Cancer Stage Testicular
Cancer Stage Testicular
Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system.
In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's risk of testicular cancer is roughly 1 in 250 (0.4%). It is most common among males aged 15–40 years, particularly those in their mid-twenties. Testicular cancer has one of the highest cure rates of all cancers: in excess of 90 percent; essentially 100 percent if it has not metastasized. Even for the relatively few cases in which malignant cancer has spread widely, chemotherapy offers a cure rate of at least 85 percent today. Not all lumps on the testicles are tumors, and not all tumors are malignant; there are many other conditions such as testicular microlithiasis, epididymal cysts, appendix testis (hydatid of Morgagni), and so on which may be painful but are non-cancerous.
Prevalence and distribution
Testicular cancer is most common among caucasian men and rare among men of African descent. Testicular cancer is uncommon in Asia and Africa. Worldwide incidence has doubled since the 1960s, with the highest rates of prevalence in Scandinavia, Germany, and New Zealand.
Incidence among African Americans doubled from 1988 to 2001 with a bias towards seminoma. The lack of significant increase in the incidence of early-stage testicular cancer during this timeframe suggests that the overall increase was not due to heightened awareness of the disease.
Although testicular cancer is most common among men aged 15–40 years, it has three peaks: infancy through the age of four as teratomas and yolk sac tumors, ages 25–40 years as post-pubertal seminomas and nonseminomas, and from age 60 as spermatocytic seminomas.
Germ cell tumors of the testis are the most common cancer in young men between the ages of 15 and 35 years.
A major risk factor for the development of testis cancer is cryptorchidism (undescended testicles). It is generally believed that the presence of a tumor contributes to cryptorchidism; when cryptorchidism occurs in conjunction with a tumor then the tumor tends to be large. Other risk factors include inguinal hernia, mumps orchitis . Physical activity is associated with decreased risk and sedentary lifestyle is associated with increased risk. Early onset of male characteristics is associated with increased risk. These may reflect endogenous or environmental hormones.
Signs and symptoms
A testicular mass can often be palpated. Because testicular cancer is curable when detected early (stage one can have a success rate of >98%), experts recommend regular monthly testicular self-examination after a hot shower or bath, when the scrotum is looser. Men should examine each testicle, feeling for pea-shaped lumps. The testicle should normally feel smooth to the touch. Ridges may be felt because of enlarged blood vessels or tumor growth. Additionally the entire testicle may feel hard and bumpy to the touch.The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in asymptomatic adolescent and adult.
Symptoms may include one or more of the following:
- a lump in one testis or a hardening of one of the testicles
- abnormal sensitivity (either numbness or pain)
- loss of sexual activity or interest
- sexual withdrawal
- A burning sensation, especially following physical activity.
- build-up of fluid in the scrotum or tunica vaginalis, known as a hydrocele
- a dull ache in the lower abdomen or groin, sometimes described as a "heavy" sensation
- lumbago - lower back pain
- An increase, or significant decrease, or sudden decrease in the size of one or both testes. The testicle with a tumor may be severely enlarged, as much as 3 times the original size. Simultaneously the other testicle may be shrunken in size, due to the tumor taking up the majority of the blood supply to the scrotum.
- blood in semen
- general weak and tired feeling
The nature of any palpated lump in the scrotum is evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by CT scans, which are used to locate metastases. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. AFP alpha1 feto protein, Beta-HCG, and LDH are the typical markers used to identify testicular cancer. The diagnosis is made by performing an inguinal orchiectomy, surgical excision of the entire testis along with attached structures epididymis and spermatic cord; the resected specimen is evaluated by a pathologist. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum. A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.
Diagnosis
The cardinal diagnostic finding in the patient with testis cancer is a mass in the substance of the testis. Unilateral enlargement of the testis with or without pain in the adolescent or young adult male should raise concern for testis cancer.
An incorrect diagnosis is made at the initial examination in up to 25% of patients with testicular tumors and may result in delay in treatment or a suboptimal approach (scrotal incision) for exploration.
