Testis Cancer

It is the most frequently diagnosed cancer in young men. Approximately 7000 cases are diagnosed in the United states annually. This cancer is very sensitive to treatment and is highly curable. It is most commonly seen in ages 20-35. It is a rare condition in African-Americans.

Causes

Various factors have been linked to an increased risk of developing this cancer:

• Prior testicular cancer

• Undescended testis

• Certain genetic disorders

• Certain chemicals

Signs and Symptoms

• Testicular swelling is the most common complaint of the patients.

• Enlargement of lymph nodes in groins

• Low back pain

• Abdominal pain

Establishing a Diagnosis

When a diagnosis is suspected, patients must be examined carefully by a qualified physician. An ultrasound of both testicles, a chest x-ray, along with blood tests for tumor markers, should be done. The next step is removal of the diseased testicle by way of surgery.

Staging:

The extent of the disease determines the appropriateness of the therapy. Chest x-ray, CT scan of the chest, abdomen and pelvis and bone scan will disclose the degree of the cancer spread. For all practical purposes, testis cancers can be grouped in three categories, depending on the mass and the amount of cancer:

• Stage 1, cancer limited to the testicle

• Stage 2, cancer involving the pelvic and abdominal lymph glands

• Stage 3, disseminated disease, involving lung, liver, brain, etc.

Patterns of spread

Testis cancer can travel to distant sites such as local lymph glands or liver, bones, brain, or the lungs.

Different Types of testis cancer

There are two basic kinds of testis cancer,

1. Seminoma, 30% of the tumors

2. Non-Seminoma, 70% of the tumors

This distinction is rather important since the treatment for the two kinds is different.

Treatment:

General guidelines for treatment of testis cancer:

1. The involved testicle must be removed, either at the time of diagnosis or later.

2. Patients with widespread disease (Stage 3) must be treated with chemotherapy.

3. Stage 2 Seminoma patients should receive radiation to the abdomen and pelvis.

4. Stage 2 non-Seminoma patients should be treated with aggressive chemotherapy.

5. Stage 1 Seminoma patients, after removal of testicle, may be either closely monitored or be offered radiation to the pelvis and abdomen.

6. Stage 1 non-Seminoma patients, after removal of testicle, may be closely monitored without any further treatment.

7. At any point and in any stage, after completion of the appropriate treatment, any sizable residual tumor should be removed surgically.

The most effective chemotherapy drugs used to treat this condition are; VP-16, Carboplatinum, Cisplatinum, Bleomycin, Velban, Actinomycin D , Ifosfamide. Chemotherapy is normally administered every three to four weeks, for a period of three to six months.

The most commonly used regimen is BEP and VIP.

Special Situations

Patients with advanced lung cancer may develop any of the following complications.

• Superior Vena Cava obstruction

• Spinal cord compression

• Brain metastasis

• Bone metastasis

• High calcium level

• Pain

Survival

Chance of survival of patients with testis cancer is excellent. The majority of patients are cured with aggressive treatment. In the minority of patients in whom cure is not possible with standard chemotherapy, bone marrow transplantation may be an alternative. Survival may vary from months to years, depending on the extent of the cancer, overall condition of the patient, as well as the patient's response to treatment, and duration of the response.

Follow-up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for possible recurrence of cancer. Follow-up shall be scheduled on a regular basis -- initially, every one-three months for one-two years. The frequency of follow-up will depend on the condition of the patient and his disease. In each follow-up visit, a patient is examined. Normally, a chest x-ray and blood tests for tumor markers is obtained every few months. A CT scan of abdomen, pelvis and chest are performed once a year.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with the same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, different pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.