Testicular cancer: Difference between revisions

| name = KreftTesticular i Ballene dinecancer

Testicular cancer is highly treatable and usually curable.<ref name="NCI2017Pro">{{Cite web |date=26 January 2017 |title=Testicular Cancer Treatment |url=https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq#section/all |access-date=19 December 2017 |website=National Cancer Institute |language=en}}</ref> Treatment options may include surgery, [[radiation therapy]], [[chemotherapy]], or [[stem cell transplantation]].<ref name=NCI2016Pt/> Even in cases in which cancer has spread widely, chemotherapy offers a cure rate greater than 80%.<ref name="JAMA2008">{{Cite journal |last1=Feldman DR |last2=Bosl GJ |last3=Sheinfeld J |last4=Motzer RJ |date=13 February 2008 |title=Medical treatment of advanced testicular cancer |journal=[[JAMA (journal)|JAMA]] |volume=299 |issue=6 |pages=672–684 |doi=10.1001/jama.299.6.672 |pmid=18270356 |doi-access=free}}</ref>

Globally testicular cancer affected about 686,000 people in 2015.<ref name="GBD2015Pre">{{Cite journal |last=GBD 2015 Disease and Injury Incidence and Prevalence |first=Collaborators. |date=8 October 2016 |title=Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. |journal=Lancet |volume=388 |issue=10053 |pages=1545–1602 |doi=10.1016/S0140-6736(16)31678-6 |pmc=5055577 |pmid=27733282 |display-authors=1 | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L }}</ref> That year it resulted in 9,400 deaths up from 7,000 deaths in 1990.<ref name="GBD2015De">{{Cite journal |last=GBD 2015 Mortality and Causes of Death |first=Collaborators. |date=8 October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |display-authors=1 | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR }}</ref><ref name="GDB2013">{{Cite journal |last=GBD 2013 Mortality and Causes of Death |first=Collaborators |date=17 December 2014 |title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 |journal=Lancet |volume=385 |issue=9963 |pages=117–171 |doi=10.1016/S0140-6736(14)61682-2 |pmc=4340604 |pmid=25530442 |author1=GBD 2013 Mortality and Causes of Death Collaborators }}</ref> Rates are lower in the [[developing world|developing]] than the [[developed world]].<ref>{{Cite web |date=15 May 2015 |title=Testicular cancer incidence statistics |url=http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer/incidence#heading-Eleven |access-date=19 December 2017 |website=Cancer Research UK |language=en}}</ref> Onset most commonly occurs in males 20 to 34 years old, rarely before 15 years old.<ref name=SEER2017/><ref name="Hay2009">{{Cite journal |last1=Hayes-Lattin |first1=Brandon |last2=Nichols |first2=Craig R. |date=October 2009 |title=Testicular Cancer: A Prototypic Tumor of Young Adults |journal=Seminars in Oncology |volume=36 |issue=5 |pages=432–438 |doi=10.1053/j.seminoncol.2009.07.006 |pmc=2796329 |pmid=19835738}}</ref> The [[five-year survival rate]] in the United States is about 95%.<ref name="SEER2017">{{Cite web |title=Cancer of the Testis - Cancer Stat Facts :3 |url=https://seer.cancer.gov/statfacts/html/testis.html |access-date=19 December 2017 |website=SEER |language=en}}</ref> Outcomes are better when the disease remains localized.<ref name=SEER2017/>

The [[differential diagnosis]] of testicular cancer requires examining the [[histology]] of tissue obtained from an [[inguinal orchiectomy]] - &mdash;that is, surgical excision of the entire [[testis]] along with attached structures ([[epididymis]] and [[spermatic cord]]). A [[biopsy]] should not be performed, as it raises the risk of spreading cancer cells into the scrotum.<ref>{{Cite web |title=How is testicular cancer diagnosed |url=https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html}}</ref>

Most pathologists use the [[World Health Organization]] classification system for testicular tumors:<ref>{{Cite journal |last1=Moch |first1=Holger |last2=Amin |first2=Mahul B. |last3=Berney |first3=Daniel M. |last4=Compérat |first4=Eva M. |last5=Gill |first5=Anthony J. |last6=Hartmann |first6=Arndt |last7=Menon |first7=Santosh |last8=Raspollini |first8=Maria R. |last9=Rubin |first9=Mark A. |last10=Srigley |first10=John R. |last11=Hoon Tan |first11=Puay |last12=Tickoo |first12=Satish K. |last13=Tsuzuki |first13=Toyonori |last14=Turajlic |first14=Samra |last15=Cree |first15=Ian |date=2022-11-01 |title=The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs—Part A: Renal, Penile, and Testicular Tumours |url=https://www.sciencedirect.com/science/article/pii/S0302283822024678 |journal=European Urology |language=en |volume=82 |issue=5 |pages=458–468 |doi=10.1016/j.eururo.2022.06.016 |pmid=35853783 |s2cid=250630557 |issn=0302-2838|doi-access=free }}</ref>

