Testicular Cancer Research Paper

Background on Testicular cancer

Testicular cancer is a relatively rare type of cancer seen in young men (ages 20-39 years) with risk factors for developing this type of cancer. Testicular cancer only occurs in 1 percent of men. The testicles (also known as testes or gonads) are a pair of male sex glands. In the early stages of the disease there may be a small, hard, usually painless lump in the testicles. Fortunately most lumps in the testicles will not be cancerous. The patient may experience a swelling in the testicle or a loss in sensation. Other symptoms include enlargement of the testicle or an ache in the lower abdomen, back or groin (Brand S, 2013). Testicular Cancer Research Paper.However, vasectomies and injuries to the testicles are not risk factors for developing testicular cancer (Brand S, 2013).
There are several possible and established risk factors considered to be responsible for developing testicular cancer. The risk factors include having a relative such as a father or a brother with testicular cancer (Holdstock R, 2010). Genetics and environmental factors play a role in the increased incidence of testicular cancer. The risk of testicular cancer is 8 to 10 times higher in a brother with testicular cancer and 4 to 6 times higher in a son as compared to a brother or son of an unaffected family member (Hanna N, 2014). This increased risk in male relatives of testicular cancer cases could be due to a testicular cancer susceptibility gene and common environmental factors (Garner MJ, 2005).
Testicular cancer is more commonly seen in white males than in black males in the US and the rates have been steadily rising during the past 20 years (Hanna N, 2014). There has also been substantial advances in the treatment of testicular cancer during the past 20 years and consequently increase in survival rates. The cure rate for testicular cancer is as high as 95 percent for all patients who have received a diagnosis of testicular cancer and 80 percent for patients with metastatic disease (Hanna N, 2014). However, most patients receive a diagnosis when the disease is Stage 1 and presents as a testicular mass (Hanna N, 2014). Testicular Cancer Research Paper.

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ETIOLOGY OF TESTICULAR CANCER

Ninety five percent of all tumors of the testis are germ cell neoplasms and there are four specific types of germ- cell neoplasms. These four types of germ- cell neoplasms are seminomas, embryonal carcinomas, malignant teratomas and choriocarcinomas (Garner MJ, 2005). Testicular cancers are classified into two general classes as seminomas or non-seminomas, all other types are rare.

Objective- Risk factors and diagnosis of testicular cancer in young men

Many young men of working age think that they are infallible and cannot get a disease like testicular cancer even if they have known risk factors for it. Men born with abnormalities of the testicles, penis or kidneys are at increased risk of developing testicular cancer (NCI Factsheet, 2005). Men who had undescended testicles at birth have a three times higher rate of developing testicular cancer than men without the condition at birth (Brand S, 2013).
The possible risk factors for developing testicular cancer in young men include maternal risk factors such as age of pregnancy and maternal smoking (Garner MJ, 2005).Testicular Cancer Research Paper.  These maternal risk factors are in addition to environmental and genetic risk factors. The established risk factors for testicular cancer in young men are related to early life events such as cryptorchidism (mal descendent testicle/s), carcinoma in situ and in utero exposure to estrogens (Garner MJ, 2005).
Diagnostic tests for testicular cancer include blood tests, ultrasounds and biopsies. Blood tests are performed for diagnostic markers such as alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) and can help suggest the presence of a tumor if it is too small to detect by physical examination or imaging tests (NCI Factsheet, 2005). Ultrasounds of the scrotum can show the presence and size of the mass in the testicle thus aiding in diagnosis and treatment. Treatment is usually more successful when testicular cancer is found in earlier stages. If testicular cancer is found then further tests are required to check that cancer has not spread to other areas of the body (NCI Factsheet, 2005).

Results: What is being done to improve the target population?

Treatment mostly includes removing the entire affected testicle through an incision in the groin by surgery (NCI Factsheet, 2005). This procedure is called radical inguinal orchiectomy. In addition, radiation therapy and chemotherapy are also used to cure the patient. Radiation therapy affects normal cells as well as cancer cells since it uses high-energy rays to kill cancer cells and shrink tumors. Radiation therapy interferes with sperm production but many men regain their fertility over a period of 1-2 years (NCI Factsheet, 2005).
Chemotherapy is preferred in patients with bulkier disease since the rate of relapse is higher than with radiotherapy alone (Hanna N, 2014). Chemotherapy may also be the initial treatment if the cancer is advanced (NCI Factsheet, 2005). Common side-effects of chemotherapy include nausea, fatigue and hair loss. Some anti-cancer drugs also interfere with sperm production (NCI Factsheet, 2005). Testicular Cancer Research Paper.
Survivors of testicular cancer as also at risk for relapse of testicular cancer and for developing secondary cancers due to therapeutic radiation (NCI Factsheet, 2005). Survivors of testicular cancer are also at risk for other diseases such as cardiovascular disease, infertility, neurotoxic, nephrotoxic and pulmonary toxic effects, psychosocial disorders, fatigue, depression and osteoporosis (Hanna N, 2014).
Overall, early detection of testicular cancer during routine physical examinations have a great impact on reducing the morbidity and possible mortality associated with testicular cancer. Men should see a doctor promptly if they suspect any of the symptoms of testicular cancer and seek treatment immediately if diagnosed or a relapse of the disease is confirmed (NCI Factsheet, 2005).

Conclusion- Thoughts and opinions on testicular cancer in young men

Research into the environmental and genetic factors responsible for testicular cancer are hampered by the lack of suitable animal models to study certain types of testicular cancer but available for other types of testicular cancer (McIver SC, 2013). The exact mechanisms in the triggers leading to the development of CIS (Carcinoma in situ) are still unknown. Until these mechanisms are identified, therapeutic interventions are limited (McIver SC, 2013).
Early diagnosis is important for successful outcomes in treating patients with testicular cancer so being aware of the symptoms is particularly important in primary care (Brand S, 2013). Current treatments are very effective for treating testicular cancer as survival rates are high but their side-effects often result in loss of fertility. This is particularly concerning for young men of reproductive age (McIver SC, 2013).

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The rates of testicular cancer have risen sharply in Western countries since the early 1900s however this rise is not consistent across all countries.Testicular Cancer Research Paper.  Increased testicular cancer rates were seen in England, Germany, Denmark and Norway but decreased rates were seen in neighboring countries such as Finland and Poland (McIver SC, 2013). Phthalates could be an environmental toxin that could potentially contribute to the incidence of testicular cancer and high levels have been documented in the blood of mothers whose sons developed testicular cancer (McIver SC, 2013). Thus, detoxification mechanisms are being investigated in testicular cancer sufferers and their mothers in small initial studies. Potential links between specific cytochrome p450 polymorphisms and an increased rate of testicular cancer have been demonstrated in small investigative studies (McIver SC, 2013).Testicular Cancer Research Paper.

REFERENCES:

Brand S, Clinical Update, Nursing Standard, Volume 28, Number 1, Sept, 2013
Hanna N, Einhorn L, Testicular Cancer- Discovery and Updates, New England Journal of Medicine, Volume 371, Number 21, Nov 2014
Garner MJ, Turner MC, Ghadirian P, Krewski D, Epidemiology of Testicular Cancer, International Journal of Cancer, Volume 116, 331-339, Apr 2005
NCI (National Cancer Institute) Factsheet, 2005
McIver SC, Roman SD, Nixon B, Loveland KL, McLaughlin EA, The rise of testicular germ cell tumors: the search for causes, risk factors and novel therapeutic targets, Review, F1000 Research, 2013. Testicular Cancer Research Paper.