– the most common type of testicular cancer is known as ‘germ cell testicular cancer’ which accounts for around 95% of all cancers.
– germ cells are a type of cell that the body uses to help create sperm.
there are two main subtypes of germ cell testicular cancer, they are:
– seminomas, 40%
– non seminomas, 60%
seminomas and non seminomas tend to respond well to chemotherapy.
– UNDERSCENDED TESTICLES = the babies testicles should have moved down by the age of 1, if not they may have a higher risk of getting testicular cancer.
– AGE AND RACE = testicular cancer is more common in young and middle aged men affecting those between 20 and 44 years of age, with 90% of cases affecting men under the age of 55.
– more common in white men.
– FAMILY HISTORY = having a close relative with a history of testicular cancer , this increases your risk of developing it.
– father = 4-6 times more likely
– brother = 8-10 times more likely.
– INFERTILITY = men who are infertile are three times more likely to develop testicular cancer than fertile men.
– SMOKING = long term smokers – 20 cigarettes a day for 12 years are twice more likely to develop testicular cancer.
– HIV AND AIDS = people who have had HIV and AID’s have an increased risk of testicular cancer.
– the lump or swelling can be about the size of a pea or larger.
– a dull ache or sharp pain in the testicles or scrotum, which may come and go.
– a feeling of heaviness in the scrotum.
– a dull ache in the lower abdomen (stomach area)
– a sudden collection of fluid in the scrotum.
– feeling fatigue.
– a general feeling of being unwell.
METASTATIC CANCER: = if testicular cancer or other cancer has spread to other parts of the body.
– around 5% of people with testicular cancer will experience symptoms of metastatic cancer.
– most common place for testicular cancer to spread to is nearby lymph nodes in the abdomen or lungs.
– symptoms include:
. persistent cough
. coughing or spitting up blood
.shortness of breath
– whether it is seminomas or non seminomas.
– the stage of cancer.
the first treatment option for all cases of testicular cancer, what ever the stage is to surgically remove the affected testicle (archidectomy).
– staged numerically
TNM STAGING SYSTEM:
T = indicates size of tumour
N = indicates whether cancer has spread to lymph nodes.
M = indicated whether cancer has spread to other parts of the body (metastasis).
NUMERICALLY STAGING SYSTEM:
stage 1 = cancer is inside testicles.
stage 2 = cancer spread from testicles to lymph nodes.
stage 3 = spread to lymph nodes and upper chest.
stage 4 = has spread to other organs, such as lungs.
– non seminomas = close follow up may be recommended and a short course of chemotherapy.
– further surgery may be needed after chemotherapy to remove any affected lymph nodes.
– MDT specialists will make recommendations, but final decision will be made by the patient.
the GP will carry out a physical examination ( torch light test).
– shines a small light against the lump in the testicle to see if light shines through.
– cancerous lumps tend to be solid which means light cant pass through.
if lump is cancerous they will be referred to secondary care.
2. in secondary care, a scrotal ultra sound will be performed , which will detect the position and size of abnormality.
– if lump is filled with fluid it is known as a cyst and is harmless. a more solid lump may be a sign of cancer.
-blood tests will be performed to look for hormones which are known as markers.
-testicular cancer produces markers , markers in the blood will be tested for:
. AFP ( alpha feta protein)
. HCG ( human chronic gonadotrpin)
. LDH ( lactate dehydrogenate)
. cells are taken from the lump and sent to the lab to be analysed.
– safest way is to remove testicle, this process is called orchidectomy.
3. cancer is staged either by TNM or numerically.
– if MDT think cancer has spread to lymph nodes and lungs, may require chest x ray, MRI scan or CT scan to check for signs of spreading cancer.
4. in cases of stage 2 and 3 cancer, three to four cycles of chemotherapy are given using a combination of medications.
– further surgery may sometimes be needed after chemotherapy to remove any affected lymph nodes.
5. a similar treatment plan is used to treat stage 4 cancer.
– additional surgery may also be required to remove tumours from other parts of the body such as the lungs.
6. follow up:
– around 25 – 30 % of people experience a return of cancer, usually within first two years after treatment has finished.
– regular checks-
– blood test for markers
– chest x ray
– CT scan.
– a medical oncologist = specialist cancer doctor
– a pathologist = specialist in study of cancer cells
– urological surgeon = who performs operation.
– a radiologist = performs ultrasound scans.
– a pharmacist = provides chemotherapy drug
– a psychologist = provides psychological support
– a specialist cancer nurse
– a cancer counsellor = provides someone to discuss problems and financial advice and support.
INDIVIDUALITY = the GP and MDT will ensure that the patient is put at the centre of the care by knowing their individual needs, problems, history and details.
RIGHTS= patients have the right to know everything that is going on and should be involved in all discussions and decision making.
PARTNERSHIP AND SUPPORT = patient will be given support from the MDT and cancer counsellor to help the patient to cope with what they are going through.
CHOICE = patient is given the choice of whether to go through treatment or not.
RESPECT = giving the patient all the information, advice, support and treatment they need.
– social relationships with others who have testicular cancer.
– more support and attention from family members and friends who want to support you through cancer.
-pain in the testicle
-pain from surgery
– removal of testicle.
– embarrassment of removal of testicle
– learn about signs and symptoms
– parking fees when going to hospital and clinics.