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.
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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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