Cancer

Over 100 distinct diseases fall under the category of cancer, but each one is a result of the body’s cells malfunctioning. Healthy cells grow, divide, and replace themselves, keeping the body’s tissue in good condition. When just one cell loses the ability to direct and limit its growth, chaos is unleashed at a cellular level and the potential for cancer begins. That one abnormal cell goes on to divide and reproduce itself. Abnormal cells tend to multiply rapidly which produces an overabundance of tissue in certain areas and tumors are formed.

Tumors are not always malignant (cancerous). Benign (non-cancerous) tumors do not spread and are not usually a threat to life, unless they are located near crucial organs like the heart or the brain, where anything out of the norm poses a threat. Benign tumors are surgically removed and tend not to return.

Malignant tumors on the other hand, can spread to other parts of the body and form more tumors, as well as invade the healthy tissues and organs in their immediate vicinity.

Testicles

The testicles, also called testes or gonads, are the male fertility organs. They are located in a pouch of skin called a scrotum, which dangles from its location behind the penis. Testicles produce male hormones, including the one most widely recognized—testosterone. They also produce spermatozoa, commonly known as “sperm,” the male seed required to fertilize the female egg for reproduction of the species.

Testicles are formed in the abdomen of a male child before he is born. Shortly before or after birth they move down through a special canal called the inguinal canal and into the scrotum. The normal process is for the inguinal canal to seal itself after the descencion. If for some reason this does not occur, tissue from the abdomen gets caught in it, creating an inguinal hernia. Fortunately, hernias are easily corrected.

Sometimes the testicles get trapped in the canal or do not come out of the abdomen at all. This situation is called cryptorchidism. The name comes from the Greek word “kryptos,” which means “hidden,” and the Greek word “orchis,’ which means “testicle.” Most cryptorchid testicles descend on their own accord during the baby’s first year. When they do not, they can be brought out with surgery (orchiopexy).

In the adult male, the testes are approximately an inch across and an inch in depth. The scrotum protects the one and one-half ounces a piece testicles and keeps them at the proper temperature for sperm production, slightly beneath the 98.6 degrees Fahrenheit (38 degrees Celsius) normal body temperature.

The scrotum sac is attached to the perineum, the area between the base of the penis and the anus. When exposed to a colder atmosphere, they are drawn up toward the body by the cremasteric muscle. They will relax back down as they warm up.

Cells within the testes called spermatogonia produce the immature sperm. These freshly created sperm then travel through a system called the rete testes, which leads them to the efferent ducts, where they exit the testicle. This process takes several weeks, during which time the little up-and-coming sperm are maturing.

They are then sent via a twisted tube called the vas deferense to the prostate gland, specifically the urethra (the pipeline which moves sperm from the testes, as well as urine from the bladder, out through the penis.) Here the sperm mix with prostatic fluid, a high sugar (fructose) liquid produced b the seminal vesicals at the top of the prostate gland. This fluid gives the sperm their yellowish color and the energy needed to complete the swim up into and beyond a woman’s cervix, in search of an egg to fertilize.

This complex process is called spermatogenesis and it takes around 70 days to produce an egg-ready sperm. In a normal ejaculation (release of sperm through the penis), 60 million sperm are sent out to begin the one-chance-only-winner-takes-all race to be the first one to find and fertilize the egg, the one to become a human. (Occasionally the rules are bent and twins are born, but that’s another topic.)

The cells within the testes that make androgens (male hormones) are called the Sertoli-Leydig cells. Androgens travel to all the body’s tissues via the bloodstream and are responsible for keeping the male breasts small, deepening the his voice, growing his facial hair, enlarging his upper torso, and keeping his red blood cell count high.

If a boy has been castrated (had his testicles removed) before puberty, he will have less facial hair, a higher pitch in his voice, larger breasts, and will be unable to father children. The unfortunate male child to suffer this fate is referred to as a eunuch.

If a boy is castrated after puberty, he retains the secondary male characteristics. In earlier cultures, young boys were sometimes castrated in order to keep their pre-pubescent voices for singing, or in preparation to be a guard of the king’s harem.