- Epididymitis or epididymoorchitis
- Hematocele
- Varicocele
The differential diagnosis of testicular cancer requires examining the histology of tissue obtained from an inguinal orchiectomy specimen. Orchiectomy, rather than transcrotal biopsy, is preferred to reduce the risk of spill and thus the risk of metastasis, in the event that the tumor is malignant. For orchiectomy, an inguinal surgical approach is preferred.
Management
Before 1970, the young man with recurrent testicular cancer was destined to have rapid progression and death from disseminated disease. Currently, although 7000 to 8000 new cases of testicular cancer occur in the United States yearly, only 400 men are expected to die of the disease. Much of this improvement is due to advances in adjuvant therapy.
Due to the risk of subsequent metastasis, post-surgical adjuvant therapy may be offered to the patient following orchiectomy. The type of adjuvant therapy depends largely on the histology of the tumor and the stage of progression at the time of surgery. These two factors contribute to the risk of recurrence, including metastasis. Adjuvant treatments may involve chemotherapy, radiotherapy or careful surveillance by frequent CT scans and blood tests by oncologists.
Classification
Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors. Most of the remaining 5% are sex cord-gonadal stromal tumours derived from Leydig cells or Sertoli cells. Correct diagnosis is necessary to ensure the most effective and least harmful treatment. To some extent, this can be done via blood tests for tumor markers, but definitive diagnosis requires examination of the histology of a specimen by a pathologist.
Most pathologists use the World Health Organization Classification system for testicular tumours:
- Germ cell tumours
- Tumours of one histologic type (pure forms)
- Spermatocytic seminoma
- Embryonal carcinoma
- Yolk sac tumour
- Trophoblastic tumours
- Placental site trophoblastic tumour
- Cystic trophoblastic tumour
- Teratoma
- Tumours of more than one histologic type (mixed forms)
- Sex cord/Gonadal stromal tumours
- Granulosa cell tumour
- Thecoma Fibroma Group
- Sex cord/gonadal stromal tunour - incompletely differentiated
- Sex cord/gonadal stromal tumour - mixed types
- Mixed Germ Cell and Sex Cord/Gonadal Stromal Tumours
- Miscellaneous tumours of the testis
- Nephroblastoma
- Paraganglioma
- Haematopoietic tumours
- Tumours of collecting ducts and rete
- Tumours of the paratesticular structures
- Mesenchymal tumours of the spermatic cord and testicular adnexae
- Secondary tumours of the testis
Staging
After removal, a testicular tumor is staged by a pathologist according to the TNM Classification of Malignant Tumors as published in the AJCC Cancer Staging Manual. Testicular cancer is categorized as being in one of three stages (which have subclassifications). The size of the tumor in the testis is irrelevant to staging. In broad terms, testicular cancer is staged as follows:
- Stage I: the cancer remains localized to the testis.
-
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Testicular cancer - Wikipedia, the free encyclopedia
[1] In broad terms, testicular cancer is staged as follows: Stage I: the cancer remains localized to the testis. Stage II: the cancer involves the testis and metastasis to ...
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Stage I Testicular Cancer. Treatment of stage I testicular cancer depends on whether the cancer is a seminoma or a nonseminoma. Treatment of seminoma may include the following:
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Stage II Testicular Cancer Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found and the tumor is nonbulky ...
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ASCO ANSWERS
ASCO ANSWERS WHAT DOES STAGE MEAN? The stage is a way of describing the cancer, such as how big the tumor is, how much it has grown, and whether it has spread to lymph nodes or other ...
Definition of stage II testicular cancer - NCI ...
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Definition of stage II testicular cancer - NCI ...
Stage II is divided into stage IIA, stage IIB, and stage IIC, and is determined after a radical inguinal orchiectomy (surgery to remove the testicle) is done.
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What type of testicular cancer do I have? What is the stage of the cancer? What are my treatment options? What are the risks and benefits of these treatments?
Testing for Cancer, Diagnosis & Stages of Testicular
The Testicular Cancer Information, Resource and Support Center. Developed to help patients with testicular cancer and their family members.
Definition of stage III testicular cancer - NCI ...
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