Testicular cancer is cancer that develops in the testicles.docx

8/11/2019 Testicular cancer is cancer that develops in the testicles.docx

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Testicular canceriscancerthat develops in thetesticles,a part of themalereproductive system.

In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made eachyear.

[1][2]In the UK, approximately 2,000 men are diagnosed each year.

[3]Over his lifetime, a

man's risk of testicular cancer is roughly 1 in 250 (0.4%). It is the most common cancer in males

aged 2039 years, the period of peak incidence, and is rarely seen before the age of 15 years.

[4]

Testicular cancer has one of the highest cure rates of all cancers: in excess of 90 percent overall;

almost 100 percent if it has not spread (metastasized).[5]

Even for the relatively few cases inwhich malignant cancer has spread widely, modernchemotherapyoffers a cure rate of at least

80%.[6]

Not all lumps on the testicles are tumors, and not all tumors are malignant (cancerous). There are

many other conditions, such astesticular microlithiasis,epididymal cysts,andappendix testis

(hydatid of Morgagni), which may be painful but are non-cancerous.

Classification

Although testicular cancer can be derived from any cell type found in the testicles, more than

95% of testicular cancers aregerm cell tumors.Most of the remaining 5% aresex cord-gonadalstromal tumoursderived fromLeydig cellsorSertoli cells.Correct diagnosis is necessary toensure the most effective and appropriate treatment. To some extent, this can be done via blood

tests fortumor markers,but definitive diagnosis requires examination of thehistologyof a

specimen by apathologist.

Most pathologists use theWorld Health Organizationclassification system for testiculartumours:

[7][8]

Germ cell tumourso Precursor lesions

Intratubular germ cell neoplasia

Unclassified type (carcinoma in situ)

Specified types

o Tumours of one histologic type (pure forms)

