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Testicular doctor called. Testicular Cancer: Diagnosis, Treatment, and What to Expect When Seeing a Urologist

How is testicular cancer diagnosed. What happens during a urologist appointment for testicular cancer. What are the stages of testicular cancer. What tests are used to diagnose testicular cancer. How is testicular cancer treated. What is the prognosis for testicular cancer.

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Understanding Testicular Cancer: Signs, Symptoms, and Risk Factors

Testicular cancer is a relatively rare but serious condition that primarily affects young men. It occurs when abnormal cells in the testicles grow uncontrollably, forming a tumor. While the exact cause remains unknown, several risk factors have been identified.

Who is at risk for testicular cancer? Men between the ages of 15 and 35 are most commonly affected, but it can occur at any age. Other risk factors include:

  • Family history of testicular cancer
  • Undescended testicle (cryptorchidism)
  • Personal history of testicular cancer in one testicle
  • HIV infection
  • Klinefelter syndrome

What are the signs and symptoms of testicular cancer? Common indicators include:

  • A painless lump or swelling in either testicle
  • A feeling of heaviness in the scrotum
  • Dull ache in the lower abdomen or groin
  • Sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or the scrotum

Can testicular cancer be detected early? Regular self-examinations can help in early detection. Men should perform monthly testicular self-exams to check for any unusual lumps, swelling, or changes in size or texture.

The Diagnostic Process: From Initial Suspicion to Confirmation

When testicular cancer is suspected, a series of diagnostic procedures are initiated to confirm the presence of cancer and determine its extent. This process typically involves several steps and different medical professionals.

Initial Examination and Tests

What happens during the first doctor’s visit for suspected testicular cancer? The initial examination usually includes:

  1. Physical examination: The doctor will carefully examine the testicles for lumps or swelling.
  2. Medical history review: Your doctor will ask about your symptoms, risk factors, and family history.
  3. Blood tests: These are performed to check for tumor markers, which are proteins that can be elevated in the presence of testicular cancer.

Imaging Studies

What imaging tests are used to diagnose testicular cancer? If the initial examination raises concerns, the following imaging studies may be ordered:

  • Ultrasound: This quick and painless scan provides detailed images of the testicles, helping to identify any abnormalities.
  • CT scan: If cancer is confirmed, a CT scan of the abdomen and chest may be performed to check for spread of the disease.

Referral to a Urologist

Why is a urologist involved in testicular cancer diagnosis? Urologists are specialists in the male reproductive system and play a crucial role in diagnosing and treating testicular cancer. They perform the surgical procedure necessary for a definitive diagnosis.

The Role of Urologists in Testicular Cancer Diagnosis and Treatment

Urologists are essential in the management of testicular cancer. These specialized surgeons focus on the urinary tracts of males and females, as well as the male reproductive system. Their expertise is crucial in accurately diagnosing and treating testicular cancer.

Diagnostic Surgery: Orchiectomy

How is testicular cancer definitively diagnosed? Unlike many other cancers, a biopsy is not typically performed for suspected testicular cancer. Instead, if cancer is strongly suspected based on initial tests, the entire affected testicle is surgically removed in a procedure called an orchiectomy.

Why is the entire testicle removed? This approach is taken for several reasons:

  • It prevents potential spread of cancer cells that could occur with a needle biopsy
  • It allows for a comprehensive examination of the entire tumor
  • It serves as both a diagnostic and initial treatment step

Is fertility affected by orchiectomy? While the removal of a testicle may sound alarming, it’s important to note that the remaining testicle can typically produce enough testosterone and sperm for normal sexual function and fertility. However, fertility preservation options may be discussed before surgery, especially if further treatment might be needed.

Post-Surgery Pathology

What happens after the testicle is removed? The removed testicle is sent to a pathology laboratory for thorough examination. Pathologists, who are specially trained doctors, will examine the tissue under a microscope to confirm the diagnosis and determine the specific type of testicular cancer.

Types of Testicular Cancer: Understanding the Pathology

Testicular cancers are primarily classified as germ cell tumors, which are further divided into two main types: seminomas and nonseminomas. Understanding the differences between these types is crucial for determining the most appropriate treatment approach.

Seminoma Tumors

What are the characteristics of seminoma tumors?

  • More common type of testicular cancer
  • Typically grow slowly
  • Often confined to the testicle but can spread
  • Highly curable, even in advanced stages
  • Generally more responsive to radiation therapy

Nonseminoma Tumors

How do nonseminoma tumors differ from seminomas?

  • Tend to grow and spread more quickly
  • More likely to metastasize beyond the testicle
  • Often require more aggressive treatment, including chemotherapy
  • Can be a mix of different cell types, including embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma

Are there other types of testicular cancer? While germ cell tumors account for about 95% of testicular cancers, there are rare types such as Leydig cell tumors and Sertoli cell tumors. These non-germ cell tumors often have a different prognosis and treatment approach.

Staging Testicular Cancer: Determining the Extent of Disease

Once testicular cancer is diagnosed, the next crucial step is determining its stage. Staging helps doctors understand how far the cancer has spread and guides treatment decisions. The staging process typically involves additional tests and imaging studies.

