Testis Function, Testis Anatomy And Testicular Cancer

 

Testes Anatomy, Atrophic Testis, Swollen Testis And Testicular Cancer

According to the Cancer Society,one out of every 250 men will develop testicular cancer at some point in their lifetime. And this is a young persons disease The average age of diagnosis is just 33.

 The major risk factors for testicular cancer include cryptorchidism and hypospadias, both of which represent genital urinary developmental abnormalities. In particular, cryptorchidism can result in development of testicular cancer either in the undescended testis.

Testicular Cancer

Testicular cancer is like any other type of cancer, But it arises from the testicle, It can spread to other parts of your body and threaten your life if left untreated.

Causes Of Testicular Cancer

Entirely there is no data of risk factors ,but some very basic things,Children who are born with undescended testicles are actually at higher risk at developing testicular cancer later in life,They should be monitored a little more closely.

Undescended Testicle

The development of an Extragonadal germ cell tumor, an alternative site,for example, in the mediastinum or pineal area, can also portend an elevated risk of the development of testicular cancer.

HIV has become an increasingly recognized risk factor for testicular cancer and to lesser extent, family history.The clinical presentation of testicular cancer is varied.

In general, most patients will notice a painless swelling or mass in the testicle as well as a dull ache of fullness in the scrotum.

More a typically, after puberty,the development of Gynecomastia impotence can also portend the development of testicular cancer.

The differential diagnosis of these lesions is broad and include testicular torsion which is a medical emergency epididymitis and hydrocele.

People who have a family history can be at risk.,Beyond that, there is no risk factors that,we know for targeting testicular cancer.

Symptoms Of Testicular Cancer

• A mass growing on their testicle.
• It feel like a lump or a bump.
• And that can often identify or differentiate.
• suspicious for cancer versus not.- And pain status.

Its usually painless, but people will often notice a rapid growth on their testicle over the course of a weeks, also their breasts,apparently can grow or become sore and this is a symptom of testicular cancer.

Its very uncommon, There are certain types of testicular cancer that can secrete hormones that can cause that to occur. But its definitely not a very common type of symptom that a person can experience.

Some cases of testicular cancer are without any symptoms.

In most cases, there are no symptoms,Which is very unsettling you can refer this as an advanced cases of testicular cancer.

• Testicular cancer can spread to other parts of the bod.
• Testicular cancer can primarily spread to the lymph nodes,but it can spread to the lungs, or the liver. Those are very common locations if left untreated. 
• The symptoms if it has spread to other parts of the body.
• Any other cancer that spreads to other parts of the body, people can develop symptoms of unintentional weight loss.
• They can develop abnormal liver function tests,which are blood tests that are commonly done to check the liver.
• They can develop respiratory problems if they have spread to the lung.
• But there are some symptoms, though,if it spreads such as low back pain.
• Low back pain can certainly occur if there s spread to the bones or if a person gets an enlarged lymph node to the point where its creating or pushing.

Shortness Of Breath

Shortness of breath, it can happen, certainly,if it spreads to the lungs and, or, again,if its pushing up against their diaphragm.

Chest pain and belly pain

Chest pain is less common. Belly pain can simply occur if anything is growing inside the abdomen and pushes up against things. You can have loss of appetite, feelings of early satiety,where you are getting full really quickly and even if you are not eating a your regular amounts of food.

Headaches And Confusion

Headaches and confusion can occur if it spreads to the brain.

Certainly, that can occur. But, short of that, that's unlikely.

So how do you know its time to go see the doctor to get these things checked out

With back pain and chest pain and belly pain,they don't usually associate that with testicular cancer, its safe to say, for the most part,with rare exceptions, if there is no lumps on your testicle, its unlikely that you have testicular cancer if you are experiencing any of those other symptoms.

A person can do very easily,especially in men, its easy to just do a self-examination to make sure you don't have any new growths on your testicle that you did otherwise detect or before.

Who is at risk for getting testicular cancer?

An undescended testicle at birth is the most common one. I think there continue to be studies to look at exactly which individuals might be at higher risk or which populations. We have not gotten a ton of information in that regard. I think the main thing is if a person has a history of an undescended testicle.

But in general, everyone in the population,especially people between the ages of probably 16 to 25,as well as people between the ages of 30 to 40s,we have a by modal distribution of the risk of testicular cancer.

It happens, it peaks in those two age categories. When people are sort of in their early 40s as well as in their early 20s.

But there were also some studies which said that certain ethnic groups, white men, for example,four to five times higher risk than African-American and Asian men.

When you are looking at all individuals with testicular cancer,there is no doubt that white men are at higher risk than other ethnic groups as far as we can tell,based on the data we have.

 An Increase Risk For People Who Have HIV Infection And AIDS

You can get tumors that grow on your testicle because of the immune suppression that's associated with HIV infection and AIDS,but that's usually related to lymphomas or other things that happen to pop up on the testicle.

