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Testicular cancer

Testicular cancer screening

Medical oncology has made huge progress during recent years in the testicular cancer field, since they are now permanently curable in most cases, in definitive way (with the exception of large volume tumors, whose prognosis is poor, but they are happily quite rare). Testicular cancer classification comprises 2 categories: the seminoma cancers, and "nonseminoma" cancers.

1) the seminomas make up about 35% of adult testicular cancers. Frequency increases with age after puberty, the peak being between 30-40 years old. These cancers react very favorably to radiotherapy and chemotherapy.

2) the nonseminomas (55% of cases) are observed among young males, average age 31, when they are quite active professionally, and ... sexually. These cancers react well to chemotherapy.

Sometimes, a testicular cancer can consist of a combination of both types. About 10 000 men will be afflicted per year in the US. This is the most common form of cancer in young men between ages 20 to 25, and accounts for 1% of all male cancers.

Diagnosis of testicular cancers:
The risks:
- undescended testicle,
- abnormal testicular development;
- more common in white than black men;
- sex chromosome disorder (Klinefelter syndrome).
The signs:
- painless increase of testicular volume;
- followed by painful testicle; painless intra-testicular lump; enlarged scrotum;
- dull ache in lower abdomen.
The diagnosis: men themselves find most testicular cancers, by noticing something unusual about their testicles.
- Clinical exam;
- The tumor markers: AFP, BHCG; CEA, CA 19-9, CA125. AFP and BHCG show high levels in 80% cases of nonseminomas. Very high levels (above 10 000 ng/ml for AFP, above 50 000mUI/ml for BHCG) signal very poor prognosis.
- Radiology: abdomen and chest tomodensitometry.
- Ultrasound, color Doppler.
- Biopsies, for identification of tumor type, and extension if applicable.

Treatments of testicular cancer:
The advances have been so important that today the question is not to know whether the patient will heal, but to determine which treatment will generate the minimum side effects, these inconveniences lying on two levels:
- first phase: minimize the treatment toxicity and sterility risk;
- and for later: reduce the risk of recurrence to a minimum.
- In minor forms, simple clinical and biological follow-up should be sufficient;
- Surgery: testicle removal: this is orchiectomy; impairment of sexual intercourse and sterility.
- Radiotherapy: local therapy with radiation; sperm production is affected, but fertility is regained (in most cases) months later.
- Chemotherapy: the advent of polychemotherapies can now heal definitely (over 10 years) more than 90% of patients.
Young men with testicular cancer should remember that treatments might lead to infertility, and doctors should refer them to a sperm bank.

Regular monitoring:
- Clinical tests;
- Radiology: tomodensitometry;
- Biology: measure the tumor marker levels.
Radiation and chemotherapies can lead to complications affecting bowels, kidneys, and bone.
Most (80%) recurrences, when occurring, are observed within 2 years. Patients are considered as definitely healed when no sign is observed for 5 years.

Prevention of testicular cancer:
Regular clinical exam, self-examination; Tumor marker assays.

The above-mentioned tumor markers are part of the CancersafeŽ test; performing this panel once a year is highly recommended.

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