Testicular Cancer

Put simply, testicular cancer is a rapid and invasive growth of malignant cells in the testicles. An abnormal cell appears, divides, and metastasizes (spreads).

In the beginning, the spread consists only of cells to small to be seen with the naked eye and is called a micrometastasis, or a “seeding.” Those “seeds” can travel via the bloodstream to other areas of the body, such as the lungs, liver, brain, etc., and begin metastasizing there.

Risk Factors

Anything that increases a person’s chance of getting a disease is called a risk factor. There are different risk factors for different cancers. And example would be that smoking is a risk factor for lung cancer, or sunbathing without sunscreen is a risk for factor for skin cancer. While the exact cause of testicular cancer is unknown, several factors do seem to increase the risk.

Testicular cancer accounts for about 1 percent of all cancers in men. Although any man can develop this testicular cancer, white American men have more than twice the risk of Asian-American men and more than five times the risk of African-American men. The reason for this has not been identified.

Testicular cancer is noted for being unusual in the age group most affected. It is the most common form of cancer in young men 15-40 years of age; most other types affect older men or children. Only about 3 percent of testicular cancers are found in young boys.

Some research has shown that the risk is higher for boys born with their testicles still within the lower abdomen (cryptorchidism). The risk appears greater if the condition is not corrected in early childhood.

Multiple atypical nevi, an unusual condition in which multiple pigmented spots or moles are found on the back, chest, abdomen and face, is also considered a potential risk factor. Multiple atypical nevi increases the risk of melanoma (a skin cancer), and it has been shown that there is an increased chance of developing melanoma in patients who have been cured of testicular cancer.

It is not known whether prenatal exposure to diethylstilbestrol (DES) increases the risk of testicular cancer, but some men whose mothers took the drug during pregnancy do have testicular abnormalities. DES is a hormone that was prescribed to pregnant women from 1938-1971 to prevent miscarriage.

Other factors under investigation as possible causes include abnormal testicular development, exposure to certain chemicals, HIV (human immunodeficiency virus) infection, precious testicular cancer, family history of testicular cancer, and Klinefelter’s Syndrome. Klinefelter’s Syndrome is a sex chromosome disorder that can be characterized by small testes, sterility, large breasts, and low levels of male hormones.

Fortunately, this cancer is not a common disease. A man has about a 1 in 300 chance of developing testicular cancer. Even with an increase in risk factors, they chance of developing it remains low. The chance of dying from this cancer is 1 in 5000.

Diagnosing Testicular Cancer

When there are symptoms to suggest the possibility of testicular cancer, a personal and family history is studied and a physical examination is given. In addition to the general health routine checking of the pulse, blood pressure, temperature, etc., the scrotum is carefully examined.

Blood and urine samples will be taken for analyzing and a chest X-ray is usually done. If the lab tests and exam do not show another infection or disorder, cancer is suspected.

The only way to know for certain if the testicle has cancerous cells is to examine a tissue sample beneath a microscope. The affected testicle must be removed through the groin to obtain the sample. This operation is called inguinal orchiectomy. A tissue sample cannot be retrieved through the scrotum because cutting through the outer layer of the testicle could potentially cause the cancer to spread out, if indeed there are cancerous cells to be found.

Types of Testicular Cancers

The next step (if the tests show cancer) is to figure out which type of cancer the malignant cells are classified as, seminoma or non-seminoma. If a single tumor has both types of cells, the tumor is treated as a non-seminoma.

Certain substances (called tumor markers) in the blood can be revealed by special lab tests. They are often found in abnormal amounts in patients with some types of cancer. Doctors look at the levels of specific tumor markers when determining what type of testicular cancer a patient has.

Seminomas are slow-growing, immature germ cells and usually localized to the testes, but in approximately 25% of the cases, the cancer has spread to lymph nodes. Seminomas are usually found in men in their 30s and 40s and account for about 30-40% percent of all testicular tumors.

Non-seminomas are more mature germ cells that grow quickly. They account for about 60% of all testicular tumors and often have more than one type of the subcategories listed below.

