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The causes of testicular cancer
It is not known exactly what causes testicular cancer. Although
it is still quite rare, the number of men who develop it
has been steadily increasing for the past few years. The
reason for this is not known, but research is going on all
the time into possible causes.
Testicular cancer is more common in men who have a testicle
that has failed to descend. In the unborn child the testicles
develop inside the abdomen between the kidneys and descend
into the scrotum at birth or during the first year of life.
If the testicles do not descend this increases the risk
of testicular cancer.
Men with a brother or father who has had testicular cancer
are slightly more at risk of developing it (although the
risk is still small). Research has shown that a particular
gene is the cause of testicular cancer in some men. It is
possible that this gene is inherited and may be the reason
why testicular cancer sometimes occurs in brothers or sons
of men who have had the disease.
Testicular cancer is more common in white men than African
or Asian men. It occurs more commonly in wealthier social
groups. The reasons for this are not known.
It is not clear whether injury to the testicle can cause
a testicular cancer. Vasectomy does not increase the risk
of a man developing testicular cancer.
The symptoms of testicular cancer
The most common symptom is swelling in part of one testicle.
This is usually painless, but some men may notice an ache
in their lower abdomen or in the affected testicle. There
may be a feeling of ‘heaviness’ in the scrotum. In a few
men the testicle suddenly becomes swollen and very tender.
When a normal testicle is examined, it is round, soft and
smooth. The epidydimis can be felt behind it as a separate
structure. Cysts and benign swellings in the epidydimis
are quite common and are usually harmless. Lumps in the
body of the testes itself may be benign but can be a cancer.
It is sensible to have any swelling examined by a doctor.
A few men may find that their first symptoms (such as backache,
stomach ache, or a cough) are caused by spread of the cancer
cells to other parts of the body. Rarely, tender nipples
may be caused by hormonal changes within the body. If you
have any of the above symptoms it is important to let your
doctor know – but remember, they are more likely to be due
to conditions other than cancer.
Cancers which are found early are the most easily treated.
The best way to check for testicular cancer is to examine
yourself once a month and the best time to do this is after
a warm bath or shower, when the scrotal skin is relaxed.
If you would like to find out more about testicular self-examination,
Cancerbackup can send you a leaflet
.
If you find a swelling in a testicle, it is very important
that you have it checked by your doctor as soon as possible.
If you feel embarrassed about seeing your GP, you can go
to your local sexual health clinic. The details will be
in the health section of your local phone book.
Types of testicular cancer
There are two main types of testicular cancer –
seminomas and teratomas. They may be called germ cell tumours.
Occasionally testicular tumours can be a mix of both types.
• Seminomas most commonly occur in men between 25 and 55
years of age.
• Teratomas usually affect younger men – from 15 to about
35 years.
Rarely, a type of non-Hodgkin’s lymphoma can occur in the
testicle. This would be treated as a non-Hodgkin’s lymphoma.
Other rare types of testicular tumour are Leydig and Sertoli
cell tumours.
How testicular cancer is diagnosed
Usually you begin by seeing your family doctor (GP), who
will examine you and take your medical details. They will
then refer you to a hospital specialist for further tests,
expert advice and treatment.
The specialist will give you a full physical examination
and take your medical history. Often, the doctor can tell
by feeling the lump, whether it is likely to be a cancer.
You may have an ultrasound scan of the scrotum and the testes.
This test can help to tell whether a lump is a cancer or
is due to other causes. An ultrasound scan uses sound waves
to build up a picture of the testes and scrotum. However,
the only way to confirm that the swelling is cancer is for
a surgeon to examine the testicle during an operation.
During the surgery the surgeon can sometimes see whether
the lump is a cancer or not. A small piece of tissue is
removed and immediately examined under a microscope by a
pathologist (this procedure is known as a biopsy). If the
biopsy shows that the lump is a cancer, the testicle will
be removed (this operation is known as orchiectomy).
The cells are then taken to the laboratory and examined
further to find out which type of testicular cancer it is.
You can usually go home the next day. If the cancer has
not spread beyond the testicle, this may be the only treatment
you may need, although for a few years you will have to
attend the hospital regularly as an outpatient for check-ups.
The removal of one testicle does not affect
your ability to have an erection or to father children.
An artificial testicle (known as an implant or prosthesis)
can be inserted into your scrotum to give a normal appearance
if you wish. Your specialist can give you more details about
this.
