Diagnosis Of Testicular Cancer Research Articles

Germ-Cell Testicular Cancer in Offspring of Finnish Immigrants to Sweden

Abstract Variation in testicular cancer incidence can be used to assist in identification of risks. Finland has a significantly lower germ-cell testicular cancer risk than Sweden. Finns who immigrate to Sweden maintain their lower risk irrespective of age at immigration. We investigated difference in risk between Finland and Sweden by examining germ-cell testicular cancer incidence in males born in Sweden to Finnish immigrant parents. Swedish general population registers were used to identify 11,662 males born in Sweden where both Finnish parents immigrated to Sweden from Finland from 1969 or afterward. All of these offspring were at least 15 years old by final follow-up in 2001. Some six offspring (all diagnosed between ages 20 and 24 years) had a diagnosis of germ-cell testicular cancer. Comparison with the Swedish population rate produced standardized incidence ratios [SIR (95% confidence interval)] of 0.85 (0.31-1.84) for all the men and 1.75 (0.64-3.81) for the 20- to 24-year age group. SIRs calculated using the Finnish population rates produced an overall SIR (95% confidence interval) of 1.11 (0.41-2.41) and 2.95 (1.08-6.42) for the 20- to 24-year age group. Although the substantially reduced risk of testicular cancer previously observed in Finnish immigrant to Sweden was not found, this study had insufficient statistical power to conclude that environmental exposures explain the difference in germ-cell testicular cancer risk between Finland and Sweden.

Delay in diagnosis of testicular cancer

4602 Background: Delay in presentation of a testis tumor may result in an advanced stage of disease at diagnosis, which may affect disease free and overall survival. The aim of this study was to determine variables related to delay in diagnosis of testicular cancer (TC). Methods: A questionnaire was developed to assess patient delay (time from first symptom till first consultation with general practitioner (GP)) and doctor delay (time from first consultation with GP till final diagnosis). In addition, patient and disease characteristics possibly related to patient and/or doctor delay, were collected: age, marital status, educational level, extensiveness of the disease (stage I vs disseminated disease), number of symptoms, change in testicle as a symptom, pain as a symptom, patients' knowledge of TC, appraisal of symptoms as threatening, embarrassment, and whether the doctor referred the patient immediately for further examination. Results: 48 men (median age 25, range 16–44 years) who were consecutively referred to the Groningen University Hospital completed the questionnaire. Median patient delay was 30 (range 1–365) days. Only educational level correlated with patient delay (r=-.30, p=.03). Median doctor delay was 14 (0–240) days. After first consultation, only 20 patients (42%) were immediately referred for further examination. The remaining 28 patients were not immediately referred, which led to a significantly longer doctor delay (median = 23 days, t=-4.47, p90 days. Age was significantly related to total delay (r=-.33, p=.03). Six patients (12.5%) did not have a change in testicle as presenting symptom, but this was not related to delay. Extensiveness of disease was not related to delay. Conclusions: Surprisingly, having disseminated disease and having a change in a testicle as presenting symptom were not related to delay, but younger and lower educated men appeared to be more likely to report delay in diagnosis. Over half of the men were not immediately referred for further examination, resulting in a significantly longer GP delay. This finding stresses the responsibility of GPs in the diagnostic process of TC. No significant financial relationships to disclose.

Delay in diagnosis of testicular cancer

Delay in diagnosis of testicular cancer

Testicular Cancer: Passage through the Help-Seeking Process for a Cohort of U.K. Men (Part 1)

Although there have been many studies in “patient delay” and help-seeking for cancer symptoms, these have tended to be focused on women and breast cancer. Few papers have investigated specifically male cancers and the help-seeking process. We interviewed 10 men who had experienced testicular changes and a diagnosis of testicular cancer. We analysed, using grounded theory methodology, the stories men told about their experience of testicular changes and the process of seeking help. The central unifying theme concerned how men faced and handled uncertainty. The theory suggested several steps whereby they sought to gain an explanation for testicular changes, justify seeking help, and anticipate exposing their fears to professionals. In so doing, men described several barriers founded in their own knowledge, perceptions, and assumptions about testicular cancer. We discuss several taboos surrounding testicular concerns, a range of issues related to masculinity and sexuality, and the role of physicians in the help-seeking process.

Fecundity and twinning rates as measures of fertility before diagnosis of germ-cell testicular cancer.

