Testicular cancer and its Treatment

What is Testicular Cancer? 

The testicular cancer occurs when cells in the testicle grow in order to form a tumor. This is rare. More than 90 % of testicular cancers develop in the germ cells, which involves in producing sperm. 

There are mainly a couple of types of germ cell cancers (GCTs), Seminoma & Non-seminoma. 

Seminoma: Seminoma generally grow slowly and respond very well to chemotherapy radiation therapy.

Non-seminoma: Although, Non-seminoma comparatively grows rapidly and is less responsive to those treatments.

This Non-seminoma has a few sub-types such as: choriocarcinomas, embryonal carcinomas, teratomas and yolk sac tumors. 

Apart from this, there are also rare testicular cancers that usually don’t form in the germ cells.

Leydig cell tumors develop from the Leydig cells, involved in producing the testosterone.

Sertoli cell tumors start from the Sertoli cells that support normal sperm growth.

Who is at Risk?

• Male with a father or brother who had testicular cancer. 
• Male with the history of testes that don’t drop prior to birth. 
• Male with germ cell neoplasia in situ (GCNIS). 

What are the Symptoms of Testicular Cancer?

Initially, the signs and symptoms of testicular cancer may be difficult to notice. Symptoms of a testicular tumor may include:

• A lump which may be painless in the testicle.
• Testicle swelling, with or without pain. 
• A feeling of weight in the testicles. 
• Pain in the testicle, groin or scrotum. 
• Changes or tenderness in the breast tissues of male. 

Interact with your doctor as soon as you notice any of these signs and symptoms. If you do have symptoms, your doctor performs a physical exam, an ultrasound and a tumor marker blood test.

You may be referred to a urologist for good care. Testicular cancer is not diagnosed with a standard biopsy (tissue sample) prior to the surgery.

The testicular cancer can be precisely diagnosed and staged after the tumor is surgically removed. At that point, your doctor will study the tissue in order to learn the exact type of cancer, where it is located and how aggressive it is.

What are the Stages of Testicular Cancer?

Stage 0: It can be considered as a warning that cancer could grow. 

Stage I (IA, IB, IS): This stage indicates that the cancer is found only in the testicle and has not spread to anywhere else in the body.

Stage II (IIA, IIB, IIC): In this stage the cancer has spread to 1 or more lymph nodes in the belly.

Stage III (IIIA, IIIB, IIIC): This stage shows the cancer has spread beyond the lymph nodes in the belly. Cancer may exist far away from the testicles, such as distant lymph nodes or the lungs.

Treatment of Testicular cancer: 

For treating testicular cancer a doctor's team, such as a urologist, oncologist or a radiation oncologist, will work together in order to find the precise treatment plan for each and every patient. The treatment plan will be based on the diagnosis as well as health of the particular patient. 

Surveillance is a specific way to look for the change with normal check-ups and is basically performed for men with Stage 0 as well as Stage I cancers.

In case your cancer gets worse, then the surgery in order to remove the testicle is the best treatment. After surgery, patients will be monitored to make sure they are well or not. 

Male patients with stage II & III testicular cancer may be recommended for comparatively more treatment, like radiation therapy, chemotherapy or the removal of tumors that have spread to the beyond lymph nodes. Radiation is preferred when the seminoma cells are detected, but in some non-seminoma cancer cells it is not effective. Chemotherapy is recommended for any testicular cancer that has spread beyond the testis, or if tumor markers rise after orchiectomy. 

On behalf of the diagnosis of testicular cancer, other surgical options can be recommended. Testis-sparing surgery (TSS) is basically an option for men or children who have a benign tumor. For Testis-sparing surgery, tumor markers must need to be negative.

A surgery known as RPLND (retroperitoneal lymph node dissection) is sometimes an option for male patients with cancers that may return. This surgery helps in order to remove the lymph nodes in the abdomen and must be performed by an experienced surgeon. 

