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Testicular Cancer

This is one of the first articles I read when I was diagnosed – found it quite useful…

Testicular Cancer is a relatively rare form of cancer. Although testicular cancer accounts for only 1 percent of cancers in men, testicular cancer is the most common cancer in men between the ages of 20 and 34. About 75% of cases of testicular cancer occur in men between 20 and 49. Nevertheless, testicular cancer is one of the most treatable forms of cancer, with cure rates approaching 100% if detected early. Additionally, testicular cancer is more common in white men than black or Asian men.

Most testicular cancer cases are found by men themselves when doing a self-examination or by accident. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves routinely become familiar with the way their testicles normally feel. Any changes in the way they feel from month-to-month should be checked by a doctor, preferably a Urologist.

If your doctor tells you that you need an orchiectomy, dont freak out. It may cause you some issues, but in most physical instances, the orchiectomy should not affect you in any way other than minor post operative recovery. One testicle is all that is needed to do all the things that you have always done. You will be able to return to your normal sex life soon after recovery from the orchiectomy – a minor surgery. Yes it is minor, infact an orchiectomy is almost always done in an outpatient facility, which means you wouldnt even need to stay in a hospital for a night. Most men can even father children after an orchiectomy with only one testicle – ask your doctor about possibly banking sperm, prior to the orchiectomy just as a precaution.

Bi-Lateral Orchiectomy, which means they remove BOTH testicles due to cancer or fear of cancer, is also nothing that will change your normal routine of life. Natrually, you will not be able to father children with no testicles – so you will definately want to bank sperm if you are planning on ever having children of your own. Medical advances has made it easy to “replace” testosterone levels in your body and maintain a normal, happy sex life! Talk to your Doctor about different hormone replacement options. Currently there are daily gel applications and shots available. To learn more about “Sex and Testicular Cancer”, Click Here.

Before the Orchiectomy…

The doctor should have some blood tests done. They need to check your blood for the presence of certain tumor markers and their levels while the tumor is still in your body. These tumor markers can later be used to determine if the cancer has spread outside of the testicle, but it is very important that they begin testing and establish some baselines before the surgery. Similarly, we strongly encourage newly diagnosed men to ask their doctors to check their serum testosterone level before the orchiectomy. There is no therapeutic reason to do this, but we have found that it may be useful to know this number at some point in the future. The doctors may also give you the option of an epidural or general anesthesia for the orchiectomy. General anesthesia is clearly the more traditional choice. However, an epidural (lower back) block may be beneficial if you do not react well to general anesthetics. With the epidural anesthetic it is possible (though maybe not desirable!) to remain awake and talkative during the whole operation! Both anesthetics have possible problems and side effects, carefully discuss your options with your doctor.

The Orchiectomy…

The actual removal is done by making about a 4 inch incision along the “bikini line” through the lower abdomen on the side in question–they will NOT cut through the scrotal sack whatsoever during an orchiectomy. Once the incision has been made, the surgeon pushes the testicle up through the pelvic region and out it comes. A snip here, a stitch there, and you’re done before you know it. Average time on the table is about 45 minutes to an hour, but you should probably expect to stay in the hospital at least overnight following the orchiectomy. Unlike the RPLND, this operation is very simple and should not require any special expertise on the part of the surgeon.

After the orchiectomy – surgery, they will probably wake you up pretty soon after and encourage you to get up and try to walk. It will hurt, but it will also get your insides working faster and get you out of the hospital sooner. You’ll probably have a reasonable amount of pain at the incision, and you might want to consider wearing sweatpants for a week or two. There may also be numbness of the skin around the incision, but that should eventually go away. Different people will react differently to the operation. Some will be up and about the next day; others will lay around in bed for a while. We recommend that you try to get up and do something because otherwise you may just end up sitting around feeling sorry for yourself. Your attitude will make a huge difference in your recovery time; the better it is the better you will do. We suggest you learn about the cancer, so that you know what to expect from the pathology report and from the doctor and the future ahead — but don’t let it overwhelm you. The doctor probably wont let you drive or do any heavy lifting for a couple of weeks, so be prepared to ask for help getting around. What is recommended post-surgery? Click Here to learn about different follow-up care plans.

There a several different ways to treat testicular cancer. Perhaps the most common start is a Orchiectomy. Once removed, the testicle can be analyzed by a clinical pathologist to diagnose the stage of the cancer. The stages are listed below. Other treatment options are Lymph Node Dissection, Chemo, Radiation and Surveillance.

Want to know more about the Orchiectomy? Click Here
Want to learn about
the RPLND? Click Here

Stage I Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), ollowed by external-beam radiation to the lymph nodes in the abdomen. Clinical trials are also being performed on radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back.

If a tumor called a nonseminoma is found, treatment may be one of the following:

  1. Radical inguinal orchiectomy and removal of some of the lymph nodes in the abdomen (lymph node dissection). Patients may undergo surgery that will preserve fertility. Blood tests and chest x-rays must be done once each month for the first year following the operation and at least every 2 months during the second year. A CT scan, a special kind of x-ray, may also be done. If results of the tests don’t look normal and the cancer has recurred (come back), the doctor will give the patient systemic chemotherapy as soon as possible.
  2. Radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back. The doctor must check the patient and do blood tests and x-rays every month for 2 years. This option is chosen only if the tumor has certain special features.

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 (no lymph nodes can be felt in the abdomen, and no lymph nodes block the ureters [the tubes that carry urine from the kidney to the bladder]), treatment will probably be surgery to remove the testis (radical inguinal orchiectomy). External-beam radiation is then given to the lymph nodes in the abdomen.

If a tumor called a seminoma is found and the tumor is bulky (lymph nodes can be felt in the abdomen and/or the lymph nodes block the ureters, or if a CT scan shows them to be large), treatment will probably be a radical inguinal orchiectomy followed by systemic chemotherapy or external-beam radiation therapy.

If a tumor called a nonseminoma is found, treatment will probably be one of the following:

  1. Radical inguinal orchiectomy and removal of the lymph nodes in the abdomen (lymph node dissection). The doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. If the test results are not normal, patients will probably receive systemic chemotherapy.
  2. Radical inguinal orchiectomy and lymph node dissection, followed by systemic chemotherapy. Blood tests and chest x-rays must be done once each month for the first year after the operation. CT scans are also done regularly.
  3. Radical inguinal orchiectomy followed by systemic chemotherapy. If x-rays following chemotherapy show that cancer remains, surgery may be done to remove the cancer. After the operation, the doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. In some cases, chemotherapy may be given before the radical inguinal orchiectomy.
  4. Clinical trials of systemic chemotherapy instead of lymph node dissection (in selected patients).

Stage III Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by systemic chemotherapy. Clinical trials are testing radical inguinal orchiectomy followed by systemic chemotherapy. If a tumor called a nonseminoma is found, treatment will probably be one of the following:

  1. Systemic chemotherapy. Clinical trials are testing new chemotherapy drugs.
  2. Systemic chemotherapy, followed by surgery to take out any masses that remain to see if there are any cancer cells left. If cancer cells remain, patients will probably receive more systemic chemotherapy.
  3. Clinical trials of systemic chemotherapy.
  4. Clinical trials of high-dose systemic chemotherapy with autologous bone marrow transplantation (in some patients).

Recurrent Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope, where the cancer recurred (came back), and other factors. Treatment options include systemic chemotherapy, high-dose systemic chemotherapy with autologous bone marrow transplantation, surgery, and clinical trials testing new chemotherapy drugs.

This entry was posted on Friday, December 9th, 2005 at 3:26 pm and is filed under Health. You can follow any responses to this entry through the RSS 2.0 feed.


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