Previous studies have suggested an association between subfertility and testicular cancer by using fecundity and semen characteristics to measure fertility. The occurrence of twinning in offspring may be used to investigate male reproductive health, because dizygotic twinning is reduced by male subfertility. We therefore assessed number of children and offspring twinning rates among 4592 Swedish patients with testicular cancer and 12 254 control subjects. Before diagnosis, case patients had a decreased number of children (for testicular cancer, odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.62 to 0.81; at least three children compared with no children), with a lower frequency of dizygotic twinning (for unlike-sex twins, OR for the father having testicular cancer = 0.49, 95% CI = 0.22 to 1.08). The ratio of unlike-sex to same-sex twins was 0.22 among children of case patients and 0.66 among children of control subjects (adjusted P =.03, two-sided Wald test). We also found an increased occurrence of twinning after diagnosis, probably attributable to treatment for iatrogenic subfertility. Our study strongly supports evidence of an association between subfertility and the subsequent risk for testicular cancer.

Testicular cancer metastatic exclusively to the brain and spleen

We report an unusual case of testicular cancer metastasized solely in the brain and spleen without retroperitoneal disease or other widespread metastasis. The patient initially presented with seizures and underwent craniotomy for presumed primary brain tumor, with a delayed diagnosis of testicular cancer as the true primary. This pattern of spread is highly unusual, and, to our knowledge, we report the first case of splenectomy performed for involvement by testicular cancer. At last follow-up, the patient was doing well, with no evidence of disease after 2 years.

Testicular cancer.

Testicular cancer remains a major success story in the realm of solid tumors. Although testicular cancer is highly treatable and curable, there are still many young men who succumb to the disease. Over the past year, important data regarding the diagnosis, treatment, and prognosis of testicular cancer have been reported. The significance of genetic and molecular alterations, such as i12p and epidermal growth factor receptor expression, remain at the forefront of research. However surgery and platinum-based chemotherapy are still the main treatment modalities. Attempts to limit chemotherapy and surgery while preserving cure rates are promising. The contribution of long-term platinum retention to the well-documented risk of late toxicity is unknown but provides a specific avenue for research. New tumor markers, such as lactate dehydrogenase isoenzyme-1, may provide a greater risk stratification. Positron emission tomography imaging may reduce the need for surgical resection posttherapy and provide a more comprehensive means of observation.

Urological cancers: do early detection strategies exist?

To determine the perceptions of healthcare professionals and the general public about the symptoms, diagnosis and available treatment of urological cancers, and thus the perceived value of screening for their early detection. Two questionnaires were developed, based on semi-structured interviews, and distributed to 288 healthcare professionals, comprising 182 general practitioners (GPs), 56 practice nurses and 50 urology nurses, and to 250 members of the general public in three different socio-economic groups. The questionnaires asked about the symptoms, diagnosis and treatment of prostate, bladder and testicular cancer, and whether the respondents considered that screening for these cancers would be useful in ameliorating morbidity or death from these diseases. The response rate was very poor (13 of the GPs, 7%; 34 of the nurses, 32%; and 58 members of the general public, 23%). This severely limited the interpretation of the results, but the responses highlighted areas which need addressing. Obvious symptoms were well understood by all the groups but less well-known symptoms could be missed. No GP supported screening for prostate cancer and only seven of the GPs believed in teaching testicular self-examination, but practice nurses were considerably more active in all aspects of patient education. The general public felt that they needed more information to make decisions about urological cancers, although there was a general feeling that 'screening saved lives'. This survey showed that no healthcare professional seems to have a clearly defined role in informing potential patients about screening. The general public, who seem to perceive from the media that early detection is beneficial, are confused by the lack of clarity about policies for urological cancers.

Three-Year Results of the First Educational and Early Detection Program for Testicular Cancer in Hungary

Objective: To determine whether a testicular self-examination-based early-detection program may help in the early diagnosis of testicular cancer. Methods: Advertisements were placed in the media describing the early signs of testicular cancer, the risk factors, the correct method of self-examination and the importance of early detection. Between April 1995 and April 1998, 5,056 men underwent physical and ultrasound examination of the testicles, and in case of suspicious findings tumor markers were checked. Results: Testicular tumors were found in 1.28% of the men with symptoms. No tumors were found in men without symptoms or in men with pain, sensitivity to palpation, or complaints unrelated to the testicle. Of those with a palpable lump or swollen testicle, 4.5 and 3.9% were found to have a tumor. In total, 28 testicular cancers (15 seminomas and 13 nonseminomas) in 26 volunteers and 4 benign tumors were detected. The occurrence of cancer was most frequent in the age group of 15–40 years (1.6%). Conclusion: The rate of cancer detection and the detected seminoma rate in the program are not sufficient to justify a widespread early detection program for testicular cancer (examination of men who reveal testicular abnormalities by self-examination) despite the increased tumor incidence. Early diagnosis should be based on an educational program for the population at risk, the training of staff engaged in the health care of the young, and the use of early ultrasound examination in men with palpable lumps and swollen testicles, especially in young men.