Seminoma

Variant - Seminoma withsyncytiotrophoblasticcells

Spermatocytic seminoma

Variant - spermatocytic seminoma withsarcoma

Embryonal carcinoma

Yolk sac tumour

Trophoblastictumours

Choriocarcinoma

Variant - monophasic choriocarcinoma
http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Testiclehttp://en.wikipedia.org/wiki/Testiclehttp://en.wikipedia.org/wiki/Testiclehttp://en.wikipedia.org/wiki/Malehttp://en.wikipedia.org/wiki/Malehttp://en.wikipedia.org/wiki/Malehttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-1http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-1http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-1http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-3http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-3http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-3http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-4http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-4http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-4http://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-5http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-5http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-5http://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-motzerjama-6http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-motzerjama-6http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-motzerjama-6http://en.wikipedia.org/wiki/Testicular_microlithiasishttp://en.wikipedia.org/wiki/Testicular_microlithiasishttp://en.wikipedia.org/wiki/Testicular_microlithiasishttp://en.wikipedia.org/wiki/Epididymal_cysthttp://en.wikipedia.org/wiki/Epididymal_cysthttp://en.wikipedia.org/wiki/Epididymal_cysthttp://en.wikipedia.org/wiki/Appendix_testishttp://en.wikipedia.org/wiki/Appendix_testishttp://en.wikipedia.org/wiki/Appendix_testishttp://en.wikipedia.org/wiki/Germ_cell_tumorhttp://en.wikipedia.org/wiki/Germ_cell_tumorhttp://en.wikipedia.org/wiki/Germ_cell_tumorhttp://en.wikipedia.org/wiki/Sex_cord-gonadal_stromal_tumourhttp://en.wikipedia.org/wiki/Sex_cord-gonadal_stromal_tumourhttp://en.wikipedia.org/wiki/Sex_cord-gonadal_stromal_tumourhttp://en.wikipedia.org/wiki/Sex_cord-gonadal_stromal_tumourhttp://en.wikipedia.org/wiki/Leydig_cellhttp://en.wikipedia.org/wiki/Leydig_cellhttp://en.wikipedia.org/wiki/Leydig_cellhttp://en.wikipedia.org/wiki/Sertoli_cellhttp://en.wikipedia.org/wiki/Sertoli_cellhttp://en.wikipedia.org/wiki/Sertoli_cellhttp://en.wikipedia.org/wiki/Tumor_markerhttp://en.wikipedia.org/wiki/Tumor_markerhttp://en.wikipedia.org/wiki/Tumor_markerhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-7http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-7http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-7http://en.wikipedia.org/wiki/Intratubular_germ_cell_neoplasiahttp://en.wikipedia.org/wiki/Intratubular_germ_cell_neoplasiahttp://en.wikipedia.org/wiki/Carcinoma_in_situhttp://en.wikipedia.org/wiki/Carcinoma_in_situhttp://en.wikipedia.org/wiki/Carcinoma_in_situhttp://en.wikipedia.org/wiki/Seminomahttp://en.wikipedia.org/wiki/Seminomahttp://en.wikipedia.org/wiki/Syncytiotrophoblasthttp://en.wikipedia.org/wiki/Syncytiotrophoblasthttp://en.wikipedia.org/wiki/Syncytiotrophoblasthttp://en.wikipedia.org/wiki/Spermatocytic_seminomahttp://en.wikipedia.org/wiki/Spermatocytic_seminomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Embryonal_carcinomahttp://en.wikipedia.org/wiki/Embryonal_carcinomahttp://en.wikipedia.org/wiki/Yolk_sac_tumourhttp://en.wikipedia.org/wiki/Yolk_sac_tumourhttp://en.wikipedia.org/wiki/Trophoblasthttp://en.wikipedia.org/wiki/Trophoblasthttp://en.wikipedia.org/wiki/Choriocarcinomahttp://en.wikipedia.org/wiki/Choriocarcinomahttp://en.wikipedia.org/wiki/Choriocarcinomahttp://en.wikipedia.org/wiki/Trophoblasthttp://en.wikipedia.org/wiki/Yolk_sac_tumourhttp://en.wikipedia.org/wiki/Embryonal_carcinomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Spermatocytic_seminomahttp://en.wikipedia.org/wiki/Syncytiotrophoblasthttp://en.wikipedia.org/wiki/Seminomahttp://en.wikipedia.org/wiki/Carcinoma_in_situhttp://en.wikipedia.org/wiki/Intratubular_germ_cell_neoplasiahttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-7http://en.wikipedia.org/wiki/Testicular_cancer#cite_note-7http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Tumor_markerhttp://en.wikipedia.org/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o Carcinoma

Tumours of the paratesticular structureso Adenomatoid tumour

o MalignantandBenignMesothelioma

o Adenocarcinomaof theepididymis

o

Papillary cystadenoma of the epididymiso Melanotic neuroectodermal tumour

o Desmoplastic small round cell tumour

Mesenchymal tumours of the spermatic cord and testicular adnexaeo Lipoma

o Liposarcoma

o Rhabdomyosarcoma

o Aggressiveangiomyxoma

o Angiomyofibroblastoma-like tumour (seeMyxoma)

o Fibromatosis

o Fibroma

o

Solitary fibrous tumouro Others

Secondary tumours of the testis

Signs and symptoms

One of the first signs of testicular cancer is often a lump or swelling in the testes. The U.S.

Preventive Services Task Force (USPSTF) recommends against routine screening for testicularcancer in asymptomatic adolescent and adults including routine testicular self-exams.

[9]

However, the American Cancer Society suggests that some men should examine their testicles

monthly, especially if they have a family history of cancer, and the American Urological

Association recommends monthly testicular self examinations for all young men.[10][11]

Symptoms may also include one or more of the following:

alumpin one testis which may or may not be painful[12][13]

sharp pain or a dull ache in the lowerabdomenor scrotum[13]

a feeling often described as "heaviness" in the scrotum[13]

breast enlargement (gynecomastia)from hormonal effects of -hCG[12][13]

low back pain(lumbago) tumor spread to the lymph nodes along the back[12][13]

It is not very common for testicular cancer to spread to other organs, apart from the lungs.

