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Testicular Cancer
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The term ” testicular
cancer “includes
several types of tumors germ testis. It is a cancer rare (about
1% of all cancers) but in all countries with a cancer registry
and / or testicular tumors , this cancer is increasing for
several decades and is also the cancer most common cancer in men
15 to 35 years. Both testes are rarely affected simultaneously
(1 to 2% of cases), and after recovery from testicular cancer,
the risk of developing cancer in the other testicle is 2 to 5%
in 25 years. |
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The chemotherapy by salts of platinum since the
1970s has dramatically changed the prognosis of
this disease, with almost 80% of these cancers
are now cured (all stages combined). The
effectiveness of treatment depends on the type
of cancer and quality of care, it justifies
refer patients to specialized centers. The futurists in epidemiology ,
in Canada believe that “It is quite likely that
the incidence of testicular cancer continues to
increase (we do not know why) and that the
incidence of mesothelioma and mortality
associated with it does growing. |
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Types Of Testicular Cancer:
We
distinguish two main types histopathological : |
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Seminomas (50% of cases) that might flow
from an uncontrolled proliferation of cells
in the germinal epithelium of the tubule .
They have an appearance hypoechoic and
hypovascular ultrasound scrotum ). They are
radio-sensitive and their prognosis is good
in 95% of cases, but requires monitoring of
the patient. A leydigome is a seminoma-induced
proliferation of Leydig cells . The
spermatocytic seminoma represents less than
1% of testicular cancer and affects the
elderly, with a very good prognosis if
treated. Non-Seminomatous cancer , or tumors
Germ cell (NSGT) whose prognosis is
generally poorer. They present a
heterogeneous appearance and vascular
ultrasound. |
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The chorio-carcinoma.
The teratomas .
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Testicular cancer is rare (about
1% of cancers, 2% in children), but its impact
as that of prostate cancer increased steadily
since the 1900s, and most significantly in
countries with white skin from the years 1950
(increase by a factor of 3 to 5 years from 1950
to 2000). Data is lacking for many developing
countries, but this cancer appears more common
among black populations in Africa and among
Asians than among the white-skinned (the
difference could be genetic and / or related to
the environment, food or certain cultural
traits). He became the tumor most common in
young men, at least in rich countries to
dominant white population. |
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In Europe:
In
all countries where it is followed by a record
cancer, except for reasons unexplained in
Finland, an increased incidence of cancer was
confirmed in early 1990 in Europe. In Europe,
Denmark seems the most affected (4 times more
than the nearby Finland to be among the least
affected, and where the quality of the sperm
looks best). In Europe, it has a west-east
gradient in regions Baltic and North-South
gradient in Western Europe. The record is
Norwegian (prevalence increasing and two times
higher than in Sweden, she even more affected
than Finland (Swedish-Norwegian Study (ongoing
from June 2008 to June 2015) aims to investigate
possible genetic factors). Its incidence has
doubled in many countries, including in France
from 1970 to 2000 in all regions where
epidemiological monitoring was. The French
urologists B. Boillot and R. Moalic estimate
that the number of testicular tumors pre-
pubertal increases in France for several decades
(like those of adults). The impact of these two
cancers (pre-and post-pubertal) combined
increases of 3.4% per year for 30 years (while
the incidence of tumors Non seminomatous
decreased in adults over 55 years); |
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The steady growth and documented
since the 1950s the incidence of testicular
cancer (TC) in developed countries experienced a
temporary exception: The incidence appears to
have been much slower for men born during the
Second World War or just before or just after, a
Norwegian study found published in 2005. This
retrospective study has shown – not to draw any
definitive conclusions – that, given the
available data, the average weight of the mother
at delivery was (between 1935 and 1955)
correlated with the average risk of testicular
cancer for future boys born at the same time.
One explanation could be that insulin levels
increased with maternal weight, which reduces
the rate of hormone-binding globulin , and
consequently makes it more bioavailable estrogen
to placental transfer. They were then in the
male fetus to endocrine disruptor action. |
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Maternal weight might increase
the risk of testicular cancer or hormonal
disorders in children and males exposed in utero
to an abnormally high dose of estrogen during
the first trimester of pregnancy. |
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Many clues suggest,
therefore, for environmental causes.
2002 new cases were registered in 2005
and its incidence has increased by 2.5%
over the period 1980-2005 and especially
for childhood cancer, exposure to
endocrine disruptors or carcinogens in
utero . In this case the cancer is one
of the testicular dysgenesis syndrome
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Incidence:
It occurs most often
between 20 and 40, but there are three
peaks in frequency of testicular cancer: |
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In the first years of life
(before age 5) and puberty . In
France, 1-2% of solid tumors of
early childhood cancers are
testicular The young child is 5%
of testicular cancer if it does
not include the period known as
adolescence in childhood, and
0.5 % if we include this period.
These tumors are increasing a
little slower than in adults,
but significantly (+ 1.3% per
year), which is an index of
common cause, probably one or
more point (s) cancer (s)
Development testes. Unlike
testicular tumors in adults who
require surgical removal of the
testicle (orchiectomy) 29 to 48%
of prepubertal testicular tumors
are malignant and allow a less
conservative surgery . A risk
factor is associated with
cryptorchidism (this risk is
associated with cancer in adults
than that of the prepubescent
child); after puberty , are the most
frequent cases (maximum
frequency between 25 and
35).
after 60 years (more rarely)
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Risk factors:
Some are clearly identified (but not explained).