An assessment of sexual difficulties in men after treatment for testicular cancer

A study of twenty-seven patients with testicular cancer who completed two questionnaires and of whom six were interviewed, as was one partner, is reported. The main aim was to obtain more information about sexual difficulties in this group of men. The study also attempted to assess the effectiveness of using the QLQ-C30 questionnaire; a self assessed physical and psychological questionnaire and the GRISS questionnaire, a specific sexual satisfaction questionnaire, in relation to sexual dysfunction in men with testicular cancer. The questionnaires revealed limited information about sexual difficulties and were of only limited usefulness with regard to extracting this information in comparison with interviewing. Qualitative interviews revealed themes of sexual attitudes and issues around body image. This would seem to suggest that a specific questionnaire needs to be devised, guided by further qualitative research in the form of interviews in order to obtain more information about body image and sexual difficulties which may be experienced by patients with testicular disease. The impact or significance of a diagnosis of testicular cancer might be influenced by the presence of a current partner, and this may be protective against future problems.

Overexpression of Aromatase Leads to Development of Testicular Leydig Cell Tumors: An in Vivo Model for Hormone-Mediated Testicular Cancer

Despite recent advances in diagnosis and treatment of testicular cancer, its causes remain unknown. The most common conditions known to be associated with testicular cancer are cryptorchidism, infertility, and overexposure to pesticides or radiation. Recent studies also indicate hormones may play a crucial role in testicular tumorigenesis. Our studies show that about half of the male transgenic mice overexpressing aromatase in testis were infertile and/or had larger than normal testicles. Gross pathology and histological analysis showed the mice to have Leydig cell tumors, unilaterally or bilaterally. Serum estradiol levels for transgenic mice were at least twice as high as those for nontransgenic mice. Expression of aromatase and estrogen receptor were also very high in testicular tissue of transgenic mice compared to nontransgenic mice. Consistent with increased estrogenic activity in the testicular tissue, we also saw an increase in the levels of genes involved in cell cycle that are regulated by the estrogen. To obtain a better understanding of the biological significance of testicular tumorigenesis, a reliable animal model is necessary to clarify the mechanisms and correlations associated with human cancers. Here we describe such a model, which shows that overexpression of aromatase results in increased estrogen production and a changed hormone milieu, leading to the induction of testicular cancer (Leydig cell tumors). This predictable and useful model is a potential tool for the study of testicular tumorigenesis, hormonal carcinogenesis, synergistic action of other carcinogens on hormone-induced tumors, and tumor dependency on endocrine factors.

Sperm cryopreservation in patients with testicular cancer

Objectives. To review a large experience with sperm cryopreservation in patients with testicular cancer and determine the effect of clinical stage and tumor histologic features on semen quality. Methods. The prefreeze and post-thaw sperm quality of 157 patients with testicular cancer was compared with that of 50 normal donors. The impact of tumor stage and histologic features (pure seminoma, pure embryonal, or mixed germ cell) was also determined. A computer-assisted semen analysis was performed before and after cryopreservation. The motile sperm count (MSC), motility, and motion characteristics were measured before and after cryopreservation and compared between groups. Results. Patients with testicular cancer had lower prefreeze and post-thaw MSC and motility compared with normal donors ( P = 0.0001 for both). The curvilinear velocity and linearity were also significantly less in patients with testicular cancer ( P <0.05 for both). The percentage of change in the semen characteristics did not differ between patients and donors, indicating that sperm from both patients and donors withstood the cryopreservation process equally well. Tumor stage (n = 143) and histologic features (n = 136) did not significantly influence semen quality. No individual histologic component significantly influenced MSC or motility. Conclusions. The effect of cryopreservation on sperm was similar in patients with testicular cancer and donors. Patients with poor prefreeze semen quality have poor post-thaw semen quality, and the effects of cryopreservation were not significantly affected by histologic features or stage. Our results indicate that routine sperm banking should be recommended for men with a diagnosis of testicular cancer to preserve future fertility potential.

Risk of testicular cancer in subfertile men: case-control study

Objective: To evaluate the association between subfertility in men and the subsequent risk of testicular cancer.Design: Population based case-control study.Setting: The Danish population.Participants: Cases were identified in the Danish Cancer...

