Testicular Cancer

DEFINITION
Testicular cancer is the growth of malignant cells in the testes (testicles), which can cause enlarged testicles or cause a lump in the scrotum.

CAUSE
Most testicular cancers occur in less than 40 years of age.

The cause is not known for sure, but there are several factors that support the occurrence of testicular cancer:

• Undesensus testis (undescended testes into the scrotum)
• Abnormal testicular development
• Klinefelter's syndrome (a sex chromosome disorder characterized by low levels of male hormones, sterility, breast enlargement (gynecomastia) and small testes).

Another factor that may be the cause of testicular cancer but research is still in its early stages of exposure to certain chemicals and infection by HIV. If in any family history of testicular cancer, the risk will increase.

1% of all cancers in men are testicular cancer. Testicular cancer is the most common cancer found in men aged 15-40 years.

Testicular cancer is grouped into:
Seminoma: 30-40% of all testicular tumors.
    Usually found in men aged 30-40 years and confined to the testis.

Non-seminoma: a 60% of all testicular tumors.
    Subdivided into several subcategories:

• Embryonic carcinoma: about 20% of testicular cancer occurs at age 20-30 years and very malignant. Growing very rapidly and spreads to the lungs and liver.
• Yolk sac tumor: approximately 60% of all testicular cancers in young men.
• Teratoma: about 7% of testicular cancers in adult men and 40% in boys. - Choriocarcinoma.
• Tumor stromal cells: a tumor composed of Leydig cells, Sertoli cells and granulosa cells. This tumor is 3-4% of all testicular tumors. Tumors can produce the hormone estradiol, which can cause one of the symptoms of testicular cancer, which is gynecomastia.

SYMPTOMS
Symptoms include: 

• Testicle enlarged or palpable weird (not as usual)
• Lump or swelling in one or both testicles
• Dull pain in the back or lower abdomen - Gynecomastia
• Discomfort / pain in the testicle or scrotum feel heavy.
• But it may also not found any symptoms at all.

Diagnosis
Diagnosis based on symptoms and physical examination.
Other tests are commonly performed:

• Scrotal ultrasound
• Blood tests for tumor markers AFP (alpha fetoprotein), HCG (human chorionic gonadotrophin) and LDH (lactic dehydrogenase).
• Nearly 85% of non-seminoma cancer showed elevated levels of AFP or beta HCG.
• Chest x-ray (to determine the spread of cancer to the lungs)
• CT scan of the abdomen (to determine the spread of cancer to the abdominal organs)
• Tissue biopsy.

TREATMENT
Treatment depends on the type, stage and severity of the disease.

Once cancer is found, the first step is to determine the type of cancer cells.
The next stage is determined:
Stage I: The cancer has not spread beyond the testicle
Stage II: Cancer has spread to lymph nodes in the abdomen
Stage III: Cancer has spread beyond the lymph nodes, get to the heart or lungs.

There are four kinds of treatment that can be used:

• Surgery: removal of the testes (orkiektomi and removal of lymph nodes (lymphadenectomy
• Radiation therapy: using high doses of X rays or other high energy rays, is often performed after lymphadenectomy in non-seminoma tumors.
• Also used as a primary treatment in seminoma, especially in its early stages.
• Chemotherapy: used drugs (eg cisplatin, bleomycin, and etoposide) to kill cancer cells.
• Chemotherapy has improved the life expectancy of patients with non-seminoma tumors.
• Bone marrow transplantation: do if the chemotherapy has caused damage to the bone marrow of patients.

Seminoma tumor 

• Stage I is treated with irradiation orkiektomi and abdominal lymph nodes
• Stage II treated with orkiektomi, lymph node irradiation and chemotherapy with sisplastin
• Stage III treated with orkiektomi and multi-drug chemotherapy.

Non-seminoma tumors: 

• Stage I: treated with orkiektomi and abdominal lymphadenectomy may be performed
• Stage II: treated with lymphadenectomy orkiektomi and abdomen, possibly followed by chemotherapy
• Stage III: treated with chemotherapy and orkiektomi.

If the cancer is a recurrence of previous testicular cancer, some drugs are given chemotherapy (ifosfamide, cisplatin and etoposide or vinblastine).