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Cancer is the abnormal growth of cells where they divide rapidly to form a tumour. It is mainly caused by the mutation of genes in a cell. Mutation that occurs on the oncogene and tumour suppressor gene initiates the formation of cancer. The cancerous tumour might break and split up in a process called metastasis, mixing with the blood and lymphatic system and circulate around the body to form another secondary tumour in various organs by dividing uncontrollably.,
Testicular cancer is a cancer that develops in the testicles, the male reproductive organ that produces sperm. There are 7500 to 8000 cases of testicular cancer being confirmed in United States of America each year. The rate of increment in number of cases of testicular cancer in developed countries is at about 2% per year since 1970. Those males who are susceptible to testicular cancer aged among 15 to 40 years old, especially those in their mid-20s. The exact cause of testicular cancer is yet to be verified by scientists. Symptoms of testicular cancer may include the following:
A hardening lump of one of the testicles
Lacking of sexual interest and having sexual withdrawal
Increase or decrease in size of one or both testes
Blood in semen
Testicular cancer will cause the enlargement of testis in the scrotum due to formation of cancerous cell lump but lump formation in elsewhere of the scrotum is not caused by the testicular cancer. Physical examination and ultrasound scanning can locate the cancerous cell and estimate the size of cancerous lump. Determining the level of human chorionic gonadotrophin may help in diagnosis of testicular cancer.
Testicular cancer is one of the cancers that have the highest cure rates, high up to 90% of the survival chance. However, nowadays there are so many ways of treatment can be given to testicular cancer patient but not all the treatments can ensure high survival and recovery rate.
Figure 1: Testicular cancer
Which are the safest treatments that can be given to a testicular patient to ensure the high survival chance up to 90% and can prevent further recurrence of the testicular cancer?
An Effective Solution
Testes, are also known as testicles, are the male sex glands. Testes are located behind the penis and are covered by a layer of skin called scrotum. The functions of testes are to produce and store sperm and also produce male sex hormone, testosterone through leydig cell in the testes.
Figure 2: Male Reproductive Organ and Testes
Orchiectomy is the removal of one or both testes in male human through surgery. An orchiectomy is done to treat testicular cancer. There are 3 types of orchiectomy named simple, subcapsular and inguinal/radical orchiectomy. Simple and subcapsular orchiectomy are carried out normally under anesthesia and requires about 30 minutes to conduct. An inguinal orchiectomy is done under general anesthesia and requires between 30 minutes to 1 hour to complete. An inguinal orchiectomy or sometimes it is called radical orchiectomy is carried out to cure testicular cancer.
Figure 3: Testis removal steps in orchiectomy
Inguinal orchiectomy can be either unilateral (removal of one testis) or bilateral (removal of both testes). This process is called an inguinal orchiectomy due to the surgeon makes an incision, about 3 inches (7.6 cm) long, in the patient's groin area rather than directly into the scrotum. When it is called a radical orchiectomy, the surgeon removes the whole spermatic cord as well as the testicle. This complete removal is to prevent the spreading of testicular cancer from the spermatic cord into the lymph nodes near the kidneys. A long suture is left in the stump of the spermatic cord in case later surgery is necessary. After the removal of cord and testicle, the surgeon washes the area with saline solution and closes the skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. Based on the figure 3, the scrotum is cut open. The testis and spermatic cord are exposed by cutting the testicle covering. The cord is tied and cut, removing the testis. The wound is repaired by suturing it.
Patients that will undergo orchiectomy will have a standard blood and urine test before going through the surgery. The patients are required to stop aspirin-based medications for a week before the surgery and stop taking all non-steroidal anti-inflammatory drugs (NSAIDs) 2 days before the surgery. Patients should not ingest any food or drink for 8 hours before the orchiectomy. Most surgeons will ask the patients to shower before the surgery using a special antibacterial soap. The patients are asked to take extra time to scrub and rinse their genitals and groin area using the soap.6
Patients who are undergoing orchiectomy for testicular cancer are advised to consider banking their sperm if they wish to have children after the surgery. Even though it is still possible to reproduce after one testicle is removed, some surgeon still recommend sperm banking as a precaution in case the other testicle will develop testicular cancer also. 6 Due to the other testis is not removed, so the patients retain adequate amount of male hormones and remain fertile. Infertility sometimes occurs with testicular cancer but may subside after the orchiectomy treatment.4
For stage 1 and 2 testicular cancer patients, radical orchiectomy and removal some of the lymph nodes in the abdomen are done. Patients will undergo surgery that will preserve fertility. CT scan is done regularly to ensure that the testicular cancer does not recur.