• But they are not primary testicular cancers,meaning they are not only in the testicle.
• They may be in other parts of the body.- You talked about this a minute ago,but this really is a young persons disease.
• When you think of cancer somebody who is in their, 50s, 60s.

Why so much younger for testicular cancer?

• The testes are more active in people when they are younger.
  
  
  
• They are producing more testosterone.
• They are producing sperm.
• Things like testosterone and sperm production are associated with our youth.
• We don't have children, necessarily, when we are much older. And so, when the testicles are more active, like any other organ in the body, that's when something might go wrong.

How do you test for testicular cancer?

In a patient with testicular erythema, concerning for epididymit is that does not resolve after a course of antibiotics,further evaluation for testicular malignancy is mandatory.

The evaluation of these patients includes physical examination,scrotal ultrasound,and serologic evaluation assessing for serum levels of alpha-feto protein,beta-human chronic gonadotropin,or beta HCG,and lactate dehydrogenase,or LDH.

• It start with an ultrasound.
• If a patient comes with an abnormal growth on their testicle.
• One that they did not identify before.
• Well order an ultrasound to evaluate it further.
• If that indicates that there might be a tumor that's concerning for cancer.
• Then some blood tests to look for something called tumor markers.
• A CT Scanner some type of imaging to look at their abdomen to make sure there are no enlarged lymph nodes.
• Do some imaging off their chest.
• Either a CT or an X-ray of their chest to take a lung and make sure their lungs looks okay.

In addition, baseline CT chest,abdomen, and pelvis for staging will help assess the degree a patients disease and allow it to better assess the patients prognosis and treatment options.

In terms of PET scanning,do the high false negative rate in testicular cancer,PET scanning is not routinely used at the time of diagnosis. Of note,from a serological perspective,any elevation in alpha-fetoprotein indicates a non semino mapathology.

And tumor marker should normalize after surgical treatment. In the case of alpha-fetoprotein, approximately three weeks.

In the case of Beta HCG,within one week with lack of normalization requiring further diagnostic evaluation. In terms of prognosis,testicular cancer has the best prognosis among solid tumors.

How do you treat testicular cancer?

Beta HCG, and LDH.Management of patients with testicular cancer requires a multi-disciplinary team.Surgery is the mainstay of diagnosis and treatment.Biopsys not advised as rupture of the scroll saccan result in tumors seeding into the peritoneum.Thus, radical inguinal or chiectomy is advised for patients suspected of having testicular cancer.

Retroperitoneal lymph node dissection may be required in some patients. Radiation, particularly in seminoma pathologies, which are more sensitive to radiation,can be helpful in reducing relapse risk.

The chemotherapeutic management of these patients is important as well and is represented a significant advance in terms of improving mortality in these patients.

Chemotherapy is the backbone of metastatic disease,and the development of Cisplatin-based chemotherapy has revolutionized the management testicular cancer.

Of note, chemotherapy regimens often include bleomycin, which is a chemotherapy agent that can lead to long-term pulmonary toxicity especially in patients receiving supplemental oxygen during chemotherapy administration.

Chemotherapy is potentially curative upfront,but for those patients who relapsed despite second line therapy, high-does chemotherapy with auto logous stem cell transplantation is a potentially curative option.

As the prognosis of these patients has improved,long term follow up is of great importance. Routine history and physical examination is important with serial measurement of serum tum or markers to detect early relapse, which can oftentimes demand your local therapy such as surgery or radiation.

Scheduled imaging with CT is also indicated, especially in the setting of rising tumor markers or new symptoms. Survivor ship issues have become increasingly important as the prognosis of this disease has improved.

Long-term toxicity to this therapy are important as patients are becoming long-term survivors of testicular cancer. As mentioned earlier, bleomycin can lead to long-term lung damage.

Cisplatin can result in Kidney damage as well as neuropathy and hearing loss. Both etopo side and radiation can lead to secondary cancers,including leukemia. Hypogonadism is an inherent problem in many patients with testicular cancer that is exacerbated by removal of the testicle,as well as administration of chemotherapy and radiation.

In addition, chemotherapy can have long-term adverse effects on patients lipid profiles and blood pressure. In summary. testicular cancers are rare but a potentially curable tumor of men in their 20s and 30s.The evaluation of tumor markers such as alpha-fetoprotein, Beta HCG, and Lactate Dehydrogenase are important in diagnosis,and assess for treatment response and relapse.

Biopsy is not advised as tumor seeding can occur and radical or chiectomy is the standard of care for diagnosis and treatment. Fertility preservation and assessment of long-term toxicity is important as outcomes for these patients improve with advances in therapy.

