Testicular Cancer

Definition

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

Testicular cancer does not always produce symptoms. A mass or lump in the testicle is usually the first sign of the disease. The mass may or may not be painful. Other symptoms include testicular swelling, hardness, and a feeling of heaviness or aching in the scrotum or lower abdomen.

Symptoms

Some types of testicular cancer (e.g., choriocarcinoma, Leydig cell tumors, Sertoli cell tumors) produce high levels of hormones (e.g., human chorionic gonadotropin [HCG], estrogen, testosterone). Increased levels of HCG may cause breast tenderness and abnormal growth of breast tissue (gynecomastia). Increased levels of estrogen may cause a loss of sexual desire (libido) and increased levels of testosterone may cause premature growth of facial and body hair in boys.

Testicular cancer that has spread to other organs (metastasized) may cause low back pain, shortness of breath, chest pain, and cough.

Causes

The cause of testicular cancer is unknown. One theory suggests that testicular germ cell tumors form when germ cells develop into sperm cells with 46 chromosomes. Normally, germ cells with 46 chromosomes develop into sperm cells with 23 chromosomes (during a process called meiosis).

Treatment

Treatment for testicular cancer depends on the stage of the disease. Surgery to remove the testicle is sometimes combined with radiation and/or chemotherapy. Some patients choose to store frozen sperm in a sperm bank before treatment to ensure fertility.

Surgery

Radical inguinal orchiectomy is the surgical removal of the testicle and the spermatic cord through an incision in the groin. Surgery is performed under general or regional anesthesia and requires an overnight stay in the hospital.

If CT scanning indicates that testicular cancer has metastasized (spread) to the lymph nodes, retroperitoneal lymph node dissection is often performed. All of the lymph nodes connected to the affected testicle are removed in this procedure. Such dissection is usually done at a later date.

Retroperitoneal lymph node dissection is performed under general anesthesia, requires a large incision, and usually takes 4 to 6 hours. Lymph node dissection is done on an inpatient basis in a hospital

Complications associated with surgery include thse following:

  • Adverse reaction to anesthesia
  • Bowel obstruction and inactivity
  • Damage to surrounding organs, blood vessels, and nerves
  • Infection
  • Infertility (caused by nerve damage that results in retrograde ejaculation)
  • Lymphocele

Following surgery, patients are usually encouraged to get up as soon as possible. Pain at the incision site and numbness in the area surrounding the incision are common and pain relievers are often prescribed. Driving and heavy lifting should be avoided for a several weeks.

Radiation

Radiation uses high energy x-rays to destroy cancer cells. In testicular seminoma, external beam radiation is primarily used after orchiectomy to destroy cancer cells that have spread (metastasized) to lymph nodes. Testicular seminoma typically requires a lower dose of radiation than other types of cancer. During treatment, a shield is placed over the remaining testicle to preserve fertility.

Side effects of radiation include the following:

  • Diarrhea
  • Fatigue
  • Nausea
  • Skin irritation that resembles sunburn

Chemotherapy

Chemotherapy is a systemic (i.e., circulates throughout the body via the bloodstream) cancer treatment that uses toxic drugs to destroy cancer cells. In testicular cancer cases, it is used to destroy cancer cells that remain after surgery. Chemotherapy may be administered intravenously (IV), taken in pill form or injected into muscle.

Drugs used alone or in combination to treat testicular cancer include the following:

  • Cisplatin (Platinol®)
  • Vinblastine (Velban®)
  • Bleomycin (Blenoxane®)
  • Cyclophosphamide (Neosar®)
  • Etoposide (Etopophos®)
  • Ifosfamide (Ifex®)

Side effects of chemotherapy are often severe and include gastrointestinal disturbances, low blood count, skin disorders, and neurological disorders.

From: Urology Channel