has not progressed to the outer layer of the double membrane that surrounds the testicle or to the blood or lymph arteries.
    At least one of the following applies in Stage IB: Cancer has spread to the outer layer of the membrane surrounding the testicle; cancer has invaded the spermatic cord or the scrotum; and/or cancer has invaded the spermatic cord or the scrotum. All tumor marker values are normal in stage IB.
    The cancer may be found anywhere in the testicle, spermatic cord, or scrotum in Stage IS, and one or more tumor markers are high.

 

  • Stage II: This stage includes Stage IIA, Stage IIB, and Stage IIC, and refers to individuals whose cancer has progressed to the lymph nodes at the rear of the abdomen (the retroperitoneum), but not to other parts of the body. Patients with lymph node cancer who have moderately or severely increased tumor markers are classified as stage III rather than stage II.

    Cancer has progressed to a maximum of five lymph nodes in the abdomen in Stage IIA. There are no lymph nodes greater than 2 cm in diameter. The levels of tumor markers must be normal or just slightly increased.
    Cancer has expanded to more than 5 nodes, none of which are bigger than 5 centimeters in diameter, or cancer has spread to 5 or fewer nodes with a lymph node mass measuring between 2 and 5 centimeters in diameter. Normal or modestly increased tumor markers are required.
    Cancer has spread to at least one lymph node in the abdomen with a diameter of more than 5 cm in Stage IIC. The levels of tumor markers must be normal or just slightly increased.

 

  • Stage III: This stage is split into three parts: Stage IIIA, Stage IIIB, and Stage IIIC, and it is diagnosed following an inguinal orchiectomy (the removal of a testicle via a groin incision).

    Cancer has progressed to lymph nodes outside of the abdomen (such as lymph nodes in the chest) and/or the lungs in Stage IIIA. The levels of tumor markers must be normal or just slightly increased.
    Cancer has expanded to lymph nodes in the abdomen or elsewhere (such as lymph nodes in the chest) and/or the lungs in stage IIIB, with tumor markers that are moderately increased.
    Cancer has progressed to an organ other than the lungs (such as the liver, bones, or brain) or tumor markers are considerably raised, indicating that cancer has spread to at least one lymph node or organ in stage IIIC.

What are the different types of testicular cancer and how are they treated?


Almost all testicular malignancies begin in the germ cells of the testes (the cells that become sperm or eggs). Seminomas and non-seminomas are the two most common kinds of testicular germ cell cancers. Non-seminomas grow and spread more quickly than seminomas. Radiation sensitivity is higher in seminomas, while chemotherapy sensitivity is high in both types. It is treated as a non-seminoma if a testicular tumor contains both seminoma and non-seminoma cells.

The following are the three primary types of testicular cancer treatments:

 

  • Surgical therapy may involve the removal of the testicle (orchiectomy) as well as the removal of any related lymph nodes (lymph node dissection). Seminoma and non-seminoma testicular malignancies are usually treated by orchiectomy, whilst non-seminomas are treated with lymph node removal. In certain cases, surgery may be required to remove malignancies from the lungs or liver that have not vanished after chemotherapy.

 

  • High-dose X-rays are used in radiation therapy to eliminate cancer cells. Patients with seminomas may be treated with radiation following surgery to prevent the tumor from recurring. Radiation is usually reserved for the treatment of seminomas.

 

  • Chemotherapy is a treatment that kills cancer cells by using medications like cisplatin, bleomycin, and etoposide. Chemotherapy has increased the survival percentage of both seminomas and non-seminomas patients.

What are the benefits of Robotic surgery in treatment of testicular cancer ?

 

Treatment of testicular cancer has made significant progress in the past decades in terms of reduction of treatment-associated morbidity and preventing over-treatment. At the forefront of this progression is utilization of the da Vinci robot to perform retroperitoneal lymph node dissections (RPLNDs) via a minimally invasive approach. The robot offers multiple potential advantages such as smaller incisions, improved 3D visualization, more precise dissection, and faster convalescence, leading to its increased usage the past several years. Promising preliminary data has also renewed interest in defining the role of primary RPLND in patients with seminoma, potentially sparing patients of the harmful long-term radiation and cisplatin-based chemotherapy.

 

The first RA-RPLND was performed in 2006 . Robotic surgery offers several potential advantages compared to its laparoscopic counterpart, including high-definition 3D visualization, increased freedom of movement, and minimization of tremors. The advantages allow the surgeon to potentially reap the benefits of minimally invasive surgery while overcoming the technical challenges associated with laparoscopic surgery.