***''[[Germ cell neoplasia in situ]]''''<ref name="Williamson2017">{{cite journal |last1=Williamson |first1=Sean R |last2=Delahunt |first2=Brett |last3=Magi-Galluzzi |first3=Cristina |last4=Algaba |first4=Ferran |last5=Egevad |first5=Lars |last6=Ulbright |first6=Thomas M |last7=Tickoo |first7=Satish K |last8=Srigley |first8=John R |last9=Epstein |first9=Jonathan I |last10=Berney |first10=Daniel M |date=February 2017 |title=The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel |url=https://onlinelibraryora.wileyox.comac.uk/doiobjects/10.1111uuid:660d023e-cb57-41b3-b515-7dbe44db41e5/his.13102files/m2d47013a944124bf964ac188ecb044db |journal=Histopathology |language=en |volume=70 |issue=3 |pages=335–346 |doi=10.1111/his.13102 |pmid=27747907}}</ref>''

Since testicular cancers can spread, patients are usually offered [[adjuvant therapy|adjuvant treatment]] - &mdash;in the form of [[chemotherapy]] or [[radiotherapy]] - &mdash;to kill any cancerous cells that may exist outside of the affected testicle. The type of adjuvant therapy depends largely on the [[histology]] of the tumor (i.e., the size and shape of its cells under the microscope) and the stage of progression at the time of surgery (i.e., how far cells have '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 periodic [[CT scans]] and blood tests, in place of adjuvant treatment.<ref>{{cite book |last1=Al-Salem |first1=Ahmed H. |url=https://link.springer.com/book/10.1007/978-3-319-44182-5 |title=An Illustrated Guide to Pediatric Urology |date=2016 |publisher=Springer |isbn=9783319441825 |page=585 |doi=10.1007/978-3-319-44182-5 |access-date=27 July 2023}}</ref>

For many patients with stage I cancer, adjuvant (preventative) therapy following surgery may not be appropriate and patients will undergo surveillance instead.<ref>{{Cite journal |last1=Krege |first1=S. |last2=Beyer |first2=J. |last3=Souchon |first3=R. |last4=Albers |first4=P. |last5=Albrecht |first5=W. |last6=Algaba |first6=F. |last7=Bamberg |first7=Michael |last8=Bodrogi |first8=István |last9=Bokemeyer |first9=Carsten |display-authors=6 |year=2008 |title=European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I |journal=European Urology |volume=53 |issue=3 |pages=478–496 |doi=10.1016/j.eururo.2007.12.024 |pmid=18191324}}</ref> The form this surveillance takes, e.g. the type and frequency of investigations and the length time it should continue, will depend on the type of cancer ([[Nonseminoma|non-seminoma]] or [[seminoma]]), but the aim is to avoid unnecessary treatments in the many patients who are cured by their surgery, and ensure that any relapses with [[metastasis|metastases]] (secondary cancers) are detected early and cured. This approach ensures that chemotherapy and or radiotherapy is only given to the patients that need it. The number of patients 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.{{citation needed|date=May 2021}}

For patients treated for stage I non-seminoma, a randomized trial ([[Medical Research Council (UK)|Medical Research Council]] TE08)<ref>{{Cite journal |last1=Rustin |first1=G. J. |last2=Mead |first2=G. M. |last3=Stenning |first3=S. P. |last4=Vasey |first4=P. A. |last5=Aass |first5=N. |last6=Huddart |first6=R. A. |last7=Sokal |first7=M. P. |last8=Joffe |first8=J. K. |last9=Harland |first9=S. J. |last10=Kirk |first10=S. J. |display-authors=6 |year=2007 |title=Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: Medical Research Council Trial TE08; ISRCTN56475197—the National Cancer Research Institute Testis Cancer Clinical Studies Group |journal=[[Journal of Clinical Oncology]] |volume=25 |issue=11 |pages=1310–1315 |doi=10.1200/JCO.2006.08.4889 |pmid=17416851|doi-access=free }}</ref> 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 early stage.