Testicular cancer occurs most often in men between the ages of 20 and 39, and is the most common form of solid tumour in men between the ages of 15 and 34. It may also occur in young boys, but only about 3% of all testicular cancer is found in this group. Tumors usually occur in one testicle, however, 2-3% of tumors can occur in both testicles, either simultaneously or at a later date. Tumors can also spread to the lymph nodes, the lungs or other organs. It is more common among Caucasians than among men of African and Asian descent.
Causes Although the exact cause of testicular cancer is unknown, several factors seem to increase risk. These include a past medical history of undescended testicle(s), abnormal testicular development, Klinefelter's syndrome (a sex chromosome disorder that may be characterized by low levels of male hormones, sterility, development of breasts, and small testes), men whose mothers used diethylstilbestrol during pregnancy, or men who have had previous testicular cancer. There is no link between vasectomy and elevated risk of testicular cancer.
Signs and Symptoms The first sign is usually a firm, painless, smooth testicular mass which is sometimes accompanied by a feeling of heaviness in the testicles. Other symptoms of testicular cancer include: a feeling of swelling in the scrotum, discomfort or pain in the scrotum, ache in the lower back, pelvis or groin area, collection of fluid in the scrotum, gynecomastia and nipple tenderness. In advanced stages symptoms include: ureteral obstruction, abdominal mass, coughing, shortness of breath, weight loss, fatigue, pallor and lethargy.
Treatment Testicular carcinoma can be treated with surgery, radiation therapy, chemotherapy, surveillance, or a combination of these treatments. Testicular cancer may be more difficult to treat if it has spread to the liver, bones, or brain, but even in those cases, men can often be cured. If the cancer is a recurrence of a previous tumour, the treatment usually consists of chemotherapy using combinations of different medications, such as ifosfamide, cisplatin, etoposide, or vinblastine, sometimes followed by an autologous bone marrow or peripheral stem-cell transplant.
While it may be possible, in some cases, to remove testicular cancer tumors from a testis while leaving the testis functional, this is almost never done, as more than 95% of testicular tumors are malignant. Usually the scrotum is not removed so that prosthesis can be put in place. Hormone replacement therapy may be needed after bilateral orchiectomy (removal of both testes). Treatment for this condition does not normally affect sexuality, masculinity or erectile function.
Prognosis Testicular cancer has one of the highest cure rates of all cancers: in excess of 90%; essentially 100% if it has not metastasized. Less than five percent of those who have testicular cancer will have it again in the remaining testis.
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