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      Testicular cancer overview

From MayoClinic.com
Special to CNN.com

Introduction

The testicles (testes) are located inside the scrotum, a loose bag of skin underneath the penis. They produce male sex hormones and sperm cells for reproduction.

Testicular cancer is the most common cancer in American males between the ages of 15 and 34. But denial and embarrassment about the testicles contribute to testicular cancer being one of the least mentioned cancers. The cause of testicular cancer is unknown.

Testicular cancer is highly treatable when diagnosed early. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify dangerous growths early, when the chance for successful treatment of testicular cancer is highest.

Signs and symptoms

Testicular cancer can result in a number of signs and symptoms. These may 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 the scrotum

• Enlargement or tenderness of the breasts

• Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

• Testicle pain: What causes it?

• Swollen testicle: What could be the cause?

• Scrotal masses overview

Risk factors

Researchers don't know what causes testicular cancer. Risk factors may include:

• An undescended testicle. Usually the testes form in the abdominal area during fetal development and later descend into the scrotum. Men who have a testicle that never descended are at greater risk of testicular cancer than other men are. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.

• Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 34.

• Race. Testicular cancer is more common in white men than in black men. The reason for racial differences in the incidence of testicular cancer is unknown.

• HIV infection. Some research has shown that men infected with the human immunodeficiency virus (HIV), especially those with AIDS, are at increased risk of developing testicular cancer.

• Undescended testicle

• HIV/AIDS overview

When to seek medical advice

See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks. Make an appointment with your doctor even if a lump in your testicle is not painful. Only a small percentage of testicular cancers are painful from the outset.

Other diseases and conditions can produce testicular lumps. These may include:

• Benign scrotal masses. Cysts, inflammations, physical injury or a hernia may cause masses of fluid or solid material in, on or around the testicles.

• Epididymitis. This inflammation affects the tubes that transport sperm.

• Hydrocele. This soft and usually painless swelling in the scrotum is due to a collection of watery fluid.

• Spermatocele. This type of cyst is formed by blockage in the tubes that transport sperm.

• Varicocele. Enlarged veins can cause swelling in the scrotum.

• Orchitis. This inflammation of the testicle is often due to a bacterial infection or the mumps virus.

Some of these conditions are harmless. However, see your doctor any time that you have a lump or other signs and symptoms that may indicate testicular cancer.

• Scrotal masses overview

• Swollen testicle: What could be the cause?

• Testicle pain: What causes it?

• Mumps overview

Screening and diagnosis

Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps.

If you bring signs and symptoms of testicular cancer to your doctor's attention, or your doctor discovers a lump during a routine office visit, your doctor will likely do a physical exam and order lab tests to see if an infection or something else is the cause. You may also undergo an ultrasound examination. This painless test passes sound waves through your scrotum to make an image of your testicles.

The testicles contain several types of cells, and each may develop into several types of cancer. Each type grows and spreads differently.

Treatment and prognosis also vary according to type.

Classifying the cancer

Doctors classify testicular cancer as one of two types:

• Seminoma. This type of testicular cancer usually occurs in men between their late 30s and early 50s. If it's discovered and treated early, nearly all men recover from this type of cancer.

• Nonseminoma. This group of cancers includes choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. These types of testicular cancer tend to develop earlier in life than seminomas, usually occurring in men between their late teens and early 40s.

If you have a testicular lump and an ultrasound examination doesn't rule out cancer, a biopsy must be performed to determine the presence of cancer. A testicular biopsy should be done through a small incision in the groin (inguinal incision). A biopsy taken from the scrotum with a needle may spread the cancer to a new area.

Once tissue has been obtained, a pathologist can check the tissue taken from the affected testicle to see if cancer cells are present. If the lump is noncancerous, there's usually no need to remove the testicle. If the lump is a cancerous (malignant) tumor, the entire testicle should be removed. The pathologist will then determine what type or types of cancer cells are present in the testicle.

After the type of cancer has been established, you'll need blood tests, X-rays, computerized tomography (CT) or magnetic resonance imaging (MRI) scans, and other tests to determine if the cancer has spread to other parts of your body.

Staging the cancer

With these test results, your doctor classifies the cancer according to its stage. These include:

• Stage I. Testicular cancer is confined to the testicle.

