Movember: Men's Health Awareness (Part 2)

As promised, this is the second part of my Movember contribution, with an aim to raise awareness about men's health issues.
If you missed the first part, you can revisit it here - Movember: Men's Health Awareness (Part 1)

So in the first post, we focused on Prostate Cancer, one of the most common types of cancer affecting male population, its risk factors, symptoms, diagnosis, prevention and treatment.

In our post today, we highlight another aspect often targeted by Movember campaigns, and while being a less risky type of cancer, yet one that could affect males anywhere between 15 and 49 years of age.

We are raising awareness today about Testicular Cancer - the most common cancer among males between 15 and 39 years.

I personally have learned a lot while researching this topic (teaser: keep an eye for the last diagnosis method, just found it too weird), so I hope you find this as educational and helpful as I did. Here we go ..

Micrograph of Seminoma - a common variant of testicular cancer

What is Testicular Cancer?

Testicular cancer occurs when cells in the one or both testicles of the male reproductive system turn into malignant tumors. Particularly, 95% of the cases (Germ cell testicular cancer) would start in germ cells - cells responsible for producing immature sperm which would then flow via tiny tubes to the epididymis to be stored till maturity, and then grow increasingly into lumps and possibly metastasizing outside of the testicle. The other less frequent type, accounting for around 5% (sex cord-gonadal stromal tumours) is derived from Sertoli cells or Leydig cells.

Germ cell testicular cancer would normally come in one of two variants, classified based on the histology (microscopic anatomy) of the tumor:

• Seminoma: consisting of seminomatous germ cell tumors (GGCT, SGCT), and accounting for around half the cases, is a slow growing tumor that would include whose treatment rate represents the easiest with highest rates of success, and normally without affecting fertility.
• Nonseminoma: consisting of nonseminomatous germ cell tumors (NGGCT, NSGCT), being the type that spreads much faster than seminoma, and usually requires more difficult treatment options.

What are the signs and symptoms?

One of the first and more prevalent symptoms of testicular cancer include the presence of a lump, or swelling, in one or both of the testicles. There could be associated pain, or lack of.
Additional symptoms could include:

• Pain in lower abdomen, or in one or both testicles
• Feeling of heaviness of scrotum
• Lower back pain due to potential metastasis of tumor
• Blood in semen during ejaculation
  While those symptoms could be similar to other diseases, such as varicocele, spermatocele, ... yet when in doubt it is best to consult a physician

How is it diagnosed?

• Physical Self/Clinical Test: While some physicians do not recommend self test, yet The American Cancer Society, along with the American Urological Association recommend for monthly self tests to be performed at home, especially for males who have high risk factors (more on that in below section). In case of suspicion, the physician will perform a physical test on the testicles.
  For self test, below are the recommended steps:
  
  
  Quick tutorial for self test - as compiled by TesticularCancerCanada
• Scrotal Ultrasound / CT Scan: In case of detection of any lump, the patient's case is normally evaluated via an ultrasound, to assess the size, location, and type of the lump. CT scans can also be used to detect for potential metastases.
• Serum tumor marker test: Which is a blood test allowing measurement of Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (β-hCG), along with LDH-1, the levels of which can assist in the diagnosis, before moving to the fourth diagnosis method.
• Inguinal orchiectomy: Which is a surgery involving the removal of the entire affected testicle(s) along with the epididymis and spermatic cord, for purposes of examining the histology of the tissue and deciding the type of tumor. Biopsies are avoided for similar reasons, whereby the risk of tumor spreading would be high.
  Notice that the cut is performed in the groin/lower abdomen, not in the scrotum, since cutting through the scrotum could risk spreading the tumor into the inguinal lymph nodes, via a 4-6 cm incision allowing the testicle to be pulled through.

Inguinal orchiectomy procedure where the whole of the testis is removed for examination, and restored normally within same day

What are the relevant risk factors?

