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Testicular Cancer

Disease Details

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Description: Testicular cancer is a type of cancer that develops in the testicles, the male reproductive glands located in the scrotum.
Type: Testicular cancer typically appears as a germ cell tumor. The genetic transmission of testicular cancer is not well-defined, but there is evidence to suggest a familial predisposition, indicating a potential hereditary component. However, a specific pattern of inheritance has not been clearly established.
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 testicular cancer in asymptomatic adolescent and adults including routine testicular self-exams. 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.Symptoms may also include one or more of the following:

a lump in one testis which may or may not be painful
sharp pain or a dull ache in the lower abdomen or scrotum
a feeling often described as "heaviness" in the scrotum
firmness of the testicle
breast enlargement (gynecomastia) from hormonal effects of β-hCG
low back pain (lumbago) due to the cancer spreading to the lymph nodes along the backIt is not very common for testicular cancer to spread to other organs, apart from the lungs. If it has, however, the following symptoms may be present:

shortness of breath (dyspnea), cough or coughing up blood (hemoptysis) from metastatic spread to the lungs
a lump in the neck due to metastases to the lymph nodesTesticular cancer, cryptorchidism, hypospadias, and poor semen quality make up the syndrome known as testicular dysgenesis syndrome.
Prognosis: Treatment of testicular cancer is one of the success stories of modern medicine, with sustained response to treatment in more than 90% of cases, regardless of stage. In 2011 overall cure rates of more than 95% were reported, and 80% for metastatic disease—the best response by any solid tumor, with improved survival being attributed primarily to effective chemotherapy. By 2013 more than 96 per cent of the 2,300 men diagnosed each year in the U.K. were deemed cured, a rise by almost a third since the 1970s, the improvement attributed substantially to the chemotherapy drug cisplatin. In the United States, when the disease is treated while it is still localized, more than 99% of people survive 5 years.
Onset: Testicular cancer typically develops in men between the ages of 15 and 35, though it can occur at any age. The onset of symptoms can vary but may include a lump or swelling in the testicle, a feeling of heaviness in the scrotum, or a dull ache in the lower abdomen or groin.
Prevalence: Testicular cancer is relatively rare but is the most common cancer in males aged 15 to 35. The incidence rate varies worldwide, but in the United States, it affects about 1 in every 250 males at some point during their lifetime.
Epidemiology: Globally testicular cancer resulted in 8,300 deaths in 2013 up from 7,000 deaths in 1990. Testicular cancer has the highest prevalence in the U.S. and Europe, and is uncommon in Asia and Africa. Worldwide incidence has doubled since the 1960s, with the highest rates of prevalence in Scandinavia, Germany, and New Zealand.Although testicular cancer is most common among men aged 15–40 years, it has three peaks: infancy through the age of four as teratomas and yolk sac tumors, ages 25–40 years as post-pubertal seminomas and non-seminomas, and from age 60 as spermatocytic tumors.Germ cell tumors of the testis are the most common cancer in young men between the ages of 15 and 35 years.
Intractability: Testicular cancer is not considered intractable. It is one of the most treatable and curable types of cancer, especially when detected early. Treatment options such as surgery, radiation therapy, and chemotherapy have high success rates. Early-stage testicular cancer has a very high cure rate, often exceeding 95%.
Disease Severity: The severity of testicular cancer can vary significantly depending on several factors, including the type and stage of the cancer at diagnosis. Early-stage testicular cancer is generally highly treatable and often curable, especially if detected promptly. Advanced stages, where cancer has spread beyond the testicle, may be more challenging to treat and could require more intensive therapies. The prognosis is typically good, particularly with early intervention and appropriate treatment.
Healthcare Professionals: Disease Ontology ID - DOID:2998
Pathophysiology: Testicular cancer originates from the uncontrolled growth of abnormal cells in the testes, primarily affecting germ cells, which are responsible for producing sperm. The two main types of germ cell tumors are seminomas and non-seminomas, each with different growth rates and responses to treatment. The exact cause is unknown, but risk factors include undescended testes, family history, and certain genetic conditions. These malignant cells proliferate and may form masses that can disrupt normal testicular function and potentially spread to other body parts, including the lymphatic system, lungs, liver, and brain.
Carrier Status: Testicular cancer is not typically associated with a carrier status in the way that some genetic diseases are. It primarily involves genetic mutations that occur spontaneously rather than being inherited. Factors that may increase the risk include family history, undescended testicles, and previous testicular cancer.
Mechanism: Testicular cancer primarily originates in the germ cells of the testes. The mechanism of this cancer involves abnormal and uncontrolled cell growth in these germ cells.

