Testicular Cancer Case Study

Introduction

Testicular cancer is common cancer found in men aged 17 to 40 years. The most common types are the seminomas and non-seminomas. Lymphomas are a rare type. The seminomas are spread via the lymphatic system to paraaortic and iliac lymph nodes whereas the non-seminomas are spread hematogenously to the lungs liver and the brain.

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Risk Factors

The predisposing factors for testicular cancer include undescended testes, a family history of testicular cancer, inguinal hernia and a previous history of testicular cancer. Another risk factor for testicular cancer is exposure to high levels of exogenous estrogen prenatally or during early childhood. Syndromes like Kleinfelter's syndrome also increase the likelihood of one getting testicular carcinoma. Infections like mumps orchitis are among the other risk factors for testicular cancer.

Signs and Symptoms

The most common presentation of testicular carcinoma is a painless testicular mass. The mass is irregular, firm and fixed to the testes. Usually, the testicular mass does not transilluminate. Some patients experience gynecomastia due to BHCG effects. Some patients have pain in the abdomen or the scrotum. Other patients may have lower back pain due to an involvement of the lymph nodes at the back. When testicular cancer has metastasized to the lungs, the patients may present with symptoms like chest pains, cough, haemoptysis, and dyspnea.

Diagnosis and Investigations

A diagnosis of testicular cancer is made from a testicular biopsy. Testicular ultrasound can also be very helpful, and the biopsy can be taken under ultrasound guidance. Other important diagnostic tools include serum tumor markers such as alpha feto proteins (AFPS) and BHCG. These serum tumor markers are usually elevated in disseminated non-seminomas. Rarely do seminomas have high levels of the named tumor makers. CT of the chest, brain, and abdomen are necessary to rule out tumor metastasis. A bone scan can be equally useful to rule out bone metastasis.

Treatment

Seminomas are sensitive to radiotherapy even when they are widespread.

Stage 1 management can be orchidectomy alone or orchidectomy and prophylactic radiotherapy of the paraaortic and iliac lymph nodes. Also, orchidectomy and preventive chemotherapy is another option. Stage 2, three and4 management is by a combination of orchidectomy chemotherapy and radiotherapy to involved lymph nodes.

Non-seminomas are chemosensitive, unlike the seminomas which are radiosensitive.

Stage 1- management is orchidectomy. Stage 2, 3 and 4 is orchidectomy, chemotherapy, and dissection of any involved lymph nodes. The most commonly used chemotherapy regimen for testicular cancer is three cycle with a combination of bleomycin, etoposide, and cisplatin.

Prognosis

Testicular cancer has a good prognosis. There is a 90% cure rate of stage one cancer and even the patients with metastatic disease have a good long time survival because of combination therapy

Penile Cancer

It is a very rare cancer which mostly affects the senior men. 96% of the penile cancers are squamous cell carcinomas. Mostly majority of penile cancers affect the glans penis, and a small percentage affects the penile shaft.

Risk Factors

There are several risk factor associated with penile carcinoma. The common risk factors include infections such as human papiloma virus, not being circumcised and having multiple sexual partners. Also, phimosis, elderly men aged more than sixty years and poor hygiene are predisposing factors. Radiation exposures to the penis and tobacco use are as well associated with penile carcinoma.

Signs and Symptoms

Patients with penile cancer present with a range of symptoms which include: Painless ulcer, a penile out growth, inguinal lymphadenopathy in advanced stages and smelly penile discharge. Some patients may also present with Swelling of the penis, and Skin color changes around the penis, irritation, and bleeding.

Diagnosis and Investigation

The best diagnostic tool for penile cancer is incision or excision biopsy. A fine needle aspirate can also be diagnostic. It is useful to do a CT scan to stage penile cancer.

Treatment

There are a number of treatment options for penile cancer depending on the stage of the tumor. For stage one penile cancer, total or partial amputation of the penis can be done in combination with radiotherapy and chemotherapy especially if the tumors are confined to the glans penis. For the partial carcinomas excision and reconstruction of the glans penis can be done. Other possible treatment modalities for stage one penile cancer include cryosurgery and wide local excision.For stage 2, 3 and four the best treatment modality would be chemotherapy, radiotherapy and partial or total penectomy.

Prognosis

The prognosis of penile cancer depends on the location and size of a tumor as well as on the stage of a tumor. The five-year survival rate for patients with stage 1 disease is about 90% whereas the five-year survival rate for stage 2, 3 and 4patients is less than 60%.

References

Colecchia, M. (2016). Pathology of testicular and penile neoplasms. Springer,.

Kimakura, M., Abe, T., Nagahara, A., Fujita, K., Kiuchi, H., Uemura, M., & Nonomura, N. (2016). Metastatic testicular cancer presenting with liver and kidney dysfunction treated with modified BEP chemotherapy combined with continuous hemodiafiltration and rasburicase. Anti-Cancer Drugs, 27(4), 364-368. http://dx.doi.org/10.1097/cad.0000000000000334

Lau, J., Wang, Z., Lau, M., & Lai, C. (2013). Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in hong kong. Archives of Sexual Behavior, 43(4), 789-800. http://dx.doi.org/10.1007/s10508-013-0172-3

Oechsle, K., Hartmann, M., Mehnert, A., Oing, C., Bokemeyer, C., & Vehling, S. (2016). Symptom burden in long-term germ cell tumor survivors. Supportive Care In Cancer, 24(5), 2243-2250. http://dx.doi.org/10.1007/s00520-015-3026-9