Cancer of the testicle
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Introduction The testicles are part of the male reproductive system. They produce sperm and the male hormone testosterone. They lie outside the body in a sac of loose skin (the scrotum) under the penis. They are soft and oval shaped, but they are not identical one normally hangs a little lower than the other. Cancer of the testicle (also called testes) is quite rare it accounts for about 1-2% of all cancers in men. There are approximately 2000 new cases per year in the UK. This number is rising, but detection and new improved treatments the chances of a recovery are high the survival rate is 95%. It is important that all men check their testicles regularly (see prevention). Cancer of the testicle is most common in younger men and is the biggest cause of cancer-related death in 15 to 35 year-old males.
Symptoms The most common symptom of testicular cancer is a painless swelling or lump in one of the testicles. Rarely (in about 2% of cases) the swelling can occur in both testicles at the same time. You, or your partner may notice the swelling and assume it is caused by exercise or a minor injury. Any lump in the scrotum or testicles should be examined by a doctor, so make an appointment to see your GP or go to your local sexual health (GUM) clinic. The earlier you seek help, the better your chances of successful treatment. Other symptoms that can be associated with testicular cancer include: pain or a dragging sensation in the testicles or groins, hardness in part or all of the testicle, a build up of fluid within the scrotum, blood in the semen you may notice when you ejaculate, or backache and stomach pains (because of the spread of the cancer). Rarely, some men experience tenderness around their nipples. This may be due to the release of hormones that are produced by some testicular tumours, or because the cancer has spread to the chest area. Most lumps are not cancer, but see your GP as soon as possible to find out.
Causes The causes of testicular cancer are not fully understood. The main risk factor appears to be having had an undescended testicle, where the testicle fails to reach its proper position within the scrotum naturally. All testicles are formed in the abdomen and usually descend (drop) into the scrotum at birth or in the first year of life. Some young boys have an operation to help their testicles descend if they do not come down naturally. Testicular cancer is seen more commonly in men with white skin than men with black skin, and also in those from more affluent backgrounds. The reason for this is not known. A particular gene has been found to be present in many men with testicular cancer and may account for its running in families, just as breast cancer runs in families. Men who have a brother or father with testicular cancer have a higher risk of developing it (although the risk is still small). Hot baths, sporting injuries, riding a bike, and having a vasectomy do not cause testicular cancer.
Diagnosis Any lump or abnormality in the testicles or scrotum needs to be seen by your GP and, if appropriate, a hospital specialist remember, most lumps are not cancer. A specialist will ask questions, perform an examination and organise tests. The first test is usually an ultrasound scan. This scan can usually tell the difference between cancerous lumps and benign lumps. Some cancers of the testicle produce chemicals and release them into the blood stream. These chemicals are called tumour markers, the main ones being alpha fetoprotein (AFP) and beta human chorionic gonadotrophin (BHCG). You may have a test to see if these chemicals are present in your blood. This can help tell if the cancer has spread, how the treatment is working, and later on, whether or not the cancer has come back. As with many cancers, the best way to diagnose testicular cancer is with an operation. You will have a general anaesthetic and a surgeon called a urologist will look at the testicle through an incision in the groin. They may take and examine a biopsy. If the operation confirms cancer, then other special tests are needed to see if it has spread. You may have a chest X-ray to look at the lungs and a computerised tomography (CT) scan to look at the lymph glands in the abdomen and chest. It will take about 1-2 weeks to get all the results and to see the specialist for advice on treatment.
Treatment Treatment for testicular cancer is usually very successful, especially if the cancer is found early. About 95% of people are cured (1). If cancer is discovered you will have your testicle removed (orchidectomy). This is the best way to make sure the cancer has completely gone. A fake testicle called a prosthesis or implant, can be inserted in the same operation. There are two major types of testicular cancers, seminomas (more common in 25-55 year-olds, and teratomas (usually affecting younger men). It is important to know what kind of cancer you have, and if it has spread, so that you can have the right treatment. Seminomas are usually treated with radiotherapy to the lymph glands within the abdomen.
Chemotherapy may also be recommended if there are signs that the cancer has spread. Teratomas do not respond to radiotherapy, but chemotherapy is very effective. A short course of chemotherapy is used when there is no spread (to prevent the cancer coming back), or longer courses if there is evidence of spread. If any cancer remains in the abdomen or chest after chemotherapy, it can be treated with an operation to remove your lymph glands (lymphadenectomy). Having only one testicle does not affect your fertility or sexuality, as the remaining testicle can produce enough sperm and testosterone. Occasionally some men may have problems with their sex life after the operation but this is uncommon and treatment such as HRT (hormone replacement therapy) is available. If you have to have chemotherapy this may reduce your sperm count and cause fertility problems. Before starting chemotherapy, your sperm can be tested and, if suitable, stored and used after treatment has finished. This procedure is called sperm banking. Men who undergo lymphadenectomy may sometimes experience ejaculation problems afterwards and may also be offered sperm banking. Prevention All men should examine their testicles once a month. The best place is in or after a warm bath or shower when the scrotal skin is relaxed. Using both hands, each testicle should be gently rolled between the thumb and index finger to find any lumps or irregular areas. You may want to ask your partner to help you. You may be more at risk of testicular cancer if you have an undescended testicle, a family history of the disease or a previous testicular tumour. In these situations, it is very important to carry out self-examination at least once a month, and report any changes to your GP. One testicle is usually bigger than the other. All men have a lumpy tubular structure on the back of the testicle called the epididymis (where sperm is stored) and a small firm tube which passes from the testicle into the groin called the vas deferens (where sperm is transported). When you get used to how your testicles feel you will recognise these parts and not mistake them for anything abnormal.
References (1) Testes/Treatment/Benefitsdisadvantages">CancerBACUP: Advantages and disadvantages of treatment Glossary Blood Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Tissue Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Stomach The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Lung Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Lymph node Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
Gene Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.
Hormone replacement therapy Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.
Testicle Testicles are the two oval-shaped reproductive organs that make up part of the male genitals. They produce sperm and sex hormones.
Testosterone Testosterone is a male sex hormone, which is involved in making sperm and sexual characteristics such as the voice getting deeper.
Ultrasound Ultrasound scans are a way of producing pictures of inside the body using sound waves.
X-ray An x-ray is a painless way of producing pictures of inside the body using radiation.
Radiotherapy Radiation therapy uses x-rays to treat disease, especially cancer.
Ultrasound scan Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Biopsy A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Anaesthetic Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Benign Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous. Incision An incision is a cut made in the body with a surgical instrument during an operation.
Pain Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Inflammation Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Chemotherapy Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
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