**Molecular mechanisms:**
1. **Genetic Mutations:** Mutations in specific genes such as KIT, KRAS, and NRAS can drive cancerous transformations in germ cells.
2. **Chromosomal Abnormalities:** Changes like the gain of an extra chromosome 12p (i12p) are commonly seen in testicular cancer, particularly in germ cell tumors.
3. **Oncogene Activation and Tumor Suppressor Inactivation:** Activation of oncogenes such as c-KIT and downregulation or inactivation of tumor suppressor genes like TP53 and PTEN are crucial in tumorigenesis.
4. **MicroRNA Dysregulation:** Deregulation of microRNAs, such as miRNA-371-373 and miRNA-302 clusters, play a significant role in the pathogenesis and progression of testicular cancer.
5. **Epigenetic Changes:** DNA methylation and histone modification patterns are often altered in testicular cancer, contributing to the deregulation of genes involved in cell cycle control and apoptosis.

These molecular mechanisms collectively contribute to the development and progression of testicular cancer by disrupting the normal regulatory pathways that control cell division and cell death.
Treatment: The three basic types of treatment are surgery, radiation therapy, and chemotherapy.Surgery is performed by urologists; radiation therapy is administered by radiation oncologists; and chemotherapy is the work of medical oncologists. In most patients with testicular cancer, the disease is cured readily with minimal long-term morbidity. While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage 1 cancer cases, if monitored properly, have essentially a 100% survival rate.
Compassionate Use Treatment: For testicular cancer, compassionate use treatment and off-label or experimental treatments may be considered when standard treatments have failed or are not suitable. These options can include:

1. **Compassionate Use Treatment:** This allows patients access to investigational drugs outside of clinical trials. Drugs that are still under investigation but have shown promise in studies may be accessible through this program.

2. **Off-Label Treatments:** Some medications approved for other cancers or conditions might be used off-label for testicular cancer if there is evidence suggesting they could be beneficial.

3. **Experimental Treatments:** These can include novel chemotherapy protocols, targeted therapies, immunotherapies, and gene therapy approaches that are still being tested in clinical trials. Patients may participate in these trials to access cutting-edge treatments.

Patients and their healthcare providers should discuss these options, considering the potential benefits and risks.
Lifestyle Recommendations: ### Lifestyle Recommendations for Testicular Cancer

1. **Regular Self-Examinations**:
- Perform monthly testicular self-exams to detect any unusual lumps or changes early.

2. **Healthy Diet**:
- Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support overall health.

3. **Physical Activity**:
- Engage in regular physical exercise to maintain a healthy weight and boost the immune system.

4. **Avoiding Risk Factors**:
- Reduce exposure to known risk factors such as HIV infection and avoid smoking and other tobacco use.

5. **Regular Medical Check-Ups**:
- Keep up with routine health check-ups to monitor for any potential health issues early on.

6. **Stress Management**:
- Practice stress reduction techniques such as meditation, yoga, or deep-breathing exercises.

7. **Safety Measures**:
- Use protective gear during sports or activities that carry a risk of injury to the testicles.

By implementing these lifestyle recommendations, individuals can support their overall health and potentially improve their outcomes if diagnosed with testicular cancer.
Medication: Medications are not typically the primary treatment for testicular cancer. Instead, surgery to remove the affected testicle (orchiectomy) is the most common initial treatment. Depending on the type and stage of the cancer, additional treatments may include chemotherapy or radiation therapy. These treatments help to eradicate any remaining cancer cells and reduce the risk of recurrence. Medications like chemotherapy drugs (e.g., bleomycin, etoposide, and cisplatin) might be used in cases where the cancer has spread beyond the testicle or to prevent recurrence after surgery.
Repurposable Drugs: Currently, no widely accepted repurposable drugs are established for testicular cancer. Treatment typically involves surgery, chemotherapy, and radiotherapy, which are tailored according to the type and stage of the cancer. Research into the repurposing of drugs is ongoing, and new potential therapies may emerge as studies continue.
Metabolites: In the context of testicular cancer, metabolites refer to the various small molecules and biochemicals involved in the metabolic processes of cancer cells. Although current research is expanding our understanding, there are no universally recognized specific metabolites uniquely associated with testicular cancer diagnosis or progression. Elevated levels of serum tumor markers like alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) are typically used in diagnosing and monitoring the disease. Research into specific metabolites continues to explore potential biomarkers for improved detection and treatment.
Nutraceuticals: Currently, there is limited evidence to suggest that nutraceuticals (dietary supplements or food products with potential health benefits) have a significant impact on the prevention or treatment of testicular cancer. Nutraceuticals have not been established as a mainstream component of clinical management for this type of cancer. Conventional treatment options such as surgery, radiation therapy, and chemotherapy remain the primary and most effective treatments for testicular cancer. Always consult healthcare professionals before considering any alternative or supplemental therapies.
Peptides: Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. Peptides can be involved in various aspects of cancer biology, including cell signaling and tumor growth, but their specific role in testicular cancer treatment or diagnosis is still under research. There are no widely established peptide-based treatments for testicular cancer as of now. Nanotechnology, however, holds potential for improved diagnostic and therapeutic strategies. Nanoscale materials and devices could potentially enhance the delivery of chemotherapeutic agents, improve imaging techniques, and enable targeted drug delivery, thereby reducing side effects and increasing treatment efficacy.