 

RA-RPLND was initially performed in the primary treatment setting for stage I and IIA NSGCT. The current reports of RA-RPLND have shown improved convalescence with good oncologic and surgical outcomes among the aforementioned patient population. In the largest series presented to date, 47 primary (chemotherapy naïve) RA-RPLNDs were performed across 6 institutions in the United States.  To date, an in-template recurrence has not been reported in any RA-RPLND series.

 

What is the treatment stages of testicular cancer?

 

In Stage I, the testicle is routinely removed by surgery. Observation, one or two doses of carboplatin chemotherapy (given 21 days apart if providing two doses), or radiation to the lymph nodes in the abdomen are the conventional treatments for stage I seminomas. Observation, chemotherapy with one round of bleomycin, etoposide, and cisplatin, or surgery to remove lymph nodes in the rear of the abdomen are all options for non-seminomas (the surgery is referred to as a retroperitoneal lymph node dissection).

Seminoma tumors are classified as bulky or non-bulky in Stage II. Bulky disease is described as tumors that are larger than 5 cm in diameter. Stage II seminomas are treated with surgery to remove the testicle, followed by either radiation to the lymph nodes or chemotherapy with bleomycin, etoposide, and cisplatin for nine weeks (three 21-day cycles) or etoposide and cisplatin for 12 weeks (four 21-day cycles) for non-bulky disease. In instances with bulky illness, surgery to remove the testicle is followed by chemotherapy with bleomycin, etoposide, and cisplatin for nine weeks (three 21-day cycles) or etoposide and cisplatin without bleomycin for 12 weeks (four 21-day cycles).

Stage II - non-seminomas are categorized into bulky and non-bulky illnesses in the same way, although the cutoff is lower at 2 centimeters. For non-bulky disease with normal AFP and BHCG blood test results, surgery to remove the testicle is usually followed by either retroperitoneal lymph node dissection to remove lymph nodes in the back of the abdomen (the retroperitoneum) or chemotherapy with bleomycin, etoposide, and cisplatin for nine weeks (three 21-day cycles) or chemotherapy with etoposide and cisplatin for 12 weeks (four 21-day cycles). If cancer is discovered in the lymph nodes excised during a lymph node dissection, six weeks of treatment with cisplatin and etoposide (with or without bleomycin) is generally suggested. Surgery to remove the testicle is undertaken for bulky disease (more than 2cm) and also for non-bulky disease if blood tests reveal unusually high levels of AFP or BHCG (the same chemotherapy as defined above for seminoma). If there are any lingering swollen lymph nodes in the rear of the abdomen after chemotherapy, surgery should be undertaken to remove them.

Surgery to remove the testicle, followed by multi-drug chemotherapy, is the treatment for Stage III. Stage III seminomas and non-seminomas get the same treatment, with the exception that non-seminomas may need surgery following chemotherapy to remove any remaining tumors. Remaining tumors in seminomas normally do not need further therapy. For patients with favorable risk factors, chemotherapy normally consists of nine weeks of bleomycin, etoposide, and cisplatin, or 12 weeks of etoposide plus cisplatin, and 12 weeks of bleomycin, etoposide, and cisplatin for patients with unfavorable risk factors. High levels of tumor markers in the blood and tumors in organs other than the lungs, such as the liver, bones, or brain, are unfavorable risk factors.

If the cancer is a recurrence of a prior testicular cancer, chemotherapy with a combination of drugs such as ifosfamide, cisplatin, etoposide, vinblastine, or paclitaxel is frequently used. Autologous bone marrow or peripheral stem-cell transplantation is occasionally used after this therapy. Recurrences that arise more than two years after initial treatment are often treated with surgery and chemotherapy.

How can I do a testicular self-examination to prevent testicular cancer?


Although testicular cancer cannot be prevented, early identification is critical. Once a month, men should do a testicular self-examination (TSE). Notify your doctor immediately away if you observe any changes in your testicles, such as lumps or nodules, hardness, chronic discomfort, or a testicle that is becoming larger or smaller. Follow these procedures to conduct a self-examination.

After a warm shower or bath, take the test. The warmth relaxes the scrotum's skin, making it simpler to detect any strange sensations.
Examine each testicle with both hands. Underneath the testicle, place your index and middle fingers, and on top, place your thumbs. Between your thumbs and fingers, roll the testicle. (It's natural for testicles to vary in size.)
You may observe a cord-like structure on top and at the rear of the testicle when you feel it. The epididymis is the name for this structure. It is used to store and transport sperm. It is not to be confused with a lump.
Any lumps should be felt for. Lumps may range in size from peas to golf balls and are usually painless. If you find a lump, make an appointment with your doctor.
The left and right testicles should be the same size, despite the fact that they are often different sizes. If you detect a change in the size of your testicles, make an appointment with your doctor.