Introduction
Testicular cancer develops in the tissues of either one or both the testicles in men. Testicles are the male reproductive glands and are located in the scrotum (ADAM Medical Encyclopedia, 2011). Men between the age groups of 15 and 35 are found to be more prone to this disease. Though it is more common among young or middle-aged men (National Cancer Institute, 2012), its incidence in older men and younger boys cannot be ruled out. Around 8,000 men are diagnosed with testicular cancer each year in the United States and around 2,000 each year in UK (Cancer Research UK, 2009). Studies also suggest that Caucasian men are at a larger risk of developing testicular cancer. Testicular cancer is one of the few topics that are rarely talked about. Every hour a man is diagnosed with testicular cancer (Testicular Cancer Awareness foundation, 2009). This could be avoided to a large extend if proper awareness is created among men especially young adults. This review is an attempt to understand the degree of awareness that is present and identify ways to improve awareness among young adults.
Compared to other types of cancers, the chances of a man developing testicular cancer is very less, roughly 0.4%. Though the exact causes of this cancer is still a mystery there are certain factors are believed to increase a person’s chance of developing this disease. Some of these factors are discussed below.
Cryptorchidismand Its Causes
Cryptorchidism also known as undescended testicle is a condition where in some males, the testicles do not move from inside the abdomen in to the scrotum. Normally this process happens before birth. There are surgical procedures to rectify this condition but still the risk of developing testicular cancer remains. Congenital abnormalities are another factor. These refer to abnormalities of penis, testicles, kidneys as well as hernia in the groin area. Testicular cancer is also believed to be hereditary. Men with a history of testicular cancer face a higher risk of developing cancer in the other testicle also (“Testicular Cancer,” 2012).
One of the most common symptoms of testicular cancer is a lump or swelling in the testicle. This lump is usually painless. Some people develop pain in the affected area and some develop back ache specifically in the lower abdominal area. A feeling of heaviness and the testicle becoming swollen and tender are also specified by some patients. Not every lump is a cancer. It is quite common for men to have small crystal like swellings in testicles which are not harmful. Proper diagnosis and confirmation can be done by a doctor. There are procedures like biopsy and ultrasound tests that can help the doctor look inside the scrotum (American Cancer Society, 2011).
It Is Important To Create Awareness on How Testicular Cancer Can Spread
Testicular cancer can spread to other parts of the body if left untreated. The most common type of testicular cancer is the germ cell tumor. Germ cells are the cells responsible for making sperms. Seminomas and non-seminomas are two types of germ cell tumors. The seminomas are slow-growing form of cancer while the non-seminomas are quicker and the more common type of testicular cancer seen (ADAM Medical Encyclopedia, 2011). Cancer that develops in the stroma of the testicles is called gonadal stromal tumor. Stroma is the hormone-generating supportive tissue of the testicles. Stromal cancer is of two types – the Leydig cell tumors and the Sertoli cell tumors. Leydig cell tumors develop in the leydig cells that are responsible for making male sex hormones. These tumors can produce an excess of estrogen or androgen in the patient. Estrogen-producing tumors results in loss of sexual desire and excessive growth of breasts. The symptom of androgen-producing tumors is excessive hair growth in the face and body at an early age. Sertoli cell tumor which is another type of stromal cancer develops from the sertoli cells which are responsible for supporting and nourishing the germ cells. These tumors do not generate hormones and often are not cancerous (ADAM Medical Encyclopedia, 2011). Cancer which has spread to other parts is called metastatic cancer. Most often testicular cancer spreads to lymph nodes and lungs. Though rare, this spreads to other organs like liver, bones and brain (NHS Choices, 2010). The symptoms of metastatic cancer include persistent cough, spitting of blood while coughing, shortness of breath, enlargement of breasts accompanied by swelling in the breast area, swelling or lump in the neck and lower back ache.
Treating Testicular Cancer
There are surgical and non-surgical methods for treating testicular cancer. The surgical procedure removes the affected testicle. An artificial testicle can be inserted in the scrotum if needed to give it a normal appearance. Testicular cancer diagnosed during the early stage can be completely cured by surgery. Chemotherapy and radiotherapy are the non-surgical treatments used. These methods are more effective in treating cancer that has spread to other parts. In chemotherapy, medicines are used in several doses over several weeks to destroy the cancer cells (Bupa’s Health Information Team, 2011). Chemotherapy is also recommended by doctors after surgery to reduce the risk of the cancer returning and before surgery to reduce the size of the tumor. Radiotherapy uses radiations to destroy cancer cells.