Choriocarcinoma—rare

Teratomata—about 40%of testicular cancers in young boys and 7% in adult men.

Yolk sac tumor—about 60% of all testicular cancers in young boys.

Embryonal carcinoma—highly malignant, grows rapidly and spreads to the liver and lungs. Occurs in 20-30 year olds and accounts for about 20% of testicular cancers.

Stromal cell tumors are a very rare form that account for only 3-4% of all testicular tumors. They are comprised of Sertoli cells, Leydig cells, and granulose cells. These tumors may cause gynecomastia (excessive development of the male breast) due to their secretions of the hormone estradiol.

Staging

Once testicular cancer has been diagnosed and classified, the next step is to find out the stage of the cancer. “Staging” is determining how far it has spread from the testicle to other parts of the body. Staging procedures include blood tests, surgery (sometimes), and any or all of the various scans listed below.

CT or CAT scan—a series of x rays of various sections of the body.

Intravenous pyelography (IVP)— a special dye is administered through an I.V. that outlines the urinary system for x-rays.

Lymphangiography—x-rays are taken with a special dye outlining the abdomen’s lymph system.

Ultrasonography—pictures are created from the echoes of high-frequency wound waves bounced off internal organs.

There are 3 stages of testicular cancer:

Stage I—the cancer has not spread beyond the testicles.

Stage II—the cancer has spread to lymph nodes in the abdomen.

Stage III—the cancer has spread beyond the lymph nodes, perhaps as far as the lungs.

Treatments

Surgery, radiation therapy, and chemotherapy, and bone marrow transplants (BMT) are all used to treat testicular cancer. Depending on all the factors involved, a patient’s treatment may include just one method or a combination of methods.

In most cases, the testicle is surgically removed (orchiectomy). In addition, sometimes surgery may be recommended to remove the lymph nodes (lymphadenectomy) from the abdomen, which helps to stop the spread of the cancer. Tumors that have spread to other parts of the body may also need to be removed.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs such as cistaplin, etoposide, ifosfamide, vinblastine, and bleomycin (among more than 100 others) to destroy cancer cells. When there are signs that the cancer has spread to other parts of the body, chemotherapy is usually recommended. Sometimes anti-cancer drugs are used as a secondary treatment (following radiation or surgery) for early stages of cancer. This is called adjuvant therapy and its purpose is to destroy any remaining cells that may have gone undetected.

Chemotherapy may be given orally, as an injection, or through an I.V (intravenously). It can also be administered directly into the spinal column. Regardless of the manner in which it is taken, it is a systemic treatment, meaning that the drugs enter the bloodstream and travel to cells all over the body.

Some patients are hospitalized for all or part of the treatments they receive, others are able to take their chemotherapy drugs as an outpatient at the doctor’s office, hospital, or even at home. That all depends on the drugs being given and the overall condition of the patient.

Radiation Therapy

Radiation therapy is also known as cobalt treatment, irradiation, radiotherapy, and x-ray therapy. The treatment is usually done as an outpatient and consists of high-energy rays directed at the cancer cells in order to kill them, thereby stopping their growth. Radiation is a localized treatment, meaning it affects only the cells in the treated area.

Seminomas are sensitive to radiation. Men with seminomas who did not have lymphadenectomy are often given radiation therapy to their abdominal lymph nodes after the tumor-removing surgery.

Non-seminomas are less responsive to radiation and usually treated with the other methods.

Bone Marrow Transplant

Bone marrow, the source of all blood cells, is a soft, spongy tissue found in the center of most large bones. A bone marrow transplant is a procedure that replaces damaged or diseased bone marrow with healthy bone marrow.

In an autologous bone marrow transplant the replacement marrow is harvested from the patient. If the marrow is from an identical twin it is called a syngeneic transplant. If the marrow is from any other donor the procedure is termed an allogeneic transplant.

Cure Rates

Stage I seminoma cancer has a cure rate of over 95%. This stage is usually treated with surgery to remove the testicle and radiation to the abdominal lymph nodes.

