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Testicular Tumors

  • Testicular tumors are growths on the testicle that can occur in boys. They can be benign or malignant.

    • They occur most often in boys under age 5 and sometimes in boys who experience puberty early.

    • Most testicular tumors are benign and, though they do not spread, still require an operation.

    • Malignant testicular tumors can spread (metastasize) to other parts of the body, most commonly the lungs, liver, lymph nodes and central nervous system (brain or spinal cord).

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  • What causes testicular tumors?

    The cause of testicular tumors is unknown. What is known is that most of them originate in the germ cells, the cells in the embryo that become the cells that make up the male or female reproductive system.

    Certain inherited defects — including some central nervous system defects, genitourinary tract malformations and major malformations of the lower spine — have been associated with an increased risk for germ cell tumors. Specifically, boys with undescended testicles have an increased risk of developing testicular germ cell tumors.

    What are the symptoms of a testicular tumor?

    • swelling
    • hardness
    • abnormal shape, or irregularity in, testicular size
    • testicular pain (although some tumors are painless)

    The symptoms of testicular tumors may resemble other conditions or medical problems. Your son's physicians will do various tests to rule out these other causes.

  • How will my physician diagnose a testicular tumor?

    Most testicular tumors are first noticed by a parent or health care provider as non-tender swellings in a boy's scrotum. Most of these scrotal masses, however, result from far more common problems, such as the following:

    Your child's doctor will usually be able to distinguish a testicular tumor from these more common conditions by the way the mass feels and if a light shines through it or not. In addition to a complete medical history and physical examination, your child's doctor may also want to perform some combination of the following tests:

    • Ultrasound (also called sonography)- This imaging technique is the best way to identify what the mass is and whether more tests or an operation are needed. Ultrasounds are used to view internal organs as they function, and to assess blood flow.

    • Computerized tomography scan (also called a CT or CAT scan)- A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

    • Magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

    • Biopsy- a sample of tissue is removed from the tumor and examined under a microscope.

    • Complete blood count (CBC)- a measurement of the size, number and maturity of different blood cells in a specific amount of blood.

    • Additional blood tests- These may include blood chemistry analyses, evaluation of liver and kidney functions and genetic studies.

  • How are testicular tumors treated?

    Testicular tumors, whether benign or malignant, are usually removed along with the entire affected testicle in a procedure known as orchiectomy. If the tumor is malignant, your son may also need to receive one or more of the following treatments:

    • Chemotherapy- a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone or in conjunction with other therapy.
      • Chemotherapy is a whole-body treatment. It can be given:
        • as a pill to swallow
        • as an injection into the muscle or fat tissue
        • intravenously (directly to the bloodstream; also called IV)
        • intrathecally (directly into the spinal column with a needle)
      • While chemotherapy can be quite effective in treating certain cancers, there can be many side effects, since the agents don't distinguish between healthy cells and cancer cells. Being able to anticipate these side effects can help you and your care team prepare, and, in some cases, prevent or alleviate symptoms.
    • Radiation therapy- a treatment using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.

    Your child will also receive supportive care - treatment to prevent and treat infections, alleviate side effects of treatments, reduce complications and keep him comfortable during treatment. He will also be placed on a schedule of continual follow-up care to monitor ongoing response to treatment and possible late effects of treatment.

    What is the long-term outlook for patients with a testicular tumor?

    The prognosis for benign testicular tumors is usually very good, with minimal if any long-term complications. If one testicle remains, fertility will be preserved, so your son will still be able to father children.

    The prognosis for a malignant tumor can vary greatly from individual to individual and depends heavily on the extent of the disease. Prompt medical attention and aggressive therapy are important. Continual follow-up care is equally essential to monitor for side effects of radiation and chemotherapy, as well as second malignancies.

    Physicians at Children's are continually developing new methods to improve treatment and to decrease side effects.

  • Keeping cholesterol in check not only benefits heart health, it may also delay the progression of prostate cancer, suggests a mouse study from Boston Children's Hospital.

    When mice with human prostate tumors were given the cholesterol-lowering drug ezetimibe (Zetia) along with a no-cholesterol diet, their tumors were smaller and grew more slowly. Mice receiving the drug, regardless of their diet, also had about a 50 percent reduction in angiogenesis, or blood-vessel growth, when compared with untreated mice on a high-cholesterol diet. "It caught my attention almost immediately that there was a great deal more blood in some tumors than in others," says Keith Solomon, PhD, of the Departments of Urology and Orthopedic Surgery, who led the study.

    The findings suggest that ezetimibe slows the growth of prostate tumors, at least in part, by inhibiting angiogenesis. This surprised Solomon, who'd hoped only to show that raising cholesterol accelerates tumor growth and that reducing cholesterol curbs growth. He speculates that cholesterol gives tumor cells, and cells in the surrounding environment, material to encourage angiogenesis.

    "The anti-angiogenic effect of cholesterol-lowering implies that these findings may have relevance to other tumor types," notes Michael Freeman, PhD, of Children's Department of Urology, the study's senior author.

    Population studies have linked prostate cancer with high cholesterol levels and Western diets high in cholesterol. In 2005, the Solomon and Freeman groups showed that cholesterol helps prostate tumors survive and grow at the cellular level by altering chemical signaling patterns.

    Since most prostate tumors are slow-growing, Solomon speculates that some men can delay medically significant cancers, and perhaps