Cancer diagram testicular

Early Detection the Key to Success Against Testicular Cancer

Modern science has fought numerous battles in the war against cancer. Rarely, though, has the margin of victory matched that achieved in the fight against cancer of the testicles, the male reproductive organs that produce sperm and the sex hormone testosterone.

Several years ago, a diagnosis of testicular cancer meant almost certain death. But today roughly 90 percent of men afflicted with the disease are cured--including many whose cancer has spread to other areas of the body.

Why the dramatic improvement? Experts point to the successful use of surgery, radiation and chemotherapy, alone or in combination, to attack the disease, along with more accurate diagnostic methods and better means to monitor the patient during treatment.

In addition, testicular cancer usually afflicts men between 15 and 35. These young men, notes Dr. Lawrence H. Einhorn of Indiana University Medical Center, are generally healthy and able to tolerate aggressive treatment that older patients could not withstand.

On the down side, these men are in their peak years sexually. The treatment threatens sexual function and fertility during this important time of life, leaving the patient with physical and emotional scars that require time to heal. Fortunately, modern medicine recently has begun to remedy this ill.

"With the high success rate in treating testicular cancer, efforts in recent years have turned to modifying treatment to remain effective but be less damaging to fertility," notes psychiatrist Leslie R. Schover in an August 1967 supplement to the journal Cancer.

Despite the strides in treating testicular cancer, the disease is still the number one cancer killer among men in their 20s and 30s, responsible for one in seven cancer deaths in this group.

Self Examination

According to the experts, the most potent weapon for decreasing the number of testicular cancer deaths is early detection. The American Cancer Society suggests that men between 15 and 35 perform a simple three-minute examination of their testicles once every month and promptly report abnormalities to a physician. (See diagram.)

Yet, many men do not know about this potentially life-saving procedure. A study of 90 students at the University of Vermont in 1978 revealed none knew how to correctly examine their testicles. Moreover, 75 percent had never heard of testicular cancer, even though over half recently had completed a health course.

Much of the ignorance arises because the disease is relatively rare and receives less publicity than more common cancers, such as those of the breast, lung and colon. Only 5,000 new cases of testicular cancer occur yearly in the United States, whereas breast, lung and colon cancer each afflict over 100,000 people a year.

Ignorance is not the only enemy of early detection. Many victims delay visiting a doctor when they notice an abnormality in their testicles.

"A young man's embarrassment at having a swollen testicle, as well as his 'macho' resistance to seeking medical attention, contributes to the significant delay in diagnosis seen in 30 percent to 50 percent of these patients," note Schover and urologist Andrew von Eschenbach in the spring 1984 issue of the Journal of Sex and Marital Therapy.

What should men look for during self-examination? The earliest symptom is often a small, hard, painless lump or slight enlargement of the testicle. The tumor is generally smooth and maintains the testicle's oval shape, meaning the mass cannot be separated from the testicle upon physical examination. In later stages, pain in the groin and lower abdomen may occur. In rare cases, the patient's breasts may become enlarged or pigmented.

The most common form of testicular cancer develops when a reproductive cell goes awry. Ninety percent of all testicular tumors are of this type, called germ cell tumor. In contrast, as reported in the 1988 Scientific American publication Medicine, in men over 40, testicular cancer usually originates in the lymph cells. The lymph system is a series of vessels and capillaries that return fluid not absorbed by blood vessels to the blood circulatory system.

Scientists generally use two broad categories to classify testicular germ cell cancer: seminoma and nonseminoma. Seminomatous cancer cells are large and uniform and have a clear cytoplasm, the part of the cell surrounding the nucleus. Nonseminomas generally have granular cytoplasm, are irregularly shaped, and vary in size. While the distinction may seem irrelevant to the layman, it is important to cancer specialists because the two types respond to different treatment.

Risk Factors

Despite the enormous success in treating testicular cancer, scientists know little about the precise cause of the disease. Still, experience has shown that certain men are at greater risk of developing the disease than others.

Men with undescended testicles are at 30 to 40 times greater risk than men with normally descended testicles. The testicles usually descend to the scrotum, the pouch that encloses them, shortly after birth; when they do not, corrective surgery should be perforated.

Other risk factors include a family history of the disease and a history of mumps orchitis, an inflammation of the testicles that occurs when the "regular" mumps, which usually affect the salivary glands, afflict the groin as well. For men who have developed cancer in one testicle, the risk of getting it in the other increases 700-fold. White men, for reasons unknown, are four times more likely to develop the disease than are blacks.

Recent evidence suggests, but has not yet confirmed, that the first-born child may also be at higher risk. Moreover, the risk appears to increase as maternal age increases, according to a study in the May 1987 British Journal of Cancer. Although uncertain as to the reason, the researchers in this study theorized that high levels of the female hormone estrogen in the mother during pregnancy may play a role in triggering the disease.

Most tumors in the testicles are malignant and spread rapidly; in over half of all cases the cancer invades another part of the body, usually the lungs or abdominal lymph tissue. To confirm their diagnosis and to determine the extent of the cancer, physicians perform an ultrasound examination of the affected testicle, as well as a chest X-ray and a CT scan of the abdomen and pelvis. Ultrasound uses high-frequency sound to obtain an image of soft tissue. The CT (computerized tomography) scan, another noninvasive visualizing technique, has replaced exploratory surgery of the abdominal lymph nodes as a means of determining the extent of the cancer. It uses a computer to obtain an X-ray picture of a "slice" of a part of the body.

Treatment

Because 95 percent of testicular tumors are malignant and the cancer spreads swiftly, doctors promptly remove the affected testicle when they suspect the disease. The operation, called an orchiectomy, involves making an incision in the groin. Surgeons do not cut through the scrotum because its lymph drainage system differs from that of the testicles; a disruption of this tissue might permit the cancer to spread through the lymph system to organs not generally involved in testicular cancer. For the same reason, doctors do not biopsy the testicle until after it is removed.

The aim of subsequent treatment is to destroy tumor cells that have spread to other parts of the body. The line of attack depends on the type and severity of the disease.

"Management of purely seminomatous testicular tumors usually differs markedly from that used for the nonseminomatous variety, mainly because of the exquisite radiosensitivity of the seminomas," states Dr. Einhorn in a recent issue of Hospital Practice. (Cells that are radiosensitive are especially susceptible to destruction by radiation treatment.)

In early stage seminoma, doctors--as a precautionary measure--irradiate the lymph nodes in the abdomen, the region to which testicular cancer first spreads. In early nonseminoma many doctors choose to remove the lymph nodes, but a number of physicians believe this surgery is unnecessary. Surgery of any type carries some risk, and since more than 40 percent of nonseminoma tumors do not spread to the abdominal lymph nodes, many doctors question the wisdom of placing patients at risk to remove tissue that may be healthy. Consequently, they may choose not to perform the surgery. Their patients must undergo monthly chest X-rays, physical examinations, and blood tests for approximately two years to ensure that the cancer has been eradicated. If the cancer later develops in the abdominal lymph nodes, the cure rate is still high.