Stage II seminoma cancer is divided into bulky and non-bulky tumors and has a cure rate of 85-95%. Both are treated with surgery to remove the testes. Bulky tumors are followed up with chemotherapy and the non-bulky types are followed up with radiation to the abdominal lymph nodes.

Stage III seminoma cancer has a cure rate of 90% and is treated by the surgical removal of the testes and multi-drug chemotherapy.

Stage I nonseminoma cancer has a cure rate of over 95% and is treated with surgery to remove the testes and possibly the removal of the abdominal lymph nodes as well.

Stage II nonseminoma cancer also has a cure rate of over 95%. The testes and abdominal lymph nodes are usually removed with a possibility of follow-up chemotherapy.

Stage II nonseminoma tumors have a 70% cure rate and are usually treated with the removal of the testes and chemotherapy.

If the testicular cancer is a recurrent one, meaning it was treated once and has returned, the treatment is usually multi-drug chemotherapy, sometimes followed by an autologous bone marrow transplant.

Side Effects of Treatments

Because the treatments used against cancer must be very aggressive and powerful, many patients experience unpleasant side effects. The side effects vary from person to person. Often one patient will experience different side effects from one treatment to the next with the same medication.

Chemotherapy drugs, unable to differentiate, damage cancer cells and healthy cells alike. The side effects of chemo depend on which drugs are given and the reaction of the patient’s system. Hair loss, compromised immune system, nausea, vomiting, mouth sores, and loss of appetite are common experiences with chemotherapy.

Most men who receive treatment continue to function sexually. There are some drugs anti-cancer drugs that interfere with sperm production; this affects some patients permanently, but many recover their fertility.

Patients undergoing radiation treatments may suffer extreme fatigue and should rest as much as possible. Radiation does not affect the ability to function sexually (except for being too tired to perform), but it does interfere with sperm production. This is usually temporary and most patients are fertile again within a few months.

Diarrhea, nausea, vomiting, and loss of appetite are other side effects of cancer but can usually be controlled with medication. There may also be skin reaction in the area(s) being treated. Consult the doctor regarding relief from any discomfort; do not apply creams or lotions without the advice of a physician.

With regards to surgery, men with one healthy testicle are able to produce sperm and have a normal erection. Men can also have a prosthesis (artificial testicle) with the weight and feel of a normal testicle implanted in the scrotum.

A man’s ability to have an erection is not affected by the removal of the lymph nodes, but the operation can cause sterility because it interferes with ejaculation. Some men are helped by medication and some recover the ability to ejaculate without treatment.

Sperm Banking

Modern medicine makes it possible for men to cryopreserve their sperm. The sperm is frozen at extremely low temperatures and saved for future use in one of several infertility options. Semen quality is often impaired by the time of a cancer diagnosis, but with several frozen samples and good sperm quality a pregnancy may be achieved through medical techniques. At the end of the day, only one good sperm is required to fertilize an egg.

Men diagnosed with testicular cancer who want to be fathers should talk to their physicians about sperm banking before beginning any course of treatment. Sperm quality, cost, and how much time is available before treatments must begin, and what kind of treatments will be given are all factors to be taken into consideration.

Symptoms

Many times testicular cancers are discovered by the man who claims the testes as his own. It is recommended that men examine themselves regularly from at least the age of 18 (some say as young as 15). It is important to become familiar with how they “normally” feel in order to notice anything different. They should be soft but somewhat firm, oval-shaped and smooth. Any changes should prompt an immediate call to the doctor.

Men should be on the lookout for:

• A lump in either testicle
• A sudden collection of fluid in the scrotum
• A dull ache in the groin or lower abdomen
• Discomfort and/or pain in the scrotum or testes
• Tenderness and/or enlargement of the breasts

It is true that these symptoms can be related to other conditions and may not be signs of a cancerous condition. Hopefully this is the case. Most professionals recommend that you see your doctor immediately and let him make the call. Others say that you should see your doctor if the symptoms persist longer than two weeks.

You, of course, will do whatever you like. But while you are making the decision, remember two things: self-diagnosis is a bad thing, and it’s better to be a hypochondriac than a corpse.