DECREASED SURVIVAL OF BLACK AMERICANS WITH TESTICULAR CANCER

Purpose A 14-year review of 215 consecutive patients with testicular cancer at the University of Illinois hospitals revealed that 25% were black. This large experience with this relatively rare cancer in black men provides a unique opportunity to compare the disease stage at presentation, histological tumor type and 5-year survival rates of black, white and Hispanic men. Materials and Methods We reviewed the records of patients with a diagnosis of testicular cancer treated at University of Illinois hospitals. The Kaplan-Meier method was used to calculate actuarial 5-year survival rates. Results The overall percentages of white, black and Hispanic men were 55 (119 men), 25 (53) and 18% (38), respectively. We found no significant differences in tumor types among the 3 racial groups. Overall 42 and 58% of the patients had seminoma and nonseminoma, respectively. Black men with some types of cancer have been shown to present with higher stages of disease but we noted no differences in clinical stage at presentation in all groups with testicular cancer (average stage I disease in 45%, II in 31% and III in 24%). Survival rates were 88% in white, 79% in Hispanic and 71% in black patients. Conclusions Black men had significantly decreased (z <0.02) 5-year disease specific survival, which was 17% less than white patients. The difference in disease specific survival for Hispanic men was not statistically significant. This review of 215 patients with testicular cancer revealed no differences in tumor type or stage at presentation for white, black or Hispanic men. However, a review of these data suggests that disease specific survival outcomes are more ominous in black men.

Risk of second malignant neoplasms among long-term survivors of testicular cancer.

We have quantified the site-specific risk of second malignant neoplasms among nearly 29,000 survivors (> or = 1 year) of testicular cancer, taking into account the histologic type of initial cancer and the primary therapy used to treat it. The study cohort consisted of 28,843 men identified within 16 population-based tumor registries in North America and Europe; over 3300 men had survived more than 20 years. New invasive cancers were identified through a search of registry files. Second cancers were reported in 1406 men (observed-to-expected ratio [O/E] = 1.43; 95% confidence interval = 1.36-1.51), with statistically significant excesses noted for acute lymphoblastic leukemia (O/E = 5.20), acute nonlymphocytic leukemia (O/E = 3.07), melanoma (O/E = 1.69), non-Hodgkin's lymphoma (O/E = 1.88), and cancers of the stomach (O/E = 1.95), colon (O/E = 1.27), rectum (O/E = 1.41), pancreas (O/E = 2.21), prostate (O/E = 1.26), kidney (O/E = 1.50), bladder (O/E = 2.02), thyroid (O/E = 2.92), and connective tissue (O/E = 3.16). Overall risk was similar after seminomas (O/E = 1.42) or nonseminomatous tumors (O/E = 1.50). Risk of solid tumors increased with time since the diagnosis of testicular cancer, yielding an O/E = 1.54 (O = 369) among 20-year survivors (two-sided P for trend = .00002). Secondary leukemia was associated with both radiotherapy and chemotherapy, whereas excess cancers of the stomach, bladder, and, possibly, pancreas were associated mainly with radiotherapy. Men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Patterns of excess second cancers suggest that many factors may be involved, although the precise roles of treatment, natural history, diagnostic surveillance, and other influences are yet to be clarified.

Late relapse of nonseminomatous germ cell tumor of the testis: Successful treatment with salvage chemotherapy alone

Late relapses of nonseminomatous germ cell tumors of the testicle are unusual. In such cases, chemotherapy is reported to have only modest success and surgery may be the preferred treatment modality. We report a patient who experienced relapse 11 years after the initial diagnosis of advanced testicular cancer and who achieved a sustained complete remission with salvage chemotherapy alone.

Testicular tumor cells pass through the epididymal ducts.

The diagnosis of early testicular cancer is based on the histological evaluation of testicular biopsies. Like the germ cells, the tumor cells find their way along the tubular duct system of the male urogenital tract into the ejaculate. But only very few data have been published on the exfoliation of testicular tumor cells into the ejaculate in men suffering from early testicular cancer. The screening of ejaculate to detect early testicular cancer would appear to be a rather unsuccessful method.

