What Is Testicular Cancer, Types, Symptoms, Causes, Diagnosis, Stages of Testicular Cancer, Tests, Treatment
Testicular cancer is a type of cancer that develops in the testicles, which are part of the male reproductive system. The testicles, also known as testes, are two small, oval-shaped glands located in the scrotum, the pouch of skin below the penis. These glands produce sperm and testosterone, the male sex hormone. Testicular cancer is relatively rare compared to other types of cancer, but it is the most common cancer in males aged 15 to 35.
The two main types of testicular cancer are seminomas and non-seminomas. These types are based on the specific cells where the cancer originates within the testicles. The treatment and prognosis for each type may vary, so proper diagnosis is crucial. Here are the primary types:
Classic Seminoma: This is the most common type of seminoma. It tends to grow more slowly than non-seminomas and is generally more responsive to radiation therapy.
Spermatocytic Seminoma: This is a rare type of seminoma that typically occurs in older men. It tends to have a better prognosis than classic seminomas.
Embryonal Carcinoma: This type is aggressive and may grow and spread more quickly than seminomas. It often contains elements that resemble early forms of developing tissues.
Yolk Sac Tumor: This type is most commonly found in infants and young children. It is rare in adults. It is usually treated successfully with surgery and chemotherapy.
Choriocarcinoma: This is a very rare and highly aggressive type of testicular cancer. It can spread rapidly to other parts of the body, such as the lungs and brain. Choriocarcinoma is often treated with chemotherapy.
Teratoma: Teratomas are tumors that contain several types of tissue, such as hair, muscle, and bone. They can be further classified as mature teratomas (benign) or immature teratomas (potentially cancerous).
Mixed Germ Cell Tumors: These tumors contain a combination of different cell types, such as a mix of seminoma and non-seminoma elements.
Common signs and symptoms of testicular cancer may include:
Lump or swelling: A painless lump or swelling in either testicle is often the first noticeable symptom.
Pain or discomfort: Some men may experience pain, discomfort, or aching in the testicle or the scrotum.
Changes in size or shape: Any changes in the size or shape of the testicles should be evaluated.
Heaviness in the scrotum: Some men may feel a sensation of heaviness or aching in the lower abdomen or scrotum.
Pain or discomfort in the lower abdomen or back: In some cases, the cancer may cause pain or discomfort in the lower abdomen or back.
The exact cause of testicular cancer is not well understood, but several risk factors have been identified. Testicular cancer occurs when normal, healthy cells in the testicles undergo genetic mutations that lead them to grow uncontrollably and form a tumor. Here are some recognized risk factors:
Clinical Examination: A doctor will often begin with a physical examination of the testicles to check for any abnormalities such as lumps, swelling, or changes in size.
Ultrasound: An ultrasound of the scrotum is commonly used to create images of the testicles. This imaging technique helps determine the presence and characteristics of any masses within the testicles.
Blood Tests: Blood tests, including tumor marker tests such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH), may be performed. Elevated levels of these markers can sometimes indicate the presence of testicular cancer.
Biopsy: While testicular cancer is often diagnosed based on imaging and blood tests, a biopsy (removal of a small tissue sample) may be performed in certain cases to confirm the diagnosis.
Imaging Studies: CT scans, MRI, or chest X-rays may be ordered to determine the extent of the cancer and whether it has spread to other parts of the body.
Testicular cancer typically progresses in several stages, which are determined by the extent to which the cancer has spread. The most commonly used staging system for testicular cancer is the TNM system, which stands for Tumor, Nodes, and Metastasis. Another staging system is the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Both systems help doctors determine the appropriate treatment and prognosis for individuals with testicular cancer.
Here is a general overview of the stages of testicular cancer:
The cancer cells are found only in the top layers of cells lining the testicle.
Often referred to as carcinoma in situ (CIS) or intratubular germ cell neoplasia.
The cancer is confined to the testicle.
Subdivided into Stage IA and Stage IB:
Stage IA: The tumor is limited to the testicle and its size is less than 3 centimeters.
Stage IB: The tumor is limited to the testicle, but its size is larger than 3 centimeters.
The cancer has spread to nearby lymph nodes, typically in the abdomen or pelvis.
Subdivided into Stage IIA, Stage IIB, and Stage IIC based on the extent of lymph node involvement.
The cancer has spread beyond the testicle and nearby lymph nodes to other parts of the body, such as the lungs, liver, or other distant lymph nodes.
Subdivided into Stage IIIA, Stage IIIB, and Stage IIIC based on the locations and sizes of metastases.
Testicular cancer is typically diagnosed through a combination of medical history evaluation, physical examination, imaging studies, and laboratory tests. Some of the common tests used for the diagnosis and evaluation of testicular cancer:
Your doctor will perform a thorough physical examination of the testicles to check for any abnormalities, such as lumps or swelling.
Ultrasound imaging is often used to create images of the testicles. It can help determine the nature of any lumps or masses, distinguishing between solid and fluid-filled structures.
Tumor markers, specifically alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH), are commonly measured. Elevated levels of these markers can indicate the presence of testicular cancer or other conditions.
In some cases, a biopsy may be performed to confirm the diagnosis. However, testicular cancer is often diagnosed based on imaging studies and blood tests without the need for a biopsy.
A chest X-ray may be done to check for the presence of metastasis (spread) to the lungs.
CT scans may be used to visualize the abdomen and pelvis to identify any lymph node involvement or spread of the cancer to other organs.
MRI may be employed to provide detailed images of the testicles and surrounding structures.
Surgery (Orchiectomy): Orchiectomy, the surgical removal of the affected testicle, is often the initial treatment for testicular cancer. This procedure helps confirm the diagnosis and provides information about the type and stage of the cancer. After surgery, many men can lead normal, active lives with one healthy testicle.
Retroperitoneal Lymph Node Dissection (RPLND): In some cases, especially for non-seminomatous germ cell tumors (NSGCT) or when lymph nodes are involved, a surgery called retroperitoneal lymph node dissection may be recommended. This procedure involves the removal of lymph nodes in the abdomen.
Radiation Therapy: Radiation therapy uses high-energy rays to target and destroy cancer cells. It may be used after surgery for seminomatous germ cell tumors or if the cancer has spread to lymph nodes. However, it is less commonly used than chemotherapy.
Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells. It is often the primary treatment for testicular cancer that has spread beyond the testicle (metastatic disease). Common chemotherapy drugs for testicular cancer include bleomycin, etoposide, and cisplatin (BEP regimen). The specific regimen and duration depend on the type and stage of the cancer.
High-Dose Chemotherapy with Stem Cell Transplant: In some cases, especially for relapsed or refractory disease, high-dose chemotherapy may be used followed by a stem cell transplant to replace the blood-forming cells destroyed by the high-dose treatment.
Surveillance: For certain cases of early-stage testicular cancer, especially seminomas, surveillance may be an option. This involves close monitoring through regular imaging tests and blood tests without immediate active treatment. Treatment is initiated if there is evidence of disease progression.
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