Further tests for testicular cancer
If the tests show that you have testicular cancer, you will
have some further tests to see if there has been any spread
of the cancer to other parts of the body.
These tests may include some or all of the following:
• Blood tests
• Chest x-ray and computerised tomography (CT) scan
• Magnetic resonance imaging (MRI or NMR scan)
Blood tests
Some testicular cancers produce chemicals which are released
into the bloodstream. The three main chemicals, called markers,
are alpha-fetoprotein (AFP), beta human chorionic gonadotrophin
(BHCG) and lactic dehydrogenase (LDH). If these chemicals
are present in the blood, they can be used to assess whether
the cancer has spread and to measure the effect of treatment
on the cancer.
Samples of your blood will also be taken regularly throughout
your treatment to check your general health and the effect
that any treatment may be having on the normal cells in
your blood.
Chest x-ray and computerised tomography
(CT) scan
Usually, a chest x-ray or CT scan is done to check for any
signs that the cancer has spread to the lungs or to the
lymph glands in your abdomen (see diagram). The CT scan
takes a series of x-rays which build up a three-dimensional
picture of the inside of the body. You may be given a drink
or injection of a dye which allows particular areas to be
seen more clearly. For a few minutes, this may make you
feel hot all over. If you are allergic to iodine or have
asthma you could have a more serious reaction to the injection,
so it is important to let your doctor know beforehand.
The scan takes from 10–30 minutes and you will probably
be able to go home as soon as it is over.
Magnetic resonance imaging (MRI
or NMR scan)
This test uses magnetism to build up cross-sectional pictures
of the body. Some people are given an injection of dye into
a vein in the arm to improve the image.
During the test you will be asked to lie very still on a
couch inside a long chamber for up to an hour. This can
be unpleasant if you don’t like enclosed spaces. If you
get claustrophobic, it may help to mention this to the radiographer.
The MRI scanning process is also very noisy, but you will
be given earplugs or headphones to wear. You can usually
take in a tape, or CD of your own music to listen to.
The chamber is a very powerful magnet, so before entering
the room you should remove any metal belongings. People
who have cardiac monitors, pacemakers or some types of surgical
clips cannot have an MRI scan because of the magnetic fields.
Once you have had all the tests you need, the doctor will
have a good idea of the type of cancer and the stage (whether
it is just within the testicle or has spread).
It will probably take several days for the results of your
tests to be ready and a follow-up appointment will be made
for you. This waiting period can be a very anxious time
and it may help to talk things over with a close friend
or relative.
Types of treatment for testicular
cancer
If your tests show that you have testicular cancer, you
will be looked after by a multidisciplinary team. This is
a team of staff who specialise in treating testicular cancer
and in giving information and support. It will normally
include:
• surgeons who are experienced in testicular surgery
• specialist nurses who give information and support
• oncologists – doctors who have experience in testicular
cancer treatment using chemotherapy and radiotherapy
• radiologists who help to analyse scans and x-rays
• pathologists who advise on the type
and extent of the cancer.
Other staff will also be available to help you if necessary,
such as:
• physiotherapists
• counsellors and psychologists
• social workers
Treatment for testicular cancer is usually very successful
and most men can now be completely cured, even if the cancer
has spread beyond the testicles. The treatment will depend
on the type of cancer (whether it is a teratoma or a seminoma)
and whether it has spread beyond the testes.
There are three main types of treatment surgery, chemotherapy
and radiotherapy
If you have any questions about your treatment don’t be
afraid to ask your doctor or a nurse. It often helps to
make a list of questions before you go for appointments.
You may also like to take a close friend or relative with
you when you see the doctor. If you work, it may be helpful
to ask the doctor or specialist nurse, whether the treatment
may affect your ability to work.
After treatment for testicular
cancer
After your treatment has finished, you will have regular
check-ups, blood tests, scans and x-rays. These will continue
for several years. Your remaining testicle will also be
checked. If you have any problems, or notice any new symptoms
in between these times, you should let your doctor know
as soon as possible. Some people find that they feel quite
low and anxious once their treatment has finished.
Cancerbackup's section on adjusting to life after cancer
gives useful advice for men whose treatment is over apart
from regular check-ups.
http://www.cancerbackup.org.uk/
Cancertype/Testes/Causesdiagnosis/Causes
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