The testicles (testes) are located inside the scrotum, a loose bag of skin underneath the penis. They produce male sex hormones and sperm cells for reproduction. Testicular cancer is the most common cancer in American males between the ages of 15 and 34. This cancer is even more common in males whose testicles have not both descended into the scrotum (undescended testicle).
Testicular cancer is highly treatable when diagnosed early. The most common initial finding is a lump or enlargement which can be felt in a testicle. Therefore, regular testicular self-examinations are essential in identifying dangerous growths early, when the chance for successful treatment of testicular cancer is highest. Although most patients can be cured even when the cancer has spread to other areas, early detection makes treatment much less rigorous.
Depending on the type and stage of testicular cancer, you may receive one or more of several treatments. If a testicular growth is highly suspected to be a cancer, treatment usually begins with removal of the entire testicle through an incision in the groin. A pathologist will then perform microscopic examination and classification of the tumor.
A CT scan of the body is performed to help determine if disease has spread to other areas. Special blood tests, referred to as “tumor markers”, are obtained both before and after testicular removal to help detect cancer cells that may not be apparent on x-rays such as CT scans. Depending on the pathology, radiology, and blood test results, one or more additional treatments may be necessary. Possibilities include removal of the lymph nodes in the back of the abdomen (retroperitoneal lymph node dissection), chemotherapy, and radiation. For low-risk diligent patients, very close observation with frequent CT scans may be an option.
Q: What information should I bring to my first office visit with Scott D. Miller, MD? A: Please bring relevant x-ray films (or computer disks) and any pertinent laboratory, radiology, and pathology reports. Completing our patient information forms (available on our website) prior to your arrival will help inform Dr. Scott Miller regarding your medical history, medications and allergies.
In patients with testicular cancer who have a normal CT scan of the body and normal blood tests (tumor markers), removal of the lymph nodes in the back of the abdomen (retroperitoneal lymph node dissection) may still be necessary. Although these patients can be observed with very frequent CT scans, a significant number of patients have cancer in these lymph nodes that cannot be seen on CT scan. Deciding between surgery and observation involves considering both the presence of high risk factors and personal preference.
Patients with slightly enlarged lymph nodes only in the back of the abdomen usually require retroperitoneal lymph node dissection. Bulky or widespread lymph node enlargement is usually best treated with chemotherapy. Persistent enlargement of these lymph nodes requires surgical removal.
Traditionally, a retroperitoneal lymph node dissection requires an incision traveling down the entire abdomen. However, this same procedure can be performed through small “button-hole” incisions laparosopically. Laparoscopic retroperitoneal lymph node dissection dramatically reduces the risks and recovery from surgery. However, a very high level of expertise is required to perform this procedure safely.