Testicular Cancer

What Is Testicular Cancer?
Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancerous and spread to other parts of the body.

What is Testicular Cancer? Cancer that starts in the testicles is called Testicular Cancer.

To understand this cancer, it helps to know about the normal structure and function of the testicles.
Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis that produces sex hormones and sperm for reproduction.
Compared with other types of cancer, Testicular Cancer is rare. But is the most common cancer in American males between the ages of 15 and 35.

What are Testicles?
Testicles (also called testes; a single testicle is called a testis) are part of the male reproductive system. The 2 organs are each normally a little smaller than a golf ball in adult males. They’re held within a sac of skin called the scrotum. The scrotum hangs under the base of the penis.

Testicles have 2 main functions:
 They make male hormones (androgens) such as testosterone.
 They make sperm, the male cells needed to fertilize a female egg cell to start a pregnancy. Sperm cells are made in long, thread-like tubes inside the testicles called
Seminiferous tubules.

Types of Testicular cancer:
The testicles are made up of many types of cells, each of which can develop into one or more types of cancer. It’s important to know the type of cell the cancer started in and what kind of cancer it is because they differ in how they’re treated and in their prognosis (outlook).

Doctors can tell what type of testicular cancer you have by looking at the cells under a microscope.

Germ cell tumors: More than 90% of cancers of the testicle start in cells known as germ cells.
These are the cells that make sperm. The main types of germ cell tumors (GCTs) in the testicles are seminomas and non-seminomas.

A.) Seminomas: Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main sub-types of these tumors are classical (or typical) seminomas and
spermatocytic seminomas.

I.) Classical seminoma: More than 95% of seminomas are classical. These usually
occur in men between 25 and 45.
II.) Spermatocytic seminoma: This rare type of seminoma tends to occur in older men.
(The average age is about 65.) Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than classical seminomas.

Some seminomas can increase blood levels of a protein called human chorionic gonadotropin (HCG). HCG can be checked with a simple blood test and is considered a tumor marker for certain types of testicular cancer.

B.) Non-seminomas: These types of germ cell tumors usually occur in men between their late teens and early 30s. The 4 main types of non-seminoma tumors are embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma.

Signs and symptoms of testicular cancer include:
 A lump or enlargement in either testicle,
 A feeling of heaviness in the scrotum,
 A dull ache in the abdomen or groin,
 A sudden collection of fluid in the scrotum,
 Pain or discomfort in a testicle or scrotum,
 Enlargement or tenderness of the breasts and,
 Back pain.

Risk factors for Testicular Cancer include:
 Family history of the disease, and previous history of testicular cancer.
 An undescended testicle (cryptorchidism): The testes usually descend into the scrotum
before birth, in cases where they don’t, those men with undescended testes are at a
greater risk of testicular cancer than men whose testes descended normally.
 Abnormal testicle development: There are conditions that can result in the abnormal
development of the testicles such as Klinefelter syndrome and such conditions may
increase your risk of testicular cancer.
 Age: Testicular cancer is more common among men aged between of 13-35 years.
 Race: Testicular cancer is more common in white men than in black men.

Treatment for Testicular Cancer:
The three basic types of treatment are surgery, radiation therapy, and chemotherapy.
Surgery is performed by Urologists; radiation therapy is administered by Radiation Oncologists; and chemotherapy is the work of Medical Oncologists. In most patients with testicular cancer, the disease is cured readily with minimal long-term morbidity. While treatment success depends on
the stage, the average survival rate after five years is around 95%, and stage 1 cancer cases, if monitored properly, have essentially a 100% survival rate.
Treatment Clinical trials have also refined doctors’ approaches to treating these cancers. For example, studies have found factors that help predict which patients have a particularly good prognosis and may not need lymph node surgery or radiation therapy.

Studies also have found unfavorable prognostic factors that suggest certain patients may benefit from more intense treatment. New drugs and new drug combinations are being tested for patients with testicular
cancer that comes back or doesn’t respond to treatment. And high-dose chemotherapy followed by a stem cell transplant is being studied in men who have tumors with a poor prognosis. Other studies are using robotic-assisted surgery to remove lymph nodes after chemotherapy. It appears to be a safe option instead of standard “open” surgery, but more research is needed to show this and to see if there are other benefits.

References:
Boccellino M, Vanacore D, Zappavigna S, et al. Testicular cancer from diagnosis to epigenetic
factors. Oncotarget. 2017;8(61):104654-104663. Loveday C, Litchfield K, Levy M, et al.
Validation of loci at 2q14.2 and 15q21.3 as risk factors for testicular cancer. Oncotarget.
2017;9(16):12630-12638. Singh A, Chatterjee S, Bansal P, Bansal A, Rawal S. Robot-assisted
retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual
mass in testicular cancer. Indian J Urol. 2017;33(4):304-309. Tselos A, Moris D, Tsilimigras DI,
et al. Robot-Assisted Retroperitoneal Lymphadenectomy in Testicular Cancer Treatment: A
Systematic Review. J Laparoendosc Adv Surg Tech A. 2018 Feb 23. Last Medical Review: May
17, 2018 Last Revised: May 17, 2018
Hyperlinks:
1.) www.cancer.org/cancer/cancer-basics/what-is-cancer.html
2.) www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/howdiagnosed.html
3.)www.cancer.org/treatment/survivorship-during-and-after-
treatment/understandingrecurrence.html
4.) www.cancer.org/cancer/non-hodgkin-lymphoma.html
5.) www.cancer.org/cancer/leukemia-in-children.html

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