Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. One in every 25,000 men get testicular cancer and it is most common among males ages 15 through 40. Thankfully, testicular cancer has one of the highest cure rates of all cancers. Cures are possible even after it has spread to other parts of the body.
Symptoms and early detection
As testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examination after a hot shower when the scrotum is looser. Men should examine each testicle first feeling for lumps then, compare them together to see if one is bigger than the other.
Symptoms include a lump in one testicle, pain and tenderness in testicles, blood in sperm during ejaculation, build up of fluid in the scrotum, enlargement or tenderness of breasts, a dull ache in the lower abdomen or groin, and an increase, or significant decrease, in the size of one testicle. Men should report any of these to a doctor as soon as possible.
Whether testicular cancer exists or not (and its extent) is evaluated by ultrasound (of the testicles) and X-rays, including CT-scans, looking for tumors. For nonseminomas, a blood test is used to test for (and measure) tumor markers that are specific to testicular cancer.
Pathology
Testicular cancer tumors are classified as either seminomas and nonseminomas. Seminomas are slow-growing, immature germ cells. (Germ cells produce sperm; they are not pathogenic.) Seminomas, when found, tend to be only in the testicles (that is, to be localized), simply because they spread releatively slowly. Nonseminomas, on the other hand, are more mature germ cells which spread more quickly. (There are four subtypes of nonseminomas; their rate of spread varies somewhat but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma.
A case of testicular cancer is categorized as being in one of three stages. Stage one is where the cancer remains in the testicle. In stage two, the cancer has spread to the nearest lymph nodes, small bean shaped structures that produce and store infection fighting cells, in the abdomen. In stage three, the cancer has spread further to locations including the kidneys, liver, bones, lungs or brain. The majority of cases are stage 1, when first identified; stage 3 is relatively rare.
Treatment
There are three basic types of treatment: surgery, radiation therapy, and chemotherapy.
Since there is no known way to remove testicular cancer tumors from a testicle while leaving it functional, surgery to remove the afflicted testicle is essentially always done. In the case of nonseminomas that appear to be stage 1, surgery is often done on the lower lymph nodes (in a separate operation) to better determine whether the cancer is in stage 1 or 2. And surgery can be done in other parts of the body where (in rare cases) there are tumors for which is this appropriate.
Radiation therapy is effective only on seminomas. It can be given to treat stage 2 cancers, or as preventive (adjuvant) therapy, in the case of stage 1 cancers, to minimize the likelihood that miniscule (non-detectable) tumors exist and will spread.
Chemotherapy is the normal treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage 2 or 3). It is also an option for stage 1 nonseminomas, as preventive (adjuvant) therapy.
While treatment success depends on the stage, the average survival rate (five year) is around 95%, and stage 1 cancers cases (if monitored properly) have essentially a 100 percent survival rate (which is why prompt action, when testicular cancer is a possibility, is so important).\
Surgery (testicle removal) is done by a urologist; radiation therapy is done by a radiation oncologist; and chemotherapy is done by a general oncologist.
Actions after treatment
For stage 1 cancers which have not had any adjuvant (preventive) therapy, close monitoring for at least a year is important (blood tests, if a nonseminoma; CT-scans in all cases) to evaluate if the cancer has spread to other parts of the body (metastasized). For other stages, and where radiation therapy or chemotherapy was used, the extent of monitoring (tests) will vary depending on circumstances, but normally should be done for a five-year period (with decreasing intensity).
A man with one remaining testicle can have a perfectly normal life, as the other testicle takes up the load, and will generally have adequate fertility. However, it is worth the (minor) expense of measuring hormone levels before surgery (removal of a testicle), and sperm banking may be appropriate for younger men who still plan to have children, since fertility will certainly be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy is done.
A man who loses both will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and is obviously infertile, but can lead a normal life. Less than five percent of those who have testicular cancer will have it again in the second testicle.
Famous survivors
A living proof that testicular cancer is curable is decorated cyclist Lance Armstrong. He once said, "It's ironic, I used to ride my bike to make a living. Now I just want to live so that I can ride."
Canadian comedian Tom Green was diagnosed with testicular cancer in 2000 and made a widely acclaimed documentary about his treatment. In 1997, figure skater Scott Hamilton survived a bout with testicular cancer. Two English footballers - Jason Cundy and Neil Harris - also survived the condition.
Famous victims
Brian Piccolo, an American football player in the late 1960s with the Chicago Bears, died of testicular cancer that was not detected until it had metastasized into his lungs. Piccolo would be a major subject of teammate and friend Gale Sayers' autobiography I Am Third ; Sayers' story of their friendship, and Piccolo's struggle with cancer, was adapted into the legendary made-for-TV movie Brian's Song .
See also
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