Q&A: Testicular Cancer Diagnosis and Treatment

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pisters.jpgTesticular cancer is the most common cancer in men ages 20 to 34. Yet, it only accounts for 1% of all cancers that occur in men. With early detection, aggressive treatment and long-term, follow-up care, chances to cure this rare cancer are high.

Louis Pisters, M.D., professor in MD Anderson's Department of Urology, answers questions about testicular cancer, how it's diagnosed, treatment options and more.

How common is testicular cancer?

Testicular cancer is a rare cancer. Coupled with its rarity, is that it affects a young population. Men from the ages of 15 to 40 encompass most of the testicular cancer patient population.

To put it in a broader perspective, compare testicular cancer to prostate cancer, the most common non-skin-related cancer in men. According to American Cancer Society estimates, there will be 8,290 cases of testicular cancer in the United States in 2011, with 350 deaths. By comparison, there are expected to be 240,890 men diagnosed with prostate cancer, with 33,720 deaths.

At MD Anderson, we see approximately 100 testicular cancer patients a year, and personally, I see two to four patients each month.

What causes testicular cancer?

Testicular cancer occurs when cells in the testicles grow and multiply at a rapid and uncontrollable rate -- causing damage to tissue and the normal function of the testicle.

Many men diagnosed with testicular cancer don't have any known or established risk factors.

Known risk factors include:

•    A family history of testicular cancer
•    Cryptorchidism (undescended testicle)
•    Abnormal testicular development
•    Klinefelter's syndrome (sex chromosome disorder)

Are there preventive measures for testicular cancer?

There aren't any preventative measures. But, there are proactive measures. Practice self-examinations to discover the cancer early and know your family history.

What are the common symptoms of testicular cancer?

Usually men don't have any symptoms. However, the most common way the cancer manifests itself is with a painless scrotal mass. Some men may notice swelling as well.

How is testicular cancer diagnosed?

Usually, the first step we take is to perform a scrotal ultrasound. This helps to rule out non-cancerous masses that could be confused as testicular cancer.

The next step is to order blood tests to analyze two embryonic proteins that, when produced at abnormal levels, may indicate testicular cancer.

How is testicular cancer treated?

All patients with testicular cancer undergo an orchiectomy (removal of the testicle) to determine which type of testicular cancer they have. The testicle is removed through as incision in the groin. This surgery technique is done so that the blood vessels that lead to the testicle, known as the spermatic cord, are removed along with the testicle.

Depending on the type of cancer, there are various approaches to treatment:

The two broad categories of testicular cancer are:

Seminomas -- These tumors account for 50% of testicular cancer cases, are slow growing and very responsive to treatment.

Nonseminomas -- These tumors grow and spread more quickly than seminomas.

Seminomas are often treated with either radiation or chemotherapy. For nonseminomas, treatment may include chemotherapy and surgery to remove lymph nodes in the retroperitoneum (the area in the abdomen behind the intestines). Patients with intermediate or high-risk testicular cancer have the best chance for a cure with aggressive chemotherapy and surgical removal of the retroperitoneal lymph nodes.

Testicular cancer is a great model or paradigm to show how using multiple therapies together can be highly effective.

What are possible side effects of treatment?

The main side effect is infertility or fertility difficulties. Often, we'll refer patients for sperm banking prior to treatment. This is particularly recommended if they're going to need intensive chemotherapy or radiation treatment, which will compromise their fertility.

What is the prognosis for testicular cancer patients?

Testicular cancer overall has a very high cure rate. Depending on how advanced the disease is, the likelihood that someone can be cured falls in the 95% to 98% range.

Long-term, follow-up care is needed to ensure that survivors continue to lead lives free of testicular cancer and other cancers. The importance of receiving good long-term, follow-up care can't be understated.

Compared to the general population, testicular cancer survivors are at a slightly higher risk of developing other cancers later in life. They should be screened regularly for a wide spectrum of cancers, be proactive in terms of their health and avoid known cancer-causing agents, such as tobacco.

With early detection education, the right treatment and long-term, follow-up care, we have the opportunity to afford young men diagnosed with testicular cancer many decades of life to live.

Related stories:

Early Detection and Swift Treatment Help Young Man Beat Testicular Cancer
Q&A: Testicular Cancer Survivorship

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