They are:
- the cryptorchidism , which would increase
the risk of developing testicular cancer by
3.6 to 5.2 according to studies, the gold
cryptorchidism and hypospadias are
significantly more frequent in Europe and
the USA: + 65 to 77% during recent decades
in the United Kingdom , for cryptorchidism,
and shypospadias doubling in 10 years (1970
to 1980) United States.
- A study on the risk factors for 131 cases of
testicular cancer (in men under 40 years)
confirmed a risk (here multiplied by 5) in
case of cryptorchidism at birth, but she has
identified two new risk factors: six mothers
of patients had received hormone treatment
during pregnancy (cons one for mothers dy
control group), eight mothers and two
mothers of patients against the control
group had reported nausea as excessive
complication of pregnancy. The authors
believe that these three factors reflect the
fact that a relative excess of certain
hormones (estrogen in particular) at the
time of testicular differentiation could
promote carcinogenesis future of these
cells;
- the contralateral cancers ;
- the Klinefelter syndrome , which is
characterized by multiple chromosomal
abnormalities resulted in a morphology
eunuchoid , gynecomastia and small testes in
adults or adolescents;
- the testicular atrophy or
mumps orchitis (rare complication of mumps).
- family history (risk 6 to 10 times higher
for a brother with this same cancer). Family
history of cancer are also a risk factor;
- Infertility;
- smoking ;
- heavy weight of the mother during pregnancy;
- exposure in utero to diethylstilbestrol or
other endocrine disrupters or hormone
treatment of the mother;
- exposure to certain cosmetics is also a risk
factor recently suggested
(endocrine-disrupting effect) …
Symptoms:
- The discovery mode is the most frequently
increase the volume of a stock because of an
intra-testicular mass. The mass is usually
painless.
- Sometimes the diagnosis is made on an
abdominal mass or a sign in relation to
metastasis brain ( seizures , impaired
consciousness, and headache ).
- Secretion of Beta HCG by the injury may
cause swelling of mammary glands (
gynecomastia ) is also present in humans.
Diagnosis:
The diagnosis of cancer is increased after
removal of the testicle essential. We
distinguish among different types of testicular
cancer and seminomas pure other tumors.
Seminomas have a better prognosis. The presence
of metastases at diagnosis decreases the chances
of recovery.
The biopsy of intra-testicular mass is not used
in the diagnostic procedure; Upon discovery of a
mass testis , the first review is proposed
ultrasound of the testicles. If it confirms the
suspicious nature of the injury, the testicle
may be necessary. This surgical procedure, known
as orchiectomy , is practiced through groin . It
aims to prevent the spread of cancer cells and
metastasis. When the diagnosis of cancer is
confirmed, a staging is required to search for
possible metastatic lymph node or visceral. The
assessment will include a scan of the thorax ,
abdomen and pelvis and in some cases a CT or MRI
brain. The measurement of tumor markers such as
HCG , AFP and LDH are also part of the staging
of the disease.
Treatment:
It is based on surgery chemotherapy and
radiotherapy and is now well codified, with the
aim of healing with the least possible sequelae.
If the use of cisplatin in the 1970s has
transformed the prognosis of testicular cancer,
it remains a serious illness warranting extreme
rigor in its management. The best results in
terms of healing are provided by specialized
medical teams. The therapeutic strategy is
defined in terms of initial assessment and
disease progression during treatment (change of
tumor markers, residual masses).
The goal of treatment, side effects in the short
and long term and the importance of monitoring
should be clearly explained to the patient to
ensure its full cooperation.
Chemotherapy:
Different protocols (i.e., the combination of
different drugs given in precise doses,
according to a particular chronology) have shown
for years to be effective in the treatment of
this cancer. Treatments equally effective, but
side effects increasingly appeared reduced. The
protocols are designated by the initials of the
products used: BEP = Bleomycin, Etoposide,
Cisplatin (P for platinum).
Radiotherapy:
Irradiation is used to treat advanced seminomas,
in one session of radiation a day for several
weeks. These rays are the lymphatic channels
from the groin area and leading to the lymph
nodes along the aorta .
The patient should be monitored over time
because there is an increased risk of second
cancer induced by radiotherapy. And it seems
that although the post-operative radiation
increases the risk of second cancer as
non-seminomatous cancers (usually not treated
with radiation) are less followed by a second
cancer.
Surgery:
The removal of the testicle,
The removal of the affected testicle (
orchiectomy ) is the first time of treatment. It
can be done under general
anesthesia, spinal anesthesia or regional
anesthesia (block ilio-face) by an inguinal
incision (at the groin) and not through the
scrotum . Prosthesis in silicone for aesthetic
purposes may be raised if the patient wants. The
stage of cancer is explained by analyzing
pathological testis removed and
thoraco-abdominopelvic. Falling rates of markers
to confirm the absence of any remaining tumor.
Depending on the type and stage of cancer,
further treatment may be proposed (radiotherapy
or chemotherapy) or para-aortic dissection, or
simple monitoring.
Lymph Node Dissection:
This is – after an initial chemotherapy – or
purpose of diagnosis (without tumor markers) to
remove (by a midline incision in the abdomen),
abdominal lymph nodes along the aorta, which
arrive in the lymph from the testicles.
The Removal Of Residual Masses:
If lymph node or visceral metastases are
detected at diagnosis, the patient is often
treated by three or four courses of chemotherapy
and a new scan is performed four weeks after the
last treatment. If the scanner finds residual
masses, removal of these residual masses is
generally performed by a surgeon.
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