Testicular cancer medication: 

In order to treat testicular cancer there are several drugs that are approved by the FDA (Food and Drug Administration). There are common drug combinations used in testicular cancer. The individual drugs used in combinations mainly are approved by FDA. However, the drug combinations usually are not approved but are widely used.

Bleomycin Sulfate: This medication is believed to work by preventing the making of DNA. The bleomycin IP 15 units is recommended to be given intravenously, by intramuscular injection, or under the skin. 

The common adverse reactions due to bleomycin injection include rash, fever, weight loss and vomiting.

Cisplatin: For patients with testicular cancer, cisplatin 50 mg chemotherapy medication should be given by injection into a vein. This platinum-based antineoplastic family of medicine functions in part by binding to DNA and inhibiting its replication. 

The common adverse reactions include vomiting, bone marrow suppression, hearing problems and kidney problems. 

Cosmegen (Dactinomycin): Dactinomycin, also known as actinomycin d, is a chemotherapy medication should be given by injection into a vein. It is shown to have the ability in order to inhibit the transcription. 

The common adverse reactions due to dactinomycin 0.5 mg include mouth ulcers, bone marrow suppression, vomiting, hair loss, infections, liver problems and muscle pains. 

Etopophos (Etoposide Phosphate): Etopophos a chemotherapy medication can be used either by mouth or injection into a vein. This topoisomerase inhibitor family of medication is believed in order to work by damaging DNA. 

The common adverse reactions include fever, low blood cell counts, hair loss, vomiting, loss of appetite and diarrhea. 

Ifex (Ifosfamide): Ifosfamide (IFO) a chemo drug should be administered by injection into a vein. This nitrogen mustard class of drug works by disrupting the duplication of the DNA as well as creation of the RNA. 

The common adverse reactions include hair loss, blood in the urine, vomiting, kidney problems and infections. 

Vinblastine Sulfate: Vinblastine a chemotherapy medication should be given by injection into a vein. Vinblastine believed to work by blocking cell division. 

The common adverse reactions include change in sensation, weakness, headaches, loss of appetite and constipation. 

Drug Combinations Used in Testicular Cancer: Drugs in combinations usually work better than single drugs because different drugs kill cancer cells in different ways.

Each of the drugs in this combination is approved by the FDA in order to treat cancer or conditions related to cancer.

BEP: BEP (Bleomycin, Etoposide Phosphate, Cisplatin). is used to treat:

• Testicular germ cell tumors that are malignant.

JEB: JEB (Carboplatin (JM8), Etoposide Phosphate, Bleomycin) is used in children to treat the following malignant extracranial germ cell tumors:

• Testicular germ cell tumors.

PEB: PEB (Cisplatin (Platinol), Etoposide Phosphate, Bleomycin) is used in children to treat:

• Testicular germ cell tumors that are malignant.

VeIP: VeIP (Velban, Ifosfamide, Cisplatin (Platinol), is used in order to treat:

• Advanced testicular cancer.

VIP: VIP (Etoposide (VP-16), Ifosfamide, Cisplatin (Platinol) is used to treat:

• Testicular cancer that is advanced. It is often recommended in those patients who cannot take bleomycin sulfate.

What is the Risk for Return?

Testicular cancer may come back but the chances are quite rare, at about 5 % or less. Apart from this, the risk of cancer growing in the other testicle is also quite less. Still, it is necessary to learn how to do a testicular self-exam. Also, regular follow-up visits with your urologist can be helpful.

How often, and for how long follow-up care is required is based on your diagnosis.

If your cancer returns, the healthcare provider will want to find and treat it quickly. Additional treatment options depend on the type of cancer and location.

Disclaimer: Above mentioned information is not a tool for the self-diagnosis or a substitute for professional medical advice. Please discuss with your urologists or health care provider about your health concerns. Always interact with a healthcare provider prior to starting or stopping any treatments, including medications.

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