Risk factors for Testicular Cancer include:

• Cryptorchidism, or an undescended testicle - whereby one or both testicles may have not descended into the scrotum at birth (or not fully), and stayed in the abdomen.
• Family history of testicular cancer.
• Personal history of testicular cancer.
• Race also plays a role as a risk factor, with white race having the highest risk, for instance, risk in white men is around 4-5 times that of black men, and 3+ times that in Asian American men.
• Physical activity level and sedentary life style is also considered a risk factor.

What are the treatment options?

Several treatment options are available, yet depend in some cases on the cancer being a seminoma or nonseminoma.

• Surgery: This includes testicle removal. Removing the tumor itself solely, even at early stages, is not performed due to the high likelihood of the testicle containing pre-cancerous cells, and hence a high risk of recurrence. This is done similarly via orchiectomy, the process described above. In case of surgery, fertility is not affected due to the existence of the other testicle for sperm production.
  In the case of nonseminomas, additional surgery could be done on the retroperitoneal/paraaortic lymph nodes to reduce risk of cancer cells that could have metastasized to lymph nodes. This surgery can be replaced with chemotherapy
• Radiation Therapy: this is only effective in the seminoma case, and can is never used with nonseminoma cases as it is ineffective with such cell types.
• Chemotherapy: This stands as they key treatment for nonseminoma cases, via drug administration and essentially 3 or 4 rounds of Bleomycin-Etoposide-Cisplatin (BEP). Alternatively Etoposide-Cisplatin (EP) can be used for 4 rounds as well.
  In the seminoma cases, chemotherapy stands as an adjuvant treatment, to reduce risk of recurrence as an alternative to radiation therapy, currently deemed to have far greater long term side effects. A single dose carboplatin is the recommended treatment.

Now, the good news!

Testicular cancer is regarded as one of the most treatable cancers, and a great success of medicine over disease. The five-year survival rate on average is at 95%.
With the cancer not metastasizing outside of the testicle, the five-year survival rate increases to 99%.
Having spread to other organs and lymph nodes, the rate would decrease to 74%, and even then, with chemotherapy, rate would increase to 80%.

So, did you learn something new with this read? found it useful?

Oh and guys, did you start growing that moustache yet? Still got a a few weeks to do that..

Take care for now!

@mcfarhat

---

References:

1. https://en.wikipedia.org/wiki/Testicular_cancer
2. https://www.nhs.uk/conditions/testicular-cancer/
3. https://www.medicinenet.com/testicular_cancer/article.htm
4. https://en.wikipedia.org/wiki/Seminoma
5. https://en.wikipedia.org/wiki/Germ_cell_tumor

Photo Credits:

1. Image 1
2. Image 2
3. Image 3

---

Founder of Arab Steem
Arab Steem is a community project to expand Steemit to the Arab world, by supporting the existing Arab steemians and promoting others to join.
You can connect with us on @arabsteem or via discord channel https://discord.gg/g98z2Ya
Your support is well appreciated!

---

Proud Member Of

• steemSTEM: SteemSTEM is a project that aims to increase both the quality as well as visibility of Science, Technology, Engineering and Mathematics (and Health). You can check out some great scientific articles via visiting the project tag #steemSTEM , project page @steemstem, or connecting with us on chat https://steemit.chat/channel/steemSTEM
• MAP(Minnows Accelerator Project): MAP is a growing community helping talented minnows accelerate their growth on Steemit.
  To join, check out the link at the home page of @accelerator account

---

Check out some of my Prior Posts

• Hilbert's Grand Hotel Paradox
• Movember: Men's Health Awareness (Part 1)
• The Coriolis Effect and how it Affects Objects
• The Napkin Ring Paradox
• Woo Product Remover - Clean up your online woocommerce installation
• Century Old Mystery of The Zipf's Law (And A Cool Experiment)
• Day 7 of my #sevendaybnwchallenge photography
• Day 6 of my #sevendaybnwchallenge photography
• Auriez-Vous Avaler Une Batterie?
• Day 5 of my #sevendaybnwchallenge photography