Testicular Cancer: Treatment and Survival (cont.)

Besides lumps, if a man notices any other abnormality--an enlarged testicle, a feeling of heaviness or sudden collection of fluid in the scrotum, a dull ache in the lower abdomen or groin, or enlargement or tenderness of the breasts--he should discuss it with a physician right away. These symptoms can be caused by conditions other than cancer. But only a doctor can tell for sure, and it is critical to seek attention promptly.

Physicians have various methods to help diagnose testicular cancer. Often a physical exam can rule out disorders other than cancer. Imaging techniques can help indicate possible tumors. One such method is ultrasound, which creates a picture from echoes of high-frequency sound waves bounced off internal organs. Malkowicz calls this method "a painless, noninvasive way to check for a mass."

But the only positive way to identify a tumor is for a pathologist to examine a tissue sample under a microscope. Doctors obtain the tissue by removing the entire affected testicle through the groin, a procedure called inguinal orchiectomy. Surgeons do not cut through the scrotum or remove just a part of the testicle, because if cancer is present, a cut through the outer layer of the testicle may cause the disease to spread locally. Besides enabling diagnosis, testicle removal also can prevent further growth of the primary tumor.

Nearly all testicular tumors stem from germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. Other forms of testicular cancer, such as sarcomas or lymphomas, are extremely rare.

Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods. It was a seminoma that struck former Philadelphia Phillies first baseman John Kruk at age 33 in 1994. His right testicle was removed, and doctors say his prognosis is good.

Nonseminomas are a group of cancers that sometimes occur in combination, including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas. According to the American Cancer Society, 60 to 70 percent of patients with nonseminomas have cancer that has spread to the lymph nodes.

Cancer Stages

Physicians measure the extent of the disease by conducting tests that allow the doctor to categorize, or "stage," the disease. These staging tests include blood analyses, imaging techniques, and sometimes additional surgery. Staging allows the doctor to plan the most appropriate treatment for each patient.

There are three stages of testicular cancer:

  • Stage 1--Cancer confined to the testicle.
  • Stage 2--Disease spread to retroperitoneal lymph nodes, located in the rear of the body below the diaphragm, a muscular wall separating the chest cavity from the abdomen.
  • Stage 3--Cancer spread beyond the lymph nodes to remote sites in the body.
Through blood tests, doctors can check for tumor-associated markers, substances often present in abnormal amounts in cancer patients. Comparing levels of markers before and after surgical treatment helps doctors determine if cancer has spread beyond the testicles. Likewise, measuring marker levels before and after chemotherapy treatment can help show how well the chemotherapeutic drugs are working.

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