However, if it has, the following symptoms may be present:

shortness of breath (dyspnea),coughor coughing up blood (hemoptysis)from metastatic

spread to the lungs[12][13]

a lump in the neck due to metastases to the lymph nodes[12][13]

Genetic defects
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Most testicular germ cell tumors have too manychromosomes,and most often they aretriploid

totetraploid.An isochromosome 12p (the short arm of chromosome 12 on both sides of the same

centromere) is present in about 80% of the testicular cancers, and also the other cancers usuallyhave extra material from this chromosome arm through other mechanisms of genomic

amplification.[14]

Diagnosis

Micrograph(high magnification) of aseminoma.H&E stain.

The main way testicular cancer is diagnosed is via a lump or mass inside the testis. More

generally, if a young adult or adolescent has a single enlarged testicle, which may or may not bepainful, this should give doctors reason to suspect testicular cancer.

Other conditions may also have symptoms similar to testicular cancer:

Epididymitisorepididymoorchitis

Hematocele Varicocele

Incorrect or mistaken diagnosis can delay access to appropriate treatment; this is thought to occur

in up to 25% of cases[citation needed]

The nature of any palpated lump in thescrotumis often evaluated by scrotalultrasound,which

can determine exact location, size, and some characteristics of the lump, such as cystic vs solid,

uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease isevaluated byCT scans,which are used to locatemetastases.

Thedifferential diagnosisof testicular cancer requires examining thehistologyof tissue obtainedfrom aninguinal orchiectomy- that is, surgical excision of the entiretestisalong with attached

structures (epididymisandspermatic cord). Abiopsyshould not be performed, as it raises the

risk of spreading cancer cells into the scrotum[citation needed]

.

Inguinal orchiectomy is the preferred method because it lowers the risk of cancer cells escaping.

This is because the lymphatic system of the scrotum, through which white blood cells (and,potentially, cancer cells) flow in and out, links to the lower extremities, while that of the testicle
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links to the back of the abdominal cavity (theretroperitoneum). A transscrotal biopsy or

orchiectomy will potentially leave cancer cells in the scrotum and create two routes for cancer

cells to spread, while in an inguinal orchiectomy only the retroperitoneal route exists.

Blood tests are also used to identify and measuretumor markers(usuallyproteinspresent in the

bloodstream) that are specific to testicular cancer.AFP alpha1 feto protein,Beta-HCG,andLDHare the typical markers used to identify testicular cancer.

A pregnancy test may be used to identify high levels of Beta-HCG, however the first sign oftesticular cancer is normally a lump.

[15]

Staging

After removal, the testicle is fixed withBouin's solution[16][17]

because it better conserves some

morphological details such as nuclear conformation. Then the testicular tumor is staged by a

pathologistaccording to the TNM Classification of Malignant Tumors as published in theAJCC

Cancer Staging Manual. Testicular cancer is categorized as being in one of threestages(whichhave subclassifications). The size of the tumor in the testis is irrelevant to staging.

[18]In broad

terms, testicular cancer is staged as follows:

Stage I: the cancer remains localized to thetestis.

Stage II: the cancer involves the testis andmetastasistoretroperitonealand/orParaaorticlymph nodes(lymph nodesbelow thediaphragm).

Stage III: the cancer involves the testis andmetastasisbeyond theretroperitonealand

Paraaortic lymph nodes.Stage 3 is further subdivided into non-bulky stage 3 and bulkystage 3.

[19]

Further information on the detailed staging system is available on the website of theAmericanCancer Society.[20]

Treatment

The three basic types of treatment aresurgery,radiation therapy,andchemotherapy.[21]

Surgery is performed byurologists;radiation therapy is administered byradiation oncologists;

and chemotherapy is the work of medicaloncologists.In most patients with testicular cancer, the

disease is cured readily with minimal long-termmorbidity.While treatment success depends on

the stage, the average survival rate after five years is around 95%, and stage 1 cancers cases (if

monitored properly) have essentially a 100% survival rate (which is why prompt action, whentesticular cancer is a possibility, is extremely important).

