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  Testicular cancer

Testicular cancer is a cancer of the male reproductive system that develops in the testicles or a single testis. Each year, in the United States around 9,000 men are diagnosed with testicular cancer. Men have a 1 in 250 chance of getting testicular cancer. Men between the age of 15 to 40 are usually diagnosed. The cure rate for testicular cancer if it has not spread to other organs is over 90%. Rarely does it spread, but when it does, the cure rate is up to 50% in patients with chemotherapy. Testicular has the highest cure rate of all cancers.

Testicular cancer
Testicular cancer


Symptoms

Symptoms for testicular cancer are specific and rarely mimic any other disease. Symptoms for this disease are a build up of fluid in the scrotum, blood in semen, an increase or decrease in size of one of the testes, a lump or hardening in one of the testicles, pain or sensitivity in one testicle, and a dull ache in the groin or lower abdomen.

The cure rate for stage 1 (cancer has not spread) for this disease is over 95%. Doctors recommend a self-exam of the testicles on a monthly basis, after a shower or bath, when the scrotum is relaxed. Men should check for pea shaped lumps.

Diagnosis

An incorrect diagnosis has the rate of 25% and can relate to a delay or treatment. After ruling out these diseases: epididymitis or epididymoorchitis, hycrocele, spermatocele or granulamotous, a few tests can be performed to determine if testicular cancer is present. A biopsy should not be performed for this type of cancer as it can enable the cancer to spread.

The size of the tumor and whether it has spread is determined through medical imaging, such as CT scan, X-Ray or ultrasound. Blood tests can identify and measure the levels of tumor markers that indicate testicular cancer. Markers that indicate testicular cancer are the beta subunit of human chorionic gonadotropin (βhCG), lactate dehydrogenase (LDH) and alpha fetoprotein (AFP).

Tumors are typed into seminoma and nonseminomatous. Placental alkaline phosphatase marker is sometimes measured in a blood test to determine whether the cancer is of the seminoma type or the non seminomatous type.

Ninety-five percent of testicular cancers are formed by germ cells, the cells that create sperm. Germ cells should not be confused with viruses or bacteria that cause infection. Germ-cell tumors have two classifications seminomas and nonseminomas. Seminomas are slow growing and localized only in the testicles. Nonseminomas are more aggressive and are classified into four subtypes. The four subtypes of nonseminomas are yolk sac tumors, teratomas, embryonal carcinomas and choriocarcinomas. A fifth subtype is a mix of the tumors. The types are determined by the gene expression of the cancer cells, as presented under microscopic examination. A patient can have a combination of seminomas and nonseminomas cancer, the classification then is nonseminoma.

Staging is the categorization of the growth or spread of testicular cancer. Testicular cancer has three stages. Stage I is cancer that has remained in the testes. Stage II is cancer that has spread to the retroperitoneal or paraaortic lymph nodes from the testis. Stage III of testicular cancer is cancer that is in the testis and has spread from the abdominal area to other organs in the body.

Treatment

Treatment for testicular cancer involves surgery, radiation therapy and chemotherapy.

Urologists perform testicular cancer surgery. A man requires only one testicle to maintain hormone levels and fertility. Therefore, the affected testicle is usually completely removed in a procedure referred to as an inguinal orchidectomy. The testicle is removed from an incision below the belt line, not the scrotum. Surgery is also used to determine if the cancer is stage I or stage II. In a separate procedure, the urologist will perform a Retroperitoneal Lymph Node Dissection (RPLND).

Radiation therapy is used to treat stage II seminoma cancers or as a preventative measure in stage I seminomas. Tiny, undetectable tumors may exist and spread and radiation can prevent that from occurring. Nonseminoma is never a choice of primary therapy since chemotherapy is more successful and radiation for this type of cancer needs to be given at higher, less safe level.s

Chemotherapy is used as an alternative to radiation therapy or in combination. Radiation therapy has more long term side effects than chemotherapy. The side effects of radiation are internal scarring and a higher risk of developing other malignancies. The current chemotherapy program that is used in association with radiation therapy is two doses of carboplatin delivered three weeks apart is providing good results.

Chemotherapy is that standard treatment when the cancer is in stage II or stage III. Standard chemotherapy is three to four rounds of a cocktail of chemotherapy drugs, Bleomycin-Etoposide-Cisplatin (BEP).

Treatment prognosis depends on the stage of the cancer and the health of the patient. Current rates of survival of five years for testicular cancer are 95%.

Stage I testicular cancer patients who have not had any preventative (in recurrence therapy) are monitored closely for one year, including blood tests and CT-scans to make sure the cancer is gone from the body. Other stages of cancer will be monitored as determined by the doctors and patient’s decision.

A man is still fertile with one remaining testicle. Many men who are younger choose to bank sperm before surgery and treatment in case fertility becomes a problem when they are ready to become fathers.

A man who needs to have both testicles removed will require hormone replacement therapy, especially testosterone which is created in the testicles. Other than being infertile, the patient can lead a normal life.

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