Testicular
Cancer Treatment
No
one treatment works for all testicular cancers. Seminomas
and nonseminomas differ in their tendency to spread,
their patterns of spread, and response to radiation
therapy. Thus, they often require different treatment
strategies, which doctors choose based on the type of
tumor and the stage of disease.
Because
they are slow growing and tend to stay localized, seminomas
generally are diagnosed in stage 1 or 2. Treatment might
be a combination of testicle removal, radiation, or
chemotherapy. But surgical removal of lymph nodes usually
is not necessary for seminoma patients because this
type of tumor is what the University of Pennsylvania's
Malkowicz calls "exquisitely sensitive" to
radiation. Normally directed to the retroperitoneal
lymph nodes but sometimes to other lymph nodes, radiation
can effectively remove cancer cells there. Stage 3 seminomas
are usually treated with multidrug chemotherapy.
Though
most nonseminomas are not diagnosed at an early stage,
cases confined to the testicle may need no further treatment
other than testicle removal. These men must have careful
follow-up for at least two years because about 10 percent
of stage 1 patients have recurrences, which then are
treated with chemotherapy. Stage 2 nonseminoma patients
who have had testicle and lymph node removal may also
need no further therapy. Some doctors opt for a short
course of multidrug chemotherapy for stage 2 patients
to reduce the risk of recurrence. Most stage 3 nonseminomas
can be cured with drug combinations.
Side
Effects
Any
kind of cancer treatment can cause undesirable side
effects. But not all patients react the same way or
to the same degree. One of the main concerns of young
men is how treatment might affect their sexual or reproductive
capabilities.
Removing
one testicle does not impair fertility or sexual function.
The remaining testicle can produce sperm and hormones
adequate for reproduction. Removal of the retroperitoneal
lymph nodes usually does not affect the ability to have
erections or orgasms. It can, however, disrupt the nerve
pathways that control ejaculation, causing infertility.
Modern
"nerve-sparing" surgical techniques have increased
the odds of retaining fertility. Many surgeons are abandoning
a "total scorched-earth policy where you take out
every single lymph node," Malkowicz says.
"We
now can limit the amount of dissection necessary to
get a good therapeutic cure, but not overdissect to
disrupt every bit of nerves," he says, adding that
"ejaculation can be preserved" in as many
as 80 percent of cases.
Testicular
cancer patient Knies points to his twin sons as proof
that though his reproductive capacity was temporarily
lost, it was restored.
Chemotherapy
can cause increased risk of infection, nausea or vomiting,
and hair loss. Not all patients experience these. Some
drugs may cause infertility, but studies have shown
that many men recover fertility two to three years after
therapy ends. Radiation patients may experience fatigue
or lowered blood counts. Infertility may also occur,
but this usually is temporary.
Doctors
emphasize that even though the cure rate is very high
for all types and stages of testicular cancer, many
of the drastic measures taken to cure later-stage disease
can be avoided if the tumor is caught early enough.
The best way to do this is through regular self-examination,
a message that Knies says might be difficult to convey
to the prime risk group.
"You
have a real sense when you're in your late teens and
early 20s of invincibility," he says. "The
last thing you're thinking then is that something can
stop you. But as I know, it can."
John
Henkel is a staff writer for FDA Consumer.
How
to Examine the Testicles
"I never examined myself."
Pennsylvania
resident Glenn Knies, 34, says he wasn't consciously
looking for possible cancer 11 years ago. He calls it
"pure luck" that he noticed an abnormality
in the shower and sought medical attention.
Now
a survivor of testicular cancer, Knies strongly urges
men to examine their testicles regularly.
Medical
professionals say men can greatly increase their chances
of finding testicular tumors by testicular self-examination,
or TSE. Locating a tumor this way can boost the odds
of early intervention and total cure.
"Diagnosis
of testicular cancer usually starts with self-discovery,"
says S. Bruce Malkowicz, co-director of urologic oncology
at the University of Pennsylvania Medical Center. He
advises men of all ages to do TSEs, not just those in
the prime risk group of ages 15 to 34.
TSE
is best performed after a warm bath or shower. Heat
relaxes the scrotum, making it easier to spot anything
abnormal. The National Cancer Institute recommends following
these steps every month:
-
Stand in front of a mirror. Check for any swelling
on the scrotum skin.
-
Examine each testicle with both hands. Place the index
and middle fingers under the testicle with the thumbs
placed on top. Roll the testicle gently between the
thumbs and fingers. Don't be alarmed if one testicle
seems slightly larger than the other. That's normal.
-
Find the epididymis, the soft, tubelike structure
behind the testicle that collects and carries sperm.
If you are familiar with this structure, you won't
mistake it for a suspicious lump. Cancerous lumps
usually are found on the sides of the testicle but
can also show up on the front.
-
If you find a lump, see a doctor right away. The abnormality
may not be cancer, but if it is, the chances are great
it can spread if not stopped by treatment.
Only
a physician can make a positive diagnosis.
Knies says fear shouldn't keep men from doing the TSE.
"And men need not feel self-conscious about touching
themselves there. It only takes a few seconds for them
to tell if everything's fine. If they find something,
they shouldn't be afraid to say something. Wishing it
away isn't going to make it go away."
--J.H.
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