Studies show that there is a 97 – 100% survival rate among patients with stage I testicular cancer (Albers et al., 2009). But the after effects of developing testicular cancer and the successful treatment are gruesome. One of the most obvious outcomes is the impact on fertility. Men with testis tumors exhibit sperm abnormalities. Chemotherapy and radiotherapy also has a negative impact on fertility of the patient. Some hospitals offer their patients an opportunity to store their sperm before going ahead with the treatments. Other side effects include psychological issues. The person might start feeling that he is exhibiting low sex drive or reduced sexual function. Men who had to get both the testicles removed are given testosterone replacement therapy. This is needed because testosterone gives men their normal libido. Low levels of testosterone can also cause mood swings and tiredness.
Tablets, injections and gels are the normally used methods for testosterone replacement therapy. Tablets are often not absorbed well and hence not used nowadays. Injections are very effective but need to be taken every two weeks. Skin patches or gels are the latest method used for testosterone replacement. Though this is the most preferred method, it causes skin irritation in some men (“Sex and Testicular Cancer’” 2012). Retrograde ejaculation is a side effect seen in men who had undergone a retroperitoneal lymph node dissection where the lymph nodes are taken to the back of the abdomen. This procedure is done if the lymph nodes are enlarged after radiotherapy or chemotherapy. Retrograde ejaculation is nothing but ejaculating backwards. The sperm and semen instead of coming out of the penis goes back into the bladder. The person with this side effect experiences dry orgasms and is infertile.
Another matter of equal concern is the effect the treatment has on the person’s sexual partner. Not much is known regarding the amount of drugs taken during chemotherapy that comes through in the semen. Doctors suggest the use of condom during and for three months after the chemotherapy treatment. Experts also suggest taking precautions to prevent pregnancy during and for a while after chemotherapy and radiotherapy. There is a very high chance that the sperm is affected and the baby will suffer abnormalities. A very important drug used in chemotherapy – cisplatin – causes damage to the kidneys (“Testicular Cancer, After Treatment,” 2012). Less than 10% of men undergoing chemotherapy develop Raynund’s phenomenon. This is a condition where the blood vessels especially in the hands start narrowing and the skin turning white, blue and then red when exposed to triggers like cold. Men undergoing radiation therapy have an increased risk of heart disease.
Research also suggests that men who had received radiation therapy for testicular cancer had twice the chance of being diagnosed with secondary cancer compared to other men and men receiving chemotherapy had 80% chance. Chemotherapy is also believed to cause chemobrain, a condition where the subject has trouble concentrating. This is an area where ongoing research is happening and experts are not clear whether undergoing treatment for testicular cancer indeed increases the chance of developing other cancers and cardiovascular diseases.
Why Is Early Diagnosis Important?
An early diagnosis of the tumor can help one to stop the advancement of the cancer. The most commonly suggested method is regular testicular self-exam (WebMD LLC, 2010). Self-exams should be done after a warm shower since warmth causes the skin of the scrotum to soften. Change in shape, size or consistency of the testis or the occurrence of lumps can suggest tumors that can develop to cancer. As per a study lead by researchers from the Fred Hutchinson Cancer Research Center in Seattle, Washington suggest that there is a link between the use of marijuana and occurrence of testicular cancer(Catharine Paddock, 2009). Men with HIV is also said to have a 35% increased risk of developing testicular cancer.
Conclusion
There are suggestions regarding the link between diet and the incidence of testicular cancer. Some suggest that diet has an influence on developing of testicular cancer and some suggest obese men are at a higher risk. It is generally agreed upon that a healthy diet which is low in fat and high in fresh fruits, vegetables and whole grains can help prevent different types of cancers that might include testicular cancer.
Whatever the general view regarding prevention of cancer, a healthy life style is essential to stay healthy. There is a need for proper awareness especially among young boys since they are at a higher risk of indulging in the habits of using drugs, smoking, sex with multiple partners and following an unhealthy diet.
References
Albers, P. Albrecht, W. Algaba, F. Bokemeyer, C. Cohn-Cedermark, G. Fizazi, K. Horwich, A. Laguna
M, P. (2009). Guidelines on Testicular Cancer.European Association of Urology.
PubMed Health. Testicular Cancer.Retrieved April 20, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002266/
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http://www.medicinenet.com/testicular_cancer/article.htm
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http://testicularcancerawarenessfoundation.org/
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http://www.nhs.uk/Conditions/Cancer-of-the-testicle/Pages/Symptoms.aspx
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http://www.bupa.co.uk/individuals/health-information/directory/t/testicular-cancer#textBlock219155