Initial treatment (orchiectomy)

Main article:Orchiectomy

See also:Monorchism
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ia.org/wiki/Monorchismhttp://en.wikipedia.org/wiki/Monorchismhttp://en.wikipedia.org/wiki/Orchiectomyhttp://en.wikipedia.org/wiki/Morbidityhttp://en.wikipedia.org/wiki/Oncologisthttp://en.wikipedia.org/wiki/Radiation_oncologisthttp://en.wikipedia.org/wiki/Urologisthttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-21http://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Radiation_therapyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-20http://en.wikipedia.org/wiki/American_Cancer_Societyhttp://en.wikipedia.org/wiki/American_Cancer_Societyhttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-titleTesticular_Cancer_Resource_Center.27s_Staging_Page-19http://en.wikipedia.org/wiki/Paraaortic_lymph_nodehttp://en.wikipedia.org/wiki/Retroperitoneumhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Thoracic_diaphragmhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Paraaortic_lymph_nodehttp://en.wikipedia.org/wiki/Paraaortic_lymph_nodehttp://en.wikipedia.org/wiki/Retroperitoneumhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Testishttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-18http://en.wikipedia.org/wiki/TNM_staging_systemhttp://en.wikipedia.org/wiki/TNM_staging_systemhttp://en.wikipedia.org/wiki/Cancer_staginghttp://en.wikipedia.org/wiki/American_Joint_Committee_on_Cancerhttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-17http://en.wikipedia.org/wiki/Bouin_Solutionhttp://en.wikipedia.org/wiki/Bouin_Solutionhttp://en.wikipedia.org/wiki/Testicular_cancer#cite_note-15http://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Beta-HCGhttp://en.wikipedia.org/wiki/Alpha-fetoproteinhttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Tumor_markerhttp://en.wikipedia.org/wiki/Retroperitoneum


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The initial treatment for testicular cancer is surgery to remove the affected testicle (orchiectomy).

While it may be possible, in some cases, to remove testicular cancer tumors from a testis while

leaving the testis functional, this is almost never done, as the affected testicle usually containspre-cancerous cells spread throughout the entire testicle. Thus removing the tumor alone without

additional treatment greatly increases the risk that another cancer will form in that testicle.

Since only one testis is typically required to maintain fertility, hormone production, and other

male functions, the afflicted testis is almost always removed completely in a procedure called

inguinal orchiectomy.(The testicle is almost never removed through the scrotum; an incision ismade beneath the belt line in the inguinal area.) In the UK, the procedure is known as a radical

orchidectomy.

Retroperitoneal Lymph Node Dissection (RPLND)

In the case ofnonseminomasthat appear to be stage I, surgery may be done on the

retroperitoneal/Paraaorticlymph nodes(in a separate operation) to accurately determine whether

the cancer is in stage I or stage II and to reduce the risk thatmalignanttesticular cancer cells thatmay havemetastasizedto lymph nodes in the lower abdomen. This surgery is called

retroperitoneal lymph node dissection(RPLND). However, this approach, while standard in

many places, especially the United States, is out of favor due to costs and the high level ofexpertise required to perform successful surgery. The urologist may take extra care in the case of

males who have not fathered children, to preserve the nerves involved in ejaculation.

Many patients are instead choosing surveillance, where no further surgery is performed unless

tests indicate that the cancer has returned. This approach maintains a high cure rate because of

the growing accuracy of surveillance techniques.

Adjuvant treatment

Since testicular cancers can spread, patients are usually offeredadjuvant treatment- in the form

ofchemotherapyorradiotherapy- to kill any cancerous cells that may exist outside of the

affected testicle. The type of adjuvant therapy depends largely on thehistologyof the tumor (i.e.the size and shape of its cells under the microscope) and the stage of progression at the time ofsurgery (i.e. how far cells has 'escaped' from the testicle, invaded the surrounding tissue, or

spread to the rest of the body). If the cancer is not particularly advanced, patients may be offered

careful surveillance by periodicCT scansand blood tests, in place of adjuvant treatment.

