Testicular Cancer:Detection and Diagnosis

Detection and Diagnosis
Most testicular tumors are discovered by patients themselves--either by accident, as Knies did, or while performing a self-examination on each testicle. "The usual presentation is of an enlarged, painless lump," says Malkowicz. "Occasionally there can be pain." The lump typically is pea-sized, but sometimes it might be as big as a marble or even an egg.
Besides lumps, if a man notices any other abnormality--an enlarged testicle, a feeling of heaviness or sudden collection of fluid in the scrotum, a dull ache in the lower abdomen or groin, or enlargement or tenderness of the breasts--he should discuss it with a physician right away. These symptoms can be caused by conditions other than cancer. But only a doctor can tell for sure, and it is critical to seek attention promptly.

Physicians have various methods to help diagnose testicular cancer. Often a physical exam can rule out disorders other than cancer. Imaging techniques can help indicate possible tumors. One such method is ultrasound, which creates a picture from echoes of high-frequency sound waves bounced off internal organs. Malkowicz calls this method "a painless, noninvasive way to check for a mass."

But the only positive way to identify a tumor is for a pathologist to examine a tissue sample under a microscope. Doctors obtain the tissue by removing the entire affected testicle through the groin, a procedure called inguinal orchiectomy. Surgeons do not cut through the scrotum or remove just a part of the testicle, because if cancer is present, a cut through the outer layer of the testicle may cause the disease to spread locally. Besides enabling diagnosis, testicle removal also can prevent further growth of the primary tumor.

Nearly all testicular tumors stem from germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. Other forms of testicular cancer, such as sarcomas or lymphomas, are extremely rare.

Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods. It was a seminoma that struck former Philadelphia Phillies first baseman John Kruk at age 33 in 1994. His right testicle was removed, and doctors say his prognosis is good.

Nonseminomas are a group of cancers that sometimes occur in combination, including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas. According to the American Cancer Society, 60 to 70 percent of patients with nonseminomas have cancer that has spread to the lymph nodes.

by John Henkel ...http://www.fda.gov