The TNM Staging System

How is testicular cancer staged? The most common system used for staging testicular cancer is the TNM system:

  • T (Tumor): Describes the size and extent of the main tumor
  • N (Nodes): Indicates whether the cancer has spread to nearby lymph nodes
  • M (Metastasis): Shows if the cancer has spread to other parts of the body

Stage Groupings

What are the main stages of testicular cancer?

  1. Stage I: Cancer is limited to the testicle
  2. Stage II: Cancer has spread to nearby lymph nodes in the abdomen
  3. Stage III: Cancer has spread beyond the lymph nodes to other parts of the body, such as the lungs or liver

Each stage can be further subdivided based on specific criteria, including tumor marker levels and the extent of spread.

Importance of Accurate Staging

Why is staging crucial in testicular cancer? Accurate staging is essential for several reasons:

  • It helps determine the most appropriate treatment plan
  • It provides important prognostic information
  • It allows for standardized communication among healthcare providers
  • It facilitates research and comparison of treatment outcomes

Treatment Options for Testicular Cancer

The treatment of testicular cancer depends on several factors, including the type and stage of cancer, as well as individual patient characteristics. Generally, testicular cancer has a high cure rate, even when diagnosed at later stages.

Surgery

What surgical procedures are used in treating testicular cancer?

  • Radical Inguinal Orchiectomy: This is the initial surgery to remove the affected testicle and is both diagnostic and therapeutic.
  • Retroperitoneal Lymph Node Dissection (RPLND): In some cases, especially for nonseminoma tumors, surgery to remove lymph nodes in the abdomen may be necessary.

Radiation Therapy

When is radiation therapy used in testicular cancer treatment? Radiation therapy is primarily used for seminoma-type tumors. It may be recommended:

  • After surgery to kill any remaining cancer cells
  • To treat lymph nodes that may contain cancer
  • As a palliative treatment to relieve symptoms in advanced cases

Chemotherapy

How is chemotherapy utilized in testicular cancer treatment? Chemotherapy plays a crucial role in many testicular cancer cases, particularly for:

  • Advanced-stage cancers
  • Nonseminoma tumors
  • Cases with high risk of recurrence
  • Recurrent cancer after initial treatment

Chemotherapy for testicular cancer typically involves a combination of drugs, with cisplatin-based regimens being the most common.

Surveillance

What is active surveillance in testicular cancer management? For some early-stage cancers, especially seminomas, active surveillance may be recommended after orchiectomy. This involves:

  • Regular check-ups and physical exams
  • Frequent blood tests to monitor tumor markers
  • Periodic imaging studies

The goal of surveillance is to detect any recurrence early while avoiding unnecessary treatment in patients who are likely cured by surgery alone.

Living with Testicular Cancer: Follow-up Care and Long-term Considerations

After completing treatment for testicular cancer, ongoing follow-up care is crucial. This phase of cancer care focuses on monitoring for recurrence, managing any long-term side effects of treatment, and supporting overall health and well-being.

Follow-up Schedule

What does follow-up care involve for testicular cancer survivors? A typical follow-up schedule may include:

  • Regular physical examinations
  • Blood tests to check tumor markers
  • Imaging studies (CT scans, chest X-rays) at prescribed intervals
  • Monitoring for late effects of treatment

The frequency of these follow-ups typically decreases over time if there’s no evidence of recurrence.

Long-term Side Effects

What are potential long-term effects of testicular cancer treatment? Some survivors may experience:

  • Infertility: Chemotherapy and radiation can affect sperm production
  • Cardiovascular issues: Some treatments may increase the risk of heart disease
  • Secondary cancers: There’s a slight increased risk of developing other cancers
  • Psychological impacts: Anxiety, depression, or body image concerns

Fertility Considerations

How can fertility be preserved in testicular cancer patients? Options may include:

  • Sperm banking before treatment
  • Testicular sperm extraction in some cases
  • Discussions about fertility preservation should occur early in the treatment process

Psychological Support

What psychological support is available for testicular cancer survivors? Many cancer centers offer:

  • Individual counseling
  • Support groups specifically for testicular cancer survivors
  • Resources for dealing with body image and sexuality concerns

Addressing the emotional aspects of cancer survivorship is an important part of comprehensive care.

Advances in Testicular Cancer Research and Treatment

The field of testicular cancer research continues to evolve, with ongoing studies aiming to improve diagnosis, treatment, and quality of life for patients. Some areas of current research include:

Molecular Profiling

How is molecular profiling advancing testicular cancer treatment? Researchers are investigating:

  • Genetic markers that may predict treatment response or risk of recurrence
  • Personalized treatment approaches based on tumor genetics
  • New targets for drug development

Immunotherapy

What role might immunotherapy play in testicular cancer? While not currently a standard treatment, studies are exploring:

  • Checkpoint inhibitors in refractory or relapsed cases
  • Combination approaches with traditional chemotherapy
  • Vaccine-based therapies to stimulate immune response against cancer cells

Minimizing Treatment Toxicity

How are researchers working to reduce treatment side effects? Current efforts focus on:

  • Tailoring treatment intensity based on risk stratification
  • Developing less toxic chemotherapy regimens
  • Improving surgical techniques to preserve fertility and reduce complications

Survivorship Studies

What aspects of survivorship are being studied? Research is ongoing in areas such as:

  • Long-term effects of treatment on cardiovascular health
  • Strategies to preserve and restore fertility
  • Psychological interventions to improve quality of life for survivors

These advancements in research hold promise for further improving outcomes and quality of life for individuals affected by testicular cancer. As our understanding of this disease continues to grow, treatment approaches are likely to become even more targeted and effective.

