Testicular cancer

The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord, which also contains the vas deferens and vessels and nerves of the testicles.

The testicles are the male sex glands and produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles) where the sperm mature and are stored.

Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's chance of getting testicular cancer is roughly 1 in 250 (four tenths of one percent). It is most common among males aged 15-40 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of ninety percent; essentially one hundred percent if it has not spread. Even for the relatively few cases in which the cancer has spread widely, chemotherapy offers a cure rate of at least fifty percent.

Symptoms and early detection

Because 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 and then compare the testicles to each other together to see whether one is larger than the other.

Symptoms may include one or more of the following:

• a lump in one testicle
• pain and tenderness in the testicles
• blood in semen during ejaculation
• build-up of fluid in the scrotum
• enlargement or tenderness of breasts
• a dull ache in the lower abdomen or groin
• an increase, or significant decrease, in the size of one testicle.

Men should report any of these to a doctor as soon as possible.

The extent of testicular cancer and whether the cancer is present are ascertained by ultrasound (of the testicles), X-rays, and/or CT-scans, which are used to locate tumors. For nonseminomas (see below), a blood test is used to identify and measure tumor indicators that are specific to that type of testicular cancer.

Pathology

Testicular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm. They are not pathogenic; i.e., they are not to be confused with the "germs" (viruses, bacteria) that cause illness.) In general, the remainder of this article discusses germ-cell testicular cancer.

Germ-cell tumors are classified as either seminomas or nonseminomas. Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be localized (i.e., only in the testicles), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more-mature germ cells and spread more quickly. (Nonseminomas are classified as one of three or four subtypes; 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 (which have subclassifications). Stage one is that in which the cancer remains localized to the testicle. In stage two, the cancer has spread to the nearest lymph nodes, which are small, bean-shaped structures that produce and store infection-fighting cells, in the abdomen. In stage three, the cancer has spread farther, to locations that may include the kidneys, liver, bones, lungs, or brain. The majority of cases are stage 1 when first identified; stage 3 is relatively rare.

Treatment

The three basic types of therapy are surgery, radiation treatment, and chemotherapy.

While it is possible, in a number of cases, to remove testicular cancer tumors from a testicle while leaving the testicle functional, this is rarely done. Since only one testicle is mandatory to maintain virility, hormone production, and other male functions, the afflicted testicle is almost always removed completely (an appropriate exception would be in the case of the second testicle's later developing cancer as well).

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. However, this approach, while standard in a number of places on Earth, is also omitted at a number of cancer centers because of the significant possibility of nerve damage.

Surgery can be performed in other parts of the body where (in rare cases) there are tumors for which this is appropriate; this may occur before or after chemotherapy or radiation treatment.

Radiation treatment is not effective on nonseminomas. It can be given to treat stage-2 seminoma cancers, or as preventive (adjuvant or primary) treatment in the case of stage 1 cancers, to minimize the likelihood that tiny, non-detectable tumors exist and will spread. Chemotherapy as an alternative to radiation treatment is increasing, because radiation treatment has more significant long-term side affects (internal scarring, for example).

Chemotherapy is the standard therapy, 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) treatment, especially for higher-risk cases. The standard chemotherapy protocol is 3 to 4 rounds of Bleomycin-Etoposide-Cisplatin (BEP). This therapy was developed by Dr. Lawrence Einhorn.

While therapy success depends on the stage, the average survival rate after five years is around 95 percent, 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 (orchiectomy) is performed by urologists; radiation treatment is administered by radiation oncologists; and chemotherapy is the work of general oncologists.

Actions after therapy

For stage-1 cancers that have not had any adjuvant (preventive) treatment, close monitoring for at least a year is important, and should include blood tests (in cases of nonseminomas) and CT-scans (in all cases), to ascertain whether the cancer has metastasized (spread to other parts of the body). For other stages, and for those cases in which radiation treatment or chemotherapy was administered, the extent of monitoring (tests) will vary on the basis of the circumstances, but normally should be done for five years (with decreasing intensity).

A man with one remaining testicle can lead a normal life, because 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 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 testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and is infertile, but can lead an otherwise normal life. Less than five percent of those who have testicular cancer will have it again in the second testicle.

Famous survivors

• Decorated cyclist Lance Armstrong is a testicular cancer survivor. 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 therapy.
• In 1997, figure-skater Scott Hamilton survived a bout with testicular cancer.
• Three English footballers (soccer players)-Alan Stubbs, Jason Cundy, and Neil Harris-also survived the condition.
• Jose Francisco Molina Jimenez, Spanish soccer goalkeeper from Real Club Deportivo de la Coruña, in 2001.
• Bulgarian Luboslav Penev, from the Valencia team, league champion and Copa del Rey with Atletico de Madrid, in 1994.

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's autobiography, I Am Third; Sayers's story of their friendship and of Piccolo's struggle with cancer was adapted into the legendary TV movie Brian's Song

Sean Kimerling, born on April 17, 1966, a New York sports anchor for The WB, died of testicular cancer at the age of 37 on September 9, 2003.