Testicular cancer refers to malignant infiltration of one or both the testicles in the male. The risk of developing testicular cancer is roughly 1 in 250 in a male. It is the most common cancer in males between the age group 20 to 39 years, and is rarely seen before the age of 15 years. It is important to note that all lumps felt in the testicles are not tumours and all tumours are not malignant. Some other conditions that may be confused for a testicular cancer are appendix testis, epididymal cysts etc. Testicular cancers are curable in almost 90 percent of all cases and almost 100 percent if it has not metastasized. In cases where there is a moderate spread of the cancer cells, modern chemotherapy offers a cure rate of atleast 80 percent inspite of the spread.
Testicular cancer symptoms: The patient may complain of a lump in one or both of the testis which may or may not be painful, they may describe a sense of heaviness or weight felt in the scrotum and some patients may complain of a sensation of a pull felt in the lower part of the abdomen which may be described as a sharp pain, discomfort or dull ache in the lower abdomen or the scrotum. Patients may also present with symptoms of metastasis like for e.g. If the metastasis is in the lymph nodes, patients may complain of a swelling in the neck due to metastasis in the cervical lymph nodes, if the metastasis is in the lungs, the patient may complain of cough, dyspnoea or haemoptysis, in some cases the spread may be into the lumbar vertebrae and the patient complains of persistent lower backache. Due to hormonal imbalance, some patients develop enlargement of the breasts also known as gynaecomastia. Those are the main testicular cancer symptoms you will find.
Diagnosis and Tests for Testicular cancer: On physical examination the physician is able to palpate a lump in the scrotum, which is fixed to the testicles, and may or may not be associated with tenderness. If there is metastasis the physician may be able to palpate cervical lymph nodes. In order to confirm the diagnosis a scrotal ultrasound may be advised. For further evaluation regarding the extent of metastasis, a CT scan is advised. Also blood tests are important to confirm the diagnosis. Blood tests to detect the levels of tumour markers like Alpha feto protein, Beta HCG and LDH are important. A testicular biopsy may or may not be advised. In general a unilateral enlargement of the testis with or without pain in the adolescent or young male should raise suspicion of testicular cancer. For further management all testicular tumours are classifies according to the TNM classification.
Management: The basic types of treatment are surgery, radiation therapy and chemotherapy. The surgery done is inguinal Orchiectomy which involves removal of the affected testicle. In cases of spread of the tumour, Retroperitoneal lymph node dissection may be done. Radiation therapy is used to treat stage 2 seminoma cancers or as a preventive therapy in the case of stage 1 seminomas. Chemotherapy
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