Testicular cancer is a malignant disease that develops in the testicles, which are part of the male reproductive system.
Testicular cancer has one of the highest rates of successful treatment. If the cancer has not spread beyond the testicle survival rate has a high percentage. Even in the case of tumor invasion into surrounding tissues or spread to nearby lymph nodes, the percentage of successful treatment is also high.
Prof. Raanan Berger – Head of the Sheba Oncology Department since 2011. Head of Cancer Institute.
Head of Clinical Research Institute, Medical Center, Chaim Sheba Tel Hashomer.
Dr. Eli Rosenbaum – Head of Urological Oncology Department, Beilinson Hospital (Rabin).
Dr. Zohar Dotan – Urology Expert, Senior surgeon, Head of the oncourology service at Sheba Medical Center, Tel Hashomer.
Not all formation on the testicles are tumors, and not all tumors are malignant (cancerous). There are many other diseases testicular microlithiasis eg testicular, epididymal cysts, which can be painful but are not cancerous.
Signs and symptoms of testicular cancer
One of the first signs of testicular cancer is often swelling in the testicles, painful or not, acute or dull pain in the lower abdomen or scrotum, breast enlargement (gynecomastia) from hormonal effect of β- hCG osteochondrosis (lumbago) – spread of cancer to the lymph nodes along the back.
Testicular cancer rarely spreads to other organs other than the lungs. However, if there is spread the person may suffer from the following symptoms: shortness of breath, coughing, or coughing up blood (hemoptysis) of metastasis to the lungs, a lump in the neck due to metastases in the lymph nodes, genetic defects.
Main way to diagnose testicular cancer is a medical examination and palpation. Wrong or misdiagnosis can delay treatment.
Any palpable character formation in scrotum should be studied with ultrasound, which can pinpoint the exact location, size and characteristics of some tumors such as cystic or solid composition, if it only begotten or heterogeneous, sharply limited or poorly defined border. Extent of disease is evaluated by CT, which is used for the detection of metastases.
Differential diagnosis – histology of tissue obtained from the groin area.
Blood tests are also used for the identification and measurement of tumor markers (usually proteins present in the blood), which are specific for testicular cancer. AFP alpha1 feto protein, beta – hCG, and LDH – typical markers used to identify testicular cancer.
Stage testicular cancer:
Stage I: the cancer is localized in the testicle.
Stage II: the cancer has metastasized and hit egg retroperitoneal and/or para-aortic lymph nodes (lymph nodes under the diaphragm).
Stage III: cancer affects egg and spreads beyond the retroperitoneal and para-aortic lymph nodes.
Testicular tumors are of the following types: germ cell tumors, intratubular neoplasia gametes sensitiotrophoblastic seminoma, spermatocystic seminoma with sarcoma, embryonal carcinoma, yolk sac tumor of testis, trophoblastic tumor, monophasic choriocarcinoma, trophoblastic tumor placental, cystic trophoblastic tumor, teratoma, dermoid cyst, epidermoid cyst, embryonal carcinoma and teratoma, seminoma and teratoma, choriocarcinoma and teratoma, gonadal stromal tumors, Leydig cell tumors, Sertoli cell tumor, intratubular Sertoli cell neoplasia in syndrome Peutz – Jeghers syndrome.
Testicular cancer treatment
Three main types of treatment are surgery, radiotherapy and chemotherapy
The operation is performed by urologists; radiation therapy under the supervision of radiation oncologists; and chemotherapy – held byoncologists-chemo therapists. The majority of patients with testicular cancer disease are treated successfully. The success of treatment depends on the stage
Inguinal orchiectomy (testicle removal) is the preferred method because it reduces the risk of the spread of cancer cells. Injured testicle usually contains pre-cancerous cells, which quickly spread throughout the testicle. Thus removing only the tumor without further treatment significantly increases the risk of a new tumor in testicle.
Retroperitoneal lymph node dissection (RPLND)
In the case of tumors that do not belong to seminoma operation can be performed on the retroperitoneal/para-aortic lymph nodes to accurately determine the stage of cancer and prevent cancer cells in the lymph nodes in the lower abdomen. This is called cross-section retroperitoneal lymph nodes (RPLND). This procedure should be performed by only a very experienced surgeon, with special precautions in the case of childless men to preserve the nerves involved in ejaculation.
Because testicular cancer can metastasize patients usually also offered adjuvant treatment in the form of chemotherapy or radiotherapy (radiation therapy) to kill cancer cells that may be beyond the affected testicle. Type of adjuvant therapy depends largely on the histology of the tumor (ie, the size and shape of its cells under a microscope) and stage progression (ie, how the cells have already spread beyond the testicle, invaded surrounding tissue or spread to other parts of the body). If cancer has spread slightly, a patient may be recommended with careful observation, periodic CT scans and blood tests, instead of adjuvant therapy.
Radiation may be used to treat stage 2 testicular seminoma, or as adjuvant (preventive) therapy in stage 1 seminoma, to minimize the likelihood that there although we tiny tumor, without detection of the tumor and spread to the inguinal and para-aortic lymph nodes. Radiation is inefficient and therefore not used as a primary therapy for tumors non-seminoma origin.
When seminoma relapse decades after removal of the primary tumor. In this case, there is need for continued vigilance monitoring and inspection, as well as adjuvant chemotherapy.
Drugs: Abiplatin (Teva), Etoposid (Teva), Etoposide (EBEWE), Cisplatin (EBEWE).
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