Graph1: Survival rate after orchiectomy
Table 1: Recurrence of testicular cancer after orchiectomy8
International Journal Of Urology Official Journal Of The Japanese Urological Association [Int J Urol] 2009 Sep; Vol. 16 (9), pp. 756-9. Date of Electronic Publication 2009 Jul 29.
Graph 1 showed the survival rate of patients after orchiectomy with years after the surgery. It showed that the survival rate of patients remains at around 90% even though after so many years since the surgery was conducted which showed that orchiectomy is a very safe and reliable method to be chosen as a cure for testicular cancer. Table 1 showed the recurrence of testicular cancer in patients after orchiectomy. Among 64 samples, 7 of them suffered recurrence of testicular cancer and the percentage of recurrence was at only 11% which showed that there were 89% of patients will be free from testicular cancer after orchiectomy.
Social and Economic Implications
Treatment of testicular cancer through orchiectomy will remove one testis from the patientââ‚¬â„¢s body. Men may be feared that losing a testis will affect their sexual ability or even make them infertile. Thus, they dare not to choose orchiectomy as their testicular cancer treatment. Men may not know that with one healthy testis they are still able to have a normal erection and sperm production. A testicle is still able to produce sufficient sperm to reproduce and adequate male hormone. Thus, orchiectomy does not cause a man to be impotent and rarely interfere with their fertility. To replace the cancerous testis, men can replace it by a prosthesis, an artificial testis and place it in the scrotum at the time they undergo orchiectomy or at any time after the surgery.
Besides that, men may have very strong feelings about any surgery regarding their genitals and may feel depressed about their genitals after the surgery. Some patients may require psychological counseling after the orchiectomy as part of their post surgery aftercare. 9
In addition, patient requires great number of money for the orchiectomy surgery and hospitalisation that will cause an economic burden on the patients. Treatment for cancer is complicated that most of the surgeons demand for high price for each surgery. Thus, the cost for orchiectomy is not cheap especially for experience and more professional surgeon to carry it out. Some of the doctor even prescibe more expensive drug to suppress the cancer from spreading.
Benefits and Risks
Patients that undergo orchiectomy as treatment for their testicular cancer reported to have a survival rate of 90% after the surgery if the cancer cells do not spread beyond the testicles.8 Most testicular cancer patients relief from the cancer symptoms after an orchiectomy. Orchiectomy is a safe surgery that has a very low mortality rate. Most of the people fear of surgery because surgery may cause death. However, orchiectomy is a safer one. Patients who undergo orchiectomy will have the higher risk dying from the cancer than from the surgery. 6
One of the risks of taking orchiectomy is that patients have to undergo general anaesthesia. If general anaesthesia given to the patients is overdose, it might cause deep venous thrombosis and other serious implication. Besides that, some risks of orchiectomy include lost of sexual desire or even impotence will happen to minority of the patients. Some men will experience hot flashes similar to those menopausal women and mood swing or depression however it can be controlled by medication. After orchiectomy, men will feel extreme fatigue and loss of sensation in the groin area or the genitals. If the testicular cancer had already spread to another area, there is the chance for recurrence of cancer after orchiectomy. 6
Chemotherapy is a treatment to kill cancer cells by using drugs. Anticancer drug is injected to kill cancer cells in this therapy. Chemotherapy can also be the initial treatment if the seriousness of cancer is advanced where the cancer cell starts spreading. Most anticancer drugs are given by injection into the vein. Chemotherapy is a type of systemic therapy where the drugs travel through the bloodstream to attack cancer cell throughout the body. Some drugs that are toxic to actively dividing cells are administered through the circulatory system in chemotherapy. This chemotherapeutic drug will interfere with some specific steps in the cell cycle. 2 Normally, carboplatin, is injected as anticancer drug. 2 doses or sometimes 1 doses of carboplatin injected 3 weeks apart is proven to be a successful treatment with recurring rate in the same range as radiotherapy. The successful rate of chemotherapy mostly depends on the stage of cancer. The earlier the patient receives treatment, the greater chance of recovering from cancer.6
There are side effects of undergoing chemotherapy. The side effects are largely depends on the drugs and doses taken. Most common side effects are nausea, hair loss, vomiting, dizziness, hair loss and hearing difficulties. Some of the anticancer drugs also interfere with sperm production. Due to the anticancer drugs are carried through bloodstream, thus it will also affect the normal cell despite of the cancer cell. The high doses of chemotherapy will also destroy the bone marrow which makes and stores blood cells. 8
Due to the side effects that will cause a lot of discomfort for the testicular cancer patients, thus chemotherapy is not recommended for the treatment of testicular cancer. Besides that, chemotherapy enables the recovery rate of 85% only that is lower than orchiectomy of 90%.3 The cost of chemotherapy is also higher that the anticancer drugs are more expensive from time to time. 9
Radiotherapy is the treatment of cancer by using high energy rays to terminate the cancer cells and shrink the tumors. High energy radiation from x-rays, gamma rays and other radiating sources are used to kill the cancer cells. It is a type of local therapy where it will only affects the cancer cells in the treated areas only. Radiation is aimed at the targeted area and kills the cancer cell at the specific area only. There are 3 types of radiation in this radiotherapy. The radiation may come from machine outside of the body called external-beam radiation therapy or may come from radioactive substance situated in the body that near the cancer cells called internal radiation therapy. The third type of radiation called systemic radiation therapy where it uses a radioactive substance such as radiolabeled monoclonal antibody to travels in the bloodstream to cancer cell throughout the body.