• Stage II. Testicular cancer has spread to the lymph nodes in the abdomen.

• Stage III. Testicular cancer has spread beyond the lymph nodes to other regions of your body, such as your lungs or liver.

If cancer is confirmed, your surgeon will remove the entire affected testicle through a surgical incision in your groin.

• Diagnosing cancer: Common tests, biopsies and examinations

• Ultrasound

• CT scan

• MRI: Viewing the body's hidden structure

Complications

Losing a testicle won't make you sterile or interfere with your ability to have sexual intercourse. The remaining healthy testicle can maintain your normal sexual and hormonal functions.

Removal of both testicles results in infertility. But you can take male hormones to keep your sexual function essentially normal. The three ways to replace testosterone are:

• Intramuscular injection, which is usually given every two weeks

• Patches, which are applied to your skin daily

• Testosterone gel, which you rub into your skin daily

If you're concerned about your ability to have children now or in the future, talk with your doctor about preserving some of your sperm before the removal of one or both testicles. Sperm can be frozen and stored (cryopreserved) before treatment for later use.

Treatment

Generally, doctors use four kinds of treatments for testicular cancer. They are:

• Radical inguinal orchiectomy. This surgical procedure involves removing one or both testicles through a cut in the groin. Lymph nodes in the abdomen also may be removed (lymph node dissection). If just one cancerous testicle is removed, there's a small chance that the other will become cancerous at some point. As a result, your doctor will likely recommend regular follow-up exams with a urologist.

• External beam radiation therapy. This treatment uses high-dose X-rays or other high-energy radiation to kill cancer cells. Seminomas are highly sensitive to radiation therapy, but nonseminomas are not.

• Chemotherapy. Chemotherapy is used to kill cancer cells outside the testicle. This drug therapy is usually given by infusions into your veins (intravenous), typically done on an outpatient basis.

• Bone marrow transplant. In this procedure, bone marrow is taken from you, treated with drugs to kill any cancer cells and then frozen. You then undergo chemotherapy, with or without radiation, to destroy the remaining cancer cells in your body.

The chemotherapy also destroys your remaining bone marrow. The frozen marrow is then thawed and injected back into you through a needle in a vein. This relatively new treatment for testicular cancer has shown some promising initial results.

Yet doctors don't routinely recommend it because traditional chemotherapy treatments are typically very successful. Bone marrow transplant is used only in rare cases of the disease.

Surgery may be in combination with radiation therapy or chemotherapy or both. It depends on the type and the stage of your cancer. Your age and overall health also are factors in choosing treatment options.

Post-treatment implications

You may wonder how treatment for testicular cancer will affect your appearance and sex life. Keep the following in mind:

• Artificial implants. After the surgical removal of a testicle, you can have an artificial testicle (prosthesis) placed inside your scrotum. The artificial implant has the weight and feel of a normal testicle.

• Surgery and your sex life. The surgical removal of lymph nodes won't affect your ability to achieve an erection or an orgasm. However, this surgery may cause sterility by interfering with ejaculation. Some men recover the ability to ejaculate without treatment; medication may help others. If you undergo surgery, ask about special techniques that may protect your ability to ejaculate.

• Radiation therapy and your sex life. Radiation therapy probably won't change your ability to have sex. However, radiation does interfere with sperm production. The effect is usually temporary, and most men regain their fertility within a few months. As a precaution, many men store sperm at a special facility (sperm bank) before treatment, where it can be preserved for later use.

• Chemotherapy and your sex life. Chemotherapy doesn't have to interfere with a normal sex life. The fatigue caused by chemotherapy, however, may decrease your interest in sexual activity during the months of treatment. Some anti-cancer drugs affect sperm production. Although the effect can be permanent, many men regain their fertility later. Men concerned about their fertility can have their sperm frozen and preserved (cryopreserved) before beginning chemotherapy.

• Radiation therapy: Using radioactivity to kill cancer cells

• Chemotherapy: Using chemicals to treat cancer

• Debunking cancer myths: An interview with a Mayo Clinic specialist

• Clinical trials: A chance to try evolving therapies

• Infertility overview

Prevention

Because the cause is unknown, there's no way to prevent testicular cancer. However, a simple procedure called testicular self-examination (TSE) can improve your chances of finding a tumor. Beginning in your midteenage years, and continuing throughout your life, examine your testicles regularly.

