Dr. Michel Kuzur, for Nashville Health and Wellness Magazine
Testicular cancer is one of the most common cancers in men between the age of 15 and 35. It is estimated that in year 2013, around 7,920 patients will be diagnosed with testicular cancer and 350 men will die from it. This disease has a 5 year survival of 95%.
Patients present with painless swelling of one testicle and in 1/3 of the patients a dull ache in the scrotum or lower abdomen may also be present. When testicular cancer is suspected on physical exam, the patient is found to have an enlarged firm testicle. Testicular ultrasound is normally ordered as well as tumor markers i.e. alpha fetoprotein and beta HCG. If testicular cancer is suspected, the patient is referred to a urologist who would normally perform an orchiectomy which is removal of the involved testicle through an inguinal incision. Direct biopsy of the testicle is contraindicated. Once the diagnosis of testicular cancer is established, staging studies are normally carried out which include CT scan of the abdomen, pelvis and chest, looking for any evidence of spread to other organs. The most common histologic types are seminoma and embryonal carcinoma. These can normally be associated with elevation in tumor markers. Tumor markers can be helpful in management of patients and also interval follow-up and evaluation of response to treatment. In addition, tumor markers are also helpful in detecting early recurrence of the malignancy. If the disease is detected in an early stage and tumor markers return to normal after surgery and there is no spread into lymph nodes in the pelvis, upper abdomen or lung, then follow-up with periodic scans and tumor markers levels is carried out on periodic intervals.
In more advanced cases, lymph node dissection in the retroperitoneal area may be needed to establish distant metastasis.
If patient has high risk for recurrence or has evidence of metastatic disease, chemotherapy is highly effective and potentially curable in most patients. The most common regimen used is a combination of cisplatin, etoposide and bleomycin.
This disease has impacted the life of many high profile men and has helped to bring awareness to need for early detection and treatment where results of therapy are best.
In conclusion, testicular cancer therapy represents a story of triumph in cancer care that most oncologists are excited about because most patients are expected to be cured from this disease and go on to live a normal life expectancy.