Radiotherapy affects the cancer cells in the body as well as the healthy cells. Radiotherapy tends to have more significant long term side effects compared to other treatment.3 The side effects of radiotherapy depend on the dosage of high energy radiation substances taken. Side effects of the radiotherapy include internal scarring, nausea, and loss of appetite. Radiotherapy also interferes with sperm production but the patients may regain their fertility over a period of 1 to 2 years. 8
Due to the long term side effects, many men do not choose radiotherapy as their treatment for testicular cancer. Radiotherapy also brings a lot of unbearable side effects that causes fear in men to take it as treatment. Having external beam of radiation aimed at their genitals to kill cancer cell have high chances to cause permanent impotency if any mistake is made. Thus, using radiotherapy as testicular cancer treatment is not advisable.
Information of cancer cell and tumor formation as mentioned in the section of ââ‚¬ËœThe Problemââ‚¬â„¢ above is reliable as the information is obtained from the Edexcel AS Biology Student Book that are published in year 2008 thus the information is up-to-date. Furthermore the information is also proven correct by another biology text, Biology 8th Edition, Pearson International Edition, by Campbell Reece where the information is identical. Thus the information mentioned by the Edexcel AS Biology Student Book is valid and reliable.
Besides that, the some information about testicular cancer, chemotherapy and radiotherapy is obtained from http://www.wikipedia.com/Testicular cancer where the information from this site is widely used globally thus it is proven to be a worldwide trusted website for its valid data. The information about testicular cancer regarding to possible signs, examination and effects are parallel to the information about testicular cancer in www.cancer.gov\testicularcancer where this website in under service of National Cancer Institute in United States of America and U.S. National Institute of Health. The information in www.cancer.gov\testicularcancer regarding to testicular cancer is just modified on 08/27/2009 where it is proven to be the latest information. The information obtained from http://www.wikipedia.com/Testicular cancer about chemotherapy and radiotherapy can also be proven to be reliable by having similar information obtained from http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=chemotherapyHYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=chemotherapy&version=Patient&language=English"&HYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=chemotherapy&version=Patient&language=English"version=PatientHYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=chemotherapy&version=Patient&language=English"&HYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=chemotherapy&version=Patient&language=English"language=English for chemotherapy and http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation%20therapyHYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation therapy&version=Patient&language=English"&HYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation therapy&version=Patient&language=English"version=PatientHYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation therapy&version=Patient&language=English"&HYPERLINK "http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation therapy&version=Patient&language=English"language=English for radiotherapy. These 2 websites supplied precise information about chemotherapy and radiotherapy because these website are also under the surveillance of U.S. National Cancer Institute. When the information of http://www.wikipedia.com/Testicular cancer is parallel to the information obtained from the trusted websites above, the information obtained is reliable from this website due to many evidence of reliability
Meanwhile, the information regarding the orchiectomy is obtained from http://www.surgeryencyclopedia.com/La-Pa/Orchiectomy.html where data from this website is also valid and reliable. The information on definition, types, process of orchiectomy is similar and more detail compare to most of the websites such as http://www.wikipedia.com/Testicular cancer and www.cancer.gov\testicularcancer, a website which is under service of the U.S. Department of Health and Human Services, U.S. National Institute of Health, and U.S. Government.