A good time to examine your testicles is after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to find anything unusual. Do this once a month.

To do this examination, follow these steps:

• Stand in front of a mirror. Look for any swelling on the skin of the scrotum.

• Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.

• Gently roll the testicle between the thumbs and the fingers. Remember that the testicles are usually smooth, oval shaped and somewhat firm.

It's normal for one testicle to be slightly larger than the other. Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum. By regularly performing this exam, you will become more familiar with your testicles and aware of any changes that might be of concern.

• If you find a lump, call your doctor as soon as possible. Testicular cancer is highly treatable, especially when identified early.

Regular self-examination is an important health habit. But it can't substitute for a doctor's examination. Your doctor should check your testicles whenever you have a physical exam. If you have an undescended testicle — less than two testicles in your scrotum — be sure to tell your doctor, who may refer you to a urologist for treatment or a more specialized exam.

Self-care

Eating well, managing stress and exercising are ways to promote your overall health and cope with any form of cancer. Ask your doctor for specific suggestions about managing testicular cancer.

These suggestions may differ from what you read below.

Eat well

Good nutrition is especially important for people undergoing cancer treatment. But eating well can be difficult if you're undergoing chemotherapy or radiation treatment. You may feel nauseated or lose your appetite. Foods may seem tasteless.

Even so, eating well during cancer treatment can help you maintain your stamina and better cope with chemotherapy or radiation. Good nutrition may also help you prevent infections and remain more active.

Remember these strategies for eating well when you don't feel well:

• Eat protein-rich foods. These foods can help build and repair your body tissues.

• Keep an open mind about food. Something that is unappealing today might taste better to you next week.

• Make the most out of feeling well. Eat as many healthy foods as you can. Prepare meals that you can easily freeze and reheat. Also look for low-fat frozen dinners and other prepared foods. Try to eat four to six small meals each day rather than one or two big meals.

• Give meals a pleasant atmosphere. Whenever possible, eat at a table set with attractive dishes and flowers.

• Pack in the calories. If you're concerned about weight loss, add extra calories to the foods you eat. For example, spread butter, jam or honey on bread. Sprinkle foods with chopped nuts.

• Eat less more often. If you have trouble eating enough food in a single meal, eat smaller amounts of food more frequently. Drink nutritious liquids, such as fruit juices and milk. Keep snacks handy so that you can easily eat when you feel like it.

Apples, grapes, carrots, celery, slices of bananas, popcorn and other healthy foods are good snack choices.

• Consider alternative cooking methods. If the aroma of cooking foods makes you feel ill, heat foods in a microwave. Choose foods that require little cooking or that don't have powerful odors.

Manage stress

When you worry, look beyond the specific event involved. Ask yourself these questions:

• What is the worst thing that can happen?

• How likely is it that the worst will happen?

• Have I done everything I realistically can to influence the outcome of the situation?

• Will the outcome change my life substantially?

Will I even remember it several years from now?

Methods for reducing physical tension can also help you manage stress. One simple and powerful technique is to simply close your eyes and notice your breathing. Pay attention as you inhale and exhale. Your breathing will become slower and deeper, promoting relaxation. Another technique is to lie down, close your eyes, slowly scan your entire body for points of tension and release each one.

Exercise

Besides increasing your endurance, aerobic exercise can lift your mood and produce a calming effect that lasts well after you finish your workout.

Jogging, swimming and brisk walking are all examples of aerobic exercise.

Side effects from treatments such as chemotherapy or radiation may leave you feeling fatigued and prevent you from exercising as much as you'd like. During these times, try to maintain some level of activity, but listen to your body and don't overexert. Once the side effects pass, slowly increase your exercise.

Activities such as running and swimming that require repetitive movements can produce a mental state similar to meditation. So can yoga and other stretching exercises.

Coping skills

Cancer can make huge demands on your ability to cope. Even if you care for yourself well, you may at times feel overwhelmed or helpless. You can't be expected to work full time, for example, and fight cancer. Be realistic when setting goals and expectations.

Remember that you don't have to handle testicular cancer alone. A counselor, psychologist, psychiatrist, clergy member or support group can help. Seeking outside help is not a sign of weakness. It takes strength and courage to ask for help.


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