Testicular cancer: Difference between revisions

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The nature of any palpated lump in the [[scrotum]] is evaluated by scrotal [[ultrasound]], which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by [[CT scan]]s, which are used to locate [[metastasis|metastases]].  Blood tests are also used to identify and measure [[tumor marker]]s that are specific to testicular cancer. The diagnosis is made by performing an orchiectomy, surgical excision of the entire [[testis]] along with attached structures [[epididymis]] and [[spermatic cord]]; the resected specimen is evaluated by a [[pathologist]]. A [[biopsy]] should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum.  A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.
The nature of any palpated lump in the [[scrotum]] is evaluated by scrotal [[ultrasound]], which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by [[CT scan]]s, which are used to locate [[metastasis|metastases]].  Blood tests are also used to identify and measure [[tumor marker]]s that are specific to testicular cancer. The diagnosis is made by performing an orchiectomy, surgical excision of the entire [[testis]] along with attached structures [[epididymis]] and [[spermatic cord]]; the resected specimen is evaluated by a [[pathologist]]. A [[biopsy]] should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum.  A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.
==Treatment==
The three basic types of treatment are [[surgery]], [[radiation therapy]], and [[chemotherapy]].
Surgery is performed by [[urologist]]s; radiation therapy is administered by [[radiation oncologist]]s; and chemotherapy is the work of medical [[oncologist]]s.
===Radiation therapy===
[[Radiation]] may be used to treat stage II seminoma cancers, or as [[adjuvant]] (preventative) therapy in the case of stage I seminomas, to minimize the likelihood that tiny, non-detectable tumors exist and will spread (in the inguinal and para-aortic [[lymph nodes]]).  Radiation is never used as a primary therapy for [[nonseminoma]] because a much higher dose is required and chemotherapy is far more effective in that setting.
===Chemotherapy===
As an [[adjuvant]] treatment, use of [[chemotherapy]] as an alternative to radiation therapy is increasing, because radiation therapy appears to have more significant long-term side effects (for example, internal scarring, increased risks of secondary malignancies, etc.).  Two doses of [[carboplatin]], typically delivered three weeks apart, is proving to be a successful [[adjuvant]] treatment, with recurrence rates in the same ranges as those of [[radiotherapy]].
Chemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage II or III).  The standard [[chemotherapy protocol]] is three to four rounds of [[Bleomycin]]-[[Etoposide]]-[[Cisplatin]] (BEP). This treatment was developed by Dr. [[Lawrence Einhorn]] at Indiana University. An alternative, equally effective treatment involves the use of four cycles of [[Etoposide]]-[[Cisplatin]] (EP).
While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage I cancers cases (if monitored properly) have essentially a 100% survival rate (which is why prompt action, when testicular cancer is a possibility, is extremely important).


==Actions after treatment==
==Actions after treatment==

Revision as of 17:18, 18 January 2012

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Testicular cancer
OMIM 273300
DiseasesDB 12966
MeSH C04.588.322.762

Testicular cancer Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S. Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

Historical Perspective

Pathophysiology

Epidemiology & Demographics

Risk Factors

Screening

Causes

Differentiating Testicular cancer

Complications & Prognosis

Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies

Symptoms and early detection

The nature of any palpated lump in the scrotum is evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by CT scans, which are used to locate metastases. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. The diagnosis is made by performing an orchiectomy, surgical excision of the entire testis along with attached structures epididymis and spermatic cord; the resected specimen is evaluated by a pathologist. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum. A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.

Actions after treatment

Surveillance

For stage I cancers that have not had any adjuvant (preventive) therapy, close monitoring for at least a year is important, and should include blood tests (in cases of nonseminomas) and CT-scans (in all cases), to ascertain whether the cancer has metastasized (spread to other parts of the body). For other stages, and for those cases in which radiation therapy or chemotherapy was administered, the extent of monitoring (tests) will vary on the basis of the circumstances, but normally should be done for five years (with decreasing intensity).

Fertility

A man with one remaining testis can lead a normal life, because the remaining testis takes up the burden of testosterone production and will generally have adequate fertility.[3] However, it is worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm banking may be appropriate for younger men who still plan to have children, since fertility may be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy and/or radiotherapy is done.

Less than five percent of those who have testicular cancer will have it again in the remaining testis. A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and will be infertile, but can lead an otherwise normal life.

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