14 Jul 2011

Testicular cancer

Cancer - testes; Germ cell tumour; Seminoma- testicular cancer;  Nonseminoma testicular cancer

Testicular cancer is cancer that starts in the testicles, the male reproductive glands located in the scrotum.
Causes, incidence, and risk factors
The exact cause of testicular cancer is unknown. There is no link between vasectomy and testicular cancer. Factors that may increase a man's risk for testicular cancer include:
    Abnormal testicle development
    History of testicular cancer
    History of undescended testicle
    Klinefelter syndrome
Other possible causes include exposure to certain chemicals and HIV infection. A family history of testicular cancer may also increase risk.
Testicular cancer is the most common form of cancer in men between the ages of 15 and 35. It can occur in older men, and rarely, in younger boys.
White men are more likely than African-American and Asian-American men to develop this type of cancer.
There are two main types of testicular cancer: Seminomas and nonseminomas. These cancers grow from germ cells, the cells that make sperm.
Seminoma: This is a slow-growing form of testicular cancer usually found in men in their 30s and 40s. The cancer is usually just in the testes, but it can spread to the lymph nodes. Seminomas are very sensitive to radiation therapy.
Nonseminoma: This more common type of testicular cancer tends to grow more quickly than seminomas. Nonseminoma tumors are often made up of more than one type of cell, and are identified according to these different cell types:
    Choriocarcinoma (rare)
    Embryonal carcinoma
    Yolk sac tumor
A stromal tumor is a rare type of testicular tumor. They are usually not cancerous. The two main types of stromal tumors are Leydig cell tumors and Sertoli cell tumors. Stromal tumors usually occur during childhood.
There may be no symptoms. Symptoms that may occur can include:
    Discomfort or pain in the testicle, or a feeling of heaviness in the scrotum
    Pain in the back or lower abdomen
    Enlargement of a testicle or a change in the way it feels
    Excess development of breast tissue (gynecomastia), however, this can occur normally in adolescent boys who do not have testicular cancer
    Lump or swelling in either testicle
Symptoms in other parts of the body, such as the lungs, abdomen, pelvis, back, or brain, may also occur if the cancer has spread.
Cipher and tests
A physical examination typically reveals a firm lump (mass) in one of the testicles. When the health care provider holds a flashlight up to the scrotum, the light does not pass through the lump.
Other tests include:
    Abdominal and pelvic CT scan
    Blood tests for tumor markers: Alpha fetoprotein (AFP), human chorionic gonadotrophin (beta HCG), and lactic dehydrogenase (LDH)
    Chest x-ray
    Ultrasound of the scrotum
An examination of the tissue is usually done after the entire testicle is surgically removed.
Action - Treatment
Treatment depends on the:
    Type of testicular tumor
    Stage of the tumor
Once cancer is found, the first step is to determine the type of cancer cell by examining it under a microscope. The cells can be seminoma, nonseminoma, or both.
The next step is to determine how far the cancer has spread to other parts of the body. This is called "staging."
    Stage I cancer has not spread beyond the testicle.
    Stage II cancer has spread to lymph nodes in the abdomen.
    Stage III cancer has spread beyond the lymph nodes (it could be as far as the liver, lungs, or brain).
Three types of treatment can be used.
    Surgical treatment removes the testicle (orchiectomy) and may also remove nearby lymph nodes (lymphadenectomy). This is usually performed in the case of both seminoma and nonseminomas.
    Radiation therapy using high-dose x-rays or other high-energy rays may be used after surgery to prevent the tumor from returning. Radiation therapy is usually only used for treating seminomas.
    Chemotherapy uses drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells. This treatment has greatly improved survival for patients with both seminomas and nonseminomas.
    Einhorn LH. Testicular cancer. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:Chap 210.
    Screening for testicular cancer: Update of the evidence for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality. 2004. Accessed May 15, 2010.
    National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Testicular cancer. V.2.2010.

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