How We Diagnose Testicular Cancer – Dana-Farber Cancer Institute

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How We Diagnose Testicular Cancer



  • Testing for testicular cancer

    What to expect during your appointment: exam, blood test, and ultrasound
    • First, the doctor will examine your testicles for lumps or swelling.
    • A blood test will be performed to test for certain proteins in your blood. These proteins are called tumor markers and can be used to diagnose testicular cancer.
    • If the doctor thinks that you may have testicular cancer, the next step is to have an ultrasound, a quick and painless scan that looks at the inside of your testicles. Normal testicles are smooth and even. Shadows on the ultrasound
      usually indicate that a cancer is present. The ultrasound also measures blood flow to the testicles, since blood flow is usually increased in the area of a cancer. The experienced ultrasound specialists at Dana-Farber Brigham Cancer Center
      understand some men may have anxiety about having an ultrasound; they will explain the process and help to ease any anxiety.
    Urology

    If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. Urologists are surgeons who focus on the urinary tracts
    of males and females, and on the reproductive system of males, including problems with the testicles. For patients with testicular cancer, a urologist will perform the surgery to remove your tumor.

    Diagnostic surgery

    Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling
    the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer, and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose
    for testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly. Our urology team will make this a priority for you. If there is any uncertainty, the urologists can examine the testicle by pulling the testicle
    out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.

    This may sound frightening, but recovery is quick. And do not worry — the remaining testicle can do the work of two. Please understand that removal of the testicle will not make you sterile (unable to have children) and does not take away your ability
    to enjoy sexual activity or have an erection.

    Pathology

    The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. A pathologist is a specially trained doctor who identifies cancerous cells and tumors. Dana-Farber Brigham Cancer Center pathologists are well-known
    for their expert evaluation of testicular cancer. They will diagnose and classify your cancer quickly and competently.

    Most testicular cancers are classified as germ cell tumors. This is not an infection. Instead, the term germ cell reflects the fact that testicles make sperm. Germ cell tumors are divided into two types: seminoma and nonseminoma.

    • Seminoma tumors are the more common kind of testicular cancer. They are usually limited to the testicle but occasionally spread to other parts of the body. Seminomas tend to grow very slowly and are very curable.
    • Nonseminoma tumors can grow more quickly and can be more likely to spread beyond the testicle to other parts of the body. While these tumors are curable, men with nonseminoma tumors are more likely to require chemotherapy at some point in their treatment.
    Another test to expect if you are diagnosed with testicular cancer

    In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. Another kind of scan can be used to look for cancer in other parts of the body:

    • A CT scan (also known as a CAT scan) is a painless procedure that takes a series of detailed x-ray pictures inside the body from different angles. The CT scan is quick and painless and will look at your abdomen and chest. The results
      are usually ready in just a few hours.

    Our experienced radiologists will review your scans to help determine the stage of your cancer.

    The stages of testicular cancer

    Testicular cancer is divided — or staged — into groups based on how far the cancer has spread to other parts of the body. Here are the basic stages for testicular cancer:

    • Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. This stage is cured more than 99% of the time.
    • Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen. These lymph nodes are usually located in the area near large blood vessels. Stage 2 testicular cancer is also
      very curable.
    • Stage 3 means that the cancer has spread beyond the testicle and abdominal lymph nodes to additional areas in the body.

      • Stage 3 can mean that the cancer has spread to the lymph nodes in front of the heart or to the lungs. Stage 3 testicular cancer is also very curable, but may require more treatment than Stage 2.
      • Stage 3 can also mean that the cancer has spread to areas beyond the lungs and lymph nodes. Lance Armstrong was diagnosed with Stage 3 testicular cancer in 1996. His cancer had spread to his lungs, stomach and brain. He has been cancer-free
        since 1997. With proper treatment, even more advanced Stage 3 testicular cancer can be cured.



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Designation Features
T (tumor)
T1 Neoplasm located within the boundaries of the testis and epididymis, may grow into the albuginea
T2 Intrusion into the albuginea and vaginal membranes is added to the signs of T1
T3 Tumor infiltration of spermatic cord
T4 Neoplasm invasion into spermatic cord and scrotum tissue
N (metastases to lymph nodes)
N1 Regional metastases (in iliac, retroperitoneal lymph nodes) up to 2 cm in size
N2 Size of metastasized regional lymph nodes 2 to 5 cm
N3 Metastases in regional lymph nodes larger than 5 cm
M (presence of metastases in distant lymph nodes and organs)
M1a Metastases are found in the lungs and distant lymph nodes
M1b Metastasis to other organs