• They start by removing the testicle.
• They make an incision in the groin
• They take the testicle out that way.
• They take it out from the scrotum.
• They have to do with the anatomic way that the testicle drains its blood.

Once they get a diagnosis from their colleagues in pathology,that can help them decide what further treatment is necessary, if any.

Continued observation with serial tumor markers and symptom-guided imaging are important in detecting early relapse which can respond to local therapies.

What's The Recovery Time?

They are told to avoid heavy lifting or straining for up to six weeks, sometimes much sooner,depending on how much of an extensive procedure we had to do to remove their testicle.-

But with the latest technology,the surgery is much less invasive.

Testicular cancer that might have spread, in that case,do abdominal surgery to actually clean out the lymph nodes in the abdomen.

There are some options to do that with Laparoscopy where they put cameras inside the body and use instruments to do that to avoid having to make a bigger incision.

They even use a robot to do that,where we connect those instruments to a robot,and the surgeon controls the robot from the corner of the room. But typically, to just remove the testicle,its an outpatient procedure and people don't have to stay in the hospital

With just a little incision in the groin they get it out and hopefully, in the majority of cases,actually, people don't need additional surgery beyond that.

Having a testicle removed, does this affect a mans ability to have sex and also father a child?

In addition, prior to surgical or chemotherapeutic intervention, discussions regarding fertility preservation and cryopreservation of sperm should be discussed with the patient.

They have a special setion with people about banking their sperm ahead of time, if we do talk to them about removal of a testicle because,as you mentioned,

They are often not yet in relationships where they are even thinking about children or maybe they are just newly married, they are convinced bout banking their sperm in the event that they want to have kids in the future.

Its not so much because, removal of a testicle makes you infertile. You should be able to father children with a perfectly good testicle on the other side,but the issue is if you have to go through additional treatment, say in the form of chemotherapy,that can be toxic to your sperm as well.

Even the remaining testicle may not have viable sperm that can be used to father children. In terms of the testosterone issue, same thing.

Talk about the other treatments, though,after surgery, radiation, chemotherapy, Immunotherapy .

How often does that come into play?

Radiation therapy can be used for certain sub-types of testicular cancer, but chemotherapy is probably the most common form of what we call systemic treatment or treatment that gets into your whole body.

  Survival Rates

The five-year survival rate is approximately 95%,and the long-term cure rate is 80%.In terms of staging for these patients,both pathologic evaluation as well as radiographic evaluation for staging are important.

• Seminoma has a better prognosis relative to nonseminoma pathology.
• Nonseminomas are characterized by four distinct pathologic types,often with overlapping including embryo carcinoma, teratoma,choriocarcinoma, and yolk sactumor.
• Oftentimes nonseminomas and seminomas can bepresent within the same pathologic specimen.

And the patients prognosis is determined by the most aggressive pathology present. Any elevation of alpha-fetoprotein indicates a non seminomapathology. From a prognostics stand point,metastatic spread to a lung is important in staging as well as the absolute degree of elevation of tumor markers including alpha-fetoprotein.

The earlier it was detect as good survival. But when you take all comers with testicular cancer,you are probably looking at over 80%, 85% plus of individuals have a cure rate.

The American Cancer Society urges women to do a monthly self-exam of their breasts in an attempt to detect breast cancer early. Is the same recommendation for men to do monthly self-exam with the testicle?

Its certainly easy to do a periodic self-examination. I do not think we have come up with any specific guidelines on how often it should be done.

But particularly in the shower or when things are a little more relaxed and its easy to feel your testicles because of the steam and the heat,

We just say periodic self-examinations are useful. Testicular cancer will often grow over the matter of weeks,you will notice, or a man will notice,if there is something growing there when he is in the shower, if he is checking himself on a reasonably regular basis.

I think monthly is perfectly fine, People should just take care of themselves as they continue to. And its an easy thing to identify if you do regularly check yourself and its a very curable disease.

There is a list of optimism to be had,even if you are someone who suffers from this

Conclusion

The learning objectives of this blog include recognizing the epidemiology, risk factors,and clinical presentation of testicular cancer;understanding the diagnosis,evaluation, and treatment testicular malignancies;and identifying the long-term follow up and survivor ship issues related to testicular cancer.

The epidemiology and the risk factors for testicular cancer followed by the clinical presentation,diagnostic valuation, prognosis,management and treatment of these patients,and, finally,long-term survivorship issues.

The epidemiology of testicular cancer in the United States,this is the most common solid tumor in males aged15 to 35.Its more common in white-skinned of European origins and less common in Asia and Africa.

In the United States,there are 8,300 new cases yearly with about 380 deaths yearly. This is due to significant advances in therapy related to testicular cancer particularly, Cisp latin-based chemotherapy and the involvement of high dose chemotherapy with auto logousstem cell rescue,

Which are both substantially improved long term outcomes in these patients.