Immunochemical mapping of gonadotropins

As a glycoprotein hormone, human chorionic gonadotropic (hCG) is not a single molecular entity but this term rather comprises an array of molecular variants such as hCG, hCGβ, hCGn, hCGβn, hCGβcf, - ctphCG, hCGβ ctp, deglyhCG, asialohCG, hCGav and the closely related molecules hLH, hLHβ and hLHβef. The advent of monoclonal antibodies (MCA), the availability of ultrasensitive detection systems and the recent determination of the crystal structure of hCG, made it possible to design special purpose diagnostic and clinical research immunoassays for hCG-like molecules. For more than a decade we and others have tried to refine epitope maps for hCG and related molecules by means of a large panel of MCA, naturally ocurring metabolic variants of hCG (hCGn, hCGβ, hCGα, hCGβcf, hCGβ ctp), homologous hormones and subunits of various species (e.g. hLH, hLHβ, hFSH, hTSH, oLH, rLHβ), chemically modified molecules (deglyhCG, asialohCG, tryptic and chymotryptic hCGβ and hCGα fragments) and synthetic peptides (octapeptides and longer). It appeared that all epitopes on molecular hCG-variants recognized by our MCA are determined by the protein backbone. Except for the two major epitopes on hCGβ ctp and parts of two antigenic domains on hCGα, epitopes on hCG-derived molecules are determined by the tertiary and quarternary structure. Operationally useful descriptive epitope maps were designed including information on assay suitability of antigenic determinants. On this basis we established ultrasensitive time-resolved fluoroimmuno-assays for hCG, hCG and hCGn, hCGβ and hCGβn and hCGβcf, hCGα and additional assays recognizing different spectra of hCG-variants. Such assays have been applied by us and others to the detection of pregnancy, early pregnancy loss, choriocarcinoma, testicular cancer, other cancers and prenatal diagnosis. However, as the molecular structure of many epitopes utilized in immunoassays of different laboratories was not resolved, comparability of results was not satisfactory. Consequently, attempts were made to compare schematic epitope maps from different research institutions. The situation has been much improved by solving the three-dimensional (3D) structure of hCG. It has been shown that hCG is a member of the structural superfamily of cystine knot growth factors like NGF, PDGF-B and TGF-β. Each of its subunits is stabilized in its topology by three disulfide bonds forming a cystine knot. Moreover, it turned out that the disulfide bridges in their majority have previously been wrongly assigned. Computer molecular modeling of crystallographic coordinates of hCG and subsequent selective combined—PCR-based and immunological—mutational analyses of hCGβ expressed via the transmembrane region of a MHC molecule made it possible to more precisely localize epitopes on hCG-derived molecules. Although the entire surface of hCG has to be regarded as potentially immunogenic there seems to be hot spots where epitopes are clustered in antigenic domains. These are located on the first and third loops protuding from the cystine knots of both subunits and are possibly centered around the knot itself. Ultimate answers on epitope localizations will be given by the crystal structure determination of hCG complexed with different Fabs.

Extragonadal Choriocarcinoma in a Patient with Down Syndrome

There are several reports suggesting that there is a higher incidence of leukemia and testicular cancer in patients with Down syndrome. Fifteen patients with Down syndrome and testicular cancer were previously reported. The median age at diagnosis of testicular cancer was 18 years, (range: 3-45). The histologic subtypes were seminoma in 9 patients, not specified in 2 patients, and 1 patient each of adenocarcinoma, yolk sac, embryonal, and teratocarcinoma. In this article we describe a case of extragonadal choriocarcinoma in a patient with Down syndrome. To our knowledge, this is the first case ever reported. The patient had a complete remission following chemotherapy with cisplatin, etoposide, and bleomycin and is disease-free with a follow-up of 32 months. Patients with Down syndrome and advanced testicular cancer should be treated with potentially curative chemotherapy.

Risk of testicular cancer associated with surrogate measures of agent orange exposure among Vietnam veterans on the agent orange registry

A case-control analysis was undertaken to examine the association between various surrogate measures of Agent Orange exposure and testicular cancer among Vietnam veterans. Study subjects were selected from the Department of Veterans Affairs Agent Orange Registry. The case patients consisted of 97 veterans with a diagnosis of testicular cancer, and 311 veterans without any clinical diagnosis served as a comparison group. The surrogate measures were branch of service, type of duty, corps area, and location of the individual's unit in relation to recorded Agent Orange spray tracts. Only Navy veterans had a statistically significant increased risk of testicular cancer (odds ratio (OR) = 2.60; 95% confidence interval (CI), 1.08 to 6.24). Risk of testicular cancer was not significantly increased for ground troops (OR = 0.46; 95% CI, 0.25 to 0.86), for combat duty (OR = 0.91; 95% CI, 0.52 to 1.58), for service in the III Corps area (OR = 1.10; 95% CI, 0.66 to 1.84), and for being close to spray tracts within 90 days/8 km (OR = 0.99; 95% CI, 0.54 to 1.84) or 3 days/2 km (OR = 1.39; 95% CI, 0.50 to 3.80). The study results are not consistent with the hypothesis that Agent Orange may be a risk factor for testicular cancer among Vietnam veterans.