Before 1970, survival rates from testicular cancer were low. Since the introduction ofadjuvant

chemotherapy,chiefly platinum-based drugs likecisplatinandcarboplatin,the outlook hasimproved substantially. Although 7000 to 8000 new cases of testicular cancer occur in the

United States yearly, only 400 men are expected to die of the disease.

In the UK, a similar trend has emerged: since improvements in treatment, survival rates have

risen rapidly to cure rates of over 95%.[22]

Radiation therapy
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Radiationmay be used to treat stage 2 seminoma cancers, or asadjuvant(preventative) therapy

in the case of stage 1 seminomas, to minimize the likelihood that tiny, non-detectable tumors

exist and will spread (in the inguinal and para-aorticlymph nodes). Radiation is ineffectiveagainst and is therefore never used as a primary therapy fornonseminoma.

Chemotherapy

Non-seminoma

Chemotherapy is the standard treatment for non-seminoma when the cancer has spread to other

parts of the body (that is, stage 2B or 3). The standardchemotherapy protocolis three, or

sometimes four, rounds ofBleomycin-Etoposide-Cisplatin(BEP). BEP as a first-line treatment

was first reported by ProfessorMichael Peckhamin 1983.[23]

The landmark trial published in1987 which established BEP as the optimum treatment was conducted by Dr.Lawrence Einhorn

atIndiana University.[24]

An alternative, equally effective treatment involves the use of four

cycles ofEtoposide-Cisplatin(EP).

Lymph node surgery may also be performed after chemotherapy to remove masses left behind

(stage 2B or more advanced), particularly in the cases of largenonseminomas.

Seminoma

As anadjuvanttreatment, use ofchemotherapyas an alternative to radiation therapy in the

treatment of seminoma is increasing, because radiation therapy appears to have more significant

long-term side effects (for example, internal scarring, increased risks of secondary malignancies,etc.). Two doses, or occasionally a single dose ofcarboplatin,typically delivered three weeks

apart, is proving to be a successfuladjuvanttreatment, with recurrence rates in the same ranges

as those ofradiotherapy.The concept ofcarboplatinas a single-dose therapy was developed byTim Oliver, Professor of Medical Oncology atBarts and The London School of Medicine and

Dentistry.[25]

However, very long term data on the efficacy of adjuvant carboplatin in this setting

do not exist.

Since seminoma can recur decades after the primary tumor is removed, patients receiving

adjuvant chemotherapy should remain vigilant and not assume they are cured 5 years aftertreatment.

Prognosis

In theNew England Journal of Medicine,treatment of testicular cancer has been called one ofthe success stories of modern medicine, with sustained response to treatment in more than 90%

of cases, regardless of stage.[26]

Because of advances in chemotherapy, cure rates now approach85% overall, with better than 95% for localized disease and 80% for metastatic diseasethe best

response by any solid tumor.[6]

Surveillance
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For many patients with stage I cancer, adjuvant (preventative) therapy following surgery may not

be appropriate and patients will undergo surveillance instead.[27]

The form this surveillance takes,

e.g. the type and frequency of investigations and the length time it should continue, will dependon the type of cancer (non-seminomaorseminoma), but the aim is to avoid unnecessary

treatments in the many patients who are cured by their surgery, and ensure that any relapses with

metastases(secondary cancers) are detected early and cured. This approach ensures thatchemotherapy and or radiotherapy is only given to the patients that need it. The number ofpatients ultimately cured is the same using surveillance as post-operative adjuvant treatments,

but the patients have to be prepared to follow a prolonged series of visits and tests.

For both non-seminomas and seminomas, surveillance tests generally include physical

examination, blood tests for tumour markers, chest x-rays andCT scanning.However, the

requirements of a surveillance programme differ according to the type of disease since, forseminoma patients, relapses can occur later and blood tests are not as good at indicating relapse.

CT scans are performed on the abdomen (and sometimes the pelvis) and also the chest in some

hospitals. Chest x-rays are increasingly preferred for the lungs as they give sufficient detailcombined with a lower false-positive rate and significantly smaller radiation dose than CT.

The frequency of CT scans during surveillance should ensure that relapses are detected at an

early stage while minimising the radiation exposure.

For patients treated for stage I non-seminoma, a randomised trial (Medical Research Council

TE08[28]

)showed that, when combined with the standard surveillance tests described above, 2

CT scans at 3 and 12 months were as good as 5 over 2 years in detecting relapse at an earlystage.

For patients treated for stage I seminoma who choose surveillance rather than undergoingadjuvant therapy, there have been no randomised trials to determine the optimum frequency of

scans and visits, and the schedules vary very widely across the world, and within individual

countries. In the UK there is an ongoing clinical trial called TRISST.[29][30]

This is assessing howoften scans should take place and whethermagnetic resonance imaging(MRI) can be used

instead of CT scans. MRI is being investigated because it does not expose the patient to radiation

and so, if it is shown to be as good at detecting relapses, it may be preferable to CT. It is possiblethat one or more centres in Canada may join the trial in the next year or so.

For more advanced stages of testicular cancer, and for those cases in which radiation therapy or

chemotherapy was administered, the extent of monitoring (tests) after treatment will vary on thebasis of the circumstances, but normally should be done for five years in uncomplicated cases

and for longer in those with higher risks of relapse.

Fertility

A man with one remaining testis can lead a normal life, because the remaining testis takes up theburden oftestosteroneproduction and will generally have adequate fertility.

[31]However, it is

worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm
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banking may be appropriate for younger men who still plan to have children, since fertility may

be lessened by removal of one testicle[citation needed]

, and can be severely affected if extensive

chemotherapyand/orradiotherapyis done.

Less than five percent of those who have testicular cancer will have it again in the remaining

testis. A man wholoses both testicleswill normally have to take hormone supplements (inparticular,testosterone,which is created in the testicles), and will be infertile, but can lead an

otherwise normal life.

Epidemiology

Testicular cancer is most common among Caucasian men and rare among men of African

descent.[32]

Testicular cancer is uncommon in Asia and Africa. Worldwide incidence has doubledsince the 1960s, with the highest rates of prevalence inScandinavia,Germany,andNew

Zealand.

Higher rates of testicular cancer in western nations have been linked to use of cannabis. A studyconducted by theFred Hutchinson Cancer Research Centerand funded by theNational Institutes

of Health,published in the journalCancerMarch 15, 2009, linked long term use of cannabis toan increased risk for testicular cancer with the scientists concluding that cannabis is harmful to

the human endocrine and reproductive system.[33][34][35]

In September 2012, a study published in

the journal Cancer became the third to link marijuana use to the development of testicular

cancer.[36]

Incidence among African Americans doubled from 1988 to 2001 with a bias towardsseminoma.

The lack of significant increase in the incidence of early-stage testicular cancer during thistimeframe suggests that the overall increase was not due to heightened awareness of the disease.

Although testicular cancer is most common among men aged 1540 years, it has three peaks:

infancy through the age of four asteratomasandyolk sac tumors,ages 2540 years as post-

pubertal seminomas and nonseminomas, and from age 60 as spermatocytic seminomas.[37]

Germ cell tumorsof the testis are the most common cancer in young men between the ages of 15

and 35 years.[38]

A major risk factor for the development of testis cancer iscryptorchidism(undescended

testicles). It is generally believed that the presence of a tumor contributes to cryptorchidism;

when cryptorchidism occurs in conjunction with a tumor then the tumor tends to be large. Other

risk factors includeinguinal hernias,Klinefelter syndrome,and[39]mumpsorchitis.[40]Physicalactivity is associated with decreased risk and sedentary lifestyle is associated with increased risk.

Early onset of male characteristics is associated with increased risk. These may reflectendogenous or environmentalhormones.
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