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Testicular Cancer


OVERVIEW OF Testicular Cancer :

   Testicular cancer occurs in the male gonads or testis.


STRUCTURE of Testicular Cancer :

Structure:

The testicles are part of the male reproductive system. These two small egg shaped gland and they are held in a sac (scrotum) below the penis.

The testicles have a firm, slightly spongy feel. The firmness of the testicle should be the same throughout. The size of the testicles should also be about the same, though one may be larger than the other. At the top and outside edge is a rubbery, tube-like structure called the epididymis.

The testicles are where sperm mature. The testicles also make male hormones such as testosterone. This hormone controls the sex drive in men. It also starts the growth of muscle, bone and body hair.


CAUSES :

Genetic causes

Men with a history of testis that don’t drop at the time of birth

Abnormal cells in the testis called germ cell neoplasia insitu and it most often found in the infertility persons

Cryptochridism( testis develops in the abdomen when scrotum develops it descend downwards but in some cases the testis does not descend downwards, it can be descended with the help of surgery but later this might result in cancer development of testis).


PATHOPHYSIOLOGY :

Seminoma: This type grows slowly and contains only seminoma cells. There are two subtypes: classic and spermatocytic.

Nonseminoma: This can involve various kinds of cancer cell. There are several subtypes, including embryonal carcinoma, yolk sac carcinoma, chiorcarcinoma, and teratoma.

The other cell tumour includes stromal cell tumour, leydig cell tumour.


COMMON CLINICAL SIGNS AND SYMPTOMS :

A pinless lump or swelling on either testicle.

 Pain, discomfrt,numbness in a testicle or the scrotum is found 

  Feeling of heaviness in the scrotum. One testicle might differ from the other testicle.

Dull ache in the lower abdomen or groin

Sudden buildup of fluid in the scrotum

Some testicular tumour results in hormonal changes and causes breast to overgrow which is known as Gynaecomastia.

Lower back pain, shortness of birth, chest pain and bloody sputum or phlegm can be a symptom of advanced stage testicular cancer.

Swelling of 1 or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. A blood clot in a large vein is called deep vein thrombosis. Development of the blood clot is the sign of testicular cancer.


DIAGNOSTIC :

Physical examination:

The physician might look for swelling, tenderness or hardening. He might also look for the any evidence of abnormal lymph nodes which may indicate the spread of cancer spread. The legs are also checked for any swelling.

Ultrasound:

It uses sound waves to create the picture of the internal organs. The sound waves produces by the ultrasound bounce off tissue in the scrotum. The echoes of the sound waves [roduces a series of images called the sonogram. The sonogram shows up the site, location and shape of the tumour.

Blood tests/Tumour marker:

Tumour markers are substances made by a cancer cells that are found at abnomally high levels in the blood of some people with cancer. The following are the tumour markers:

  • The alpha-fetoprotein (AFP) level is often, but not everytime is elevated in people with non-seminoma. AFP is not made by seminomas, so an increased level of AFP is a sign that the tumor is not a pure seminoma.
  • Beta human chorionic gonadotropin (beta-HCG) is often, but not always, elevated in people with seminoma or non-seminoma. However, beta-HCG levels above 1,000 IU/L generally indicate that the cancer is a non-seminoma and not a seminoma.

Elevated levels of these tumor markers may indicate testicular cancer or another type of cancer. However, it is possible to have testicular cancer and have normal tumor marker levels. It is also possible to have elevated levels of these markers without having cancer.

Other tumour marker:

Alkaline phosphatase

Lactate dehydrogenase.

Computed tomography:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Positron emission tomography (PET) or PET-CT scan:

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

Orchiectomy for pathology test:

During this surgery the entire testicle is removed through the incision in the groin. Then the pathologist will examine for very thin slices of tissue from the testicle to look under microscope.

The doctor then look for the testis for the presence of cancer cells.


TREATMENT AND PROGNOSIS :

Treatment:

  • Surgery:
  • Radical inguinal orchiectomy:

A testis is removed along with spermatic cord which supplies the nutritive blood vessels to the testis. The spermatic cord also carries the sperm from the testis and pass it to the penis. The incision is made at the groin region.

  • Surveillance:
  •    After the surgery the patient should have follow up.
  • Chemotherapy:
  • A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously

    Radiation therapy:

  • It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

  • Immunotherapy
    • it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.
  • Targeted therapy:
  • This therapy involves targeting the specific organs. It involves the emission of rays.


PROGNOSIS :

The five year survival rate for stage 1 cancer is 93%

The five year survival rate for stage 4 cancer is 71%


PREVENTION :

Routine check up if you find any difficultis with the testis

Correct the cryptochridism at the earlier stage

Do self check up by palapating the testis and compare testis on both side.Look for size, weight, swelling and shape of the testis.


Medicines used in the Treatment :

  • Bleomycin
  • Carboplatin
  • Cisplatin
  • Etoposide
  • Gemcitabine
  • Ifosfamide
  • Oxaliplatin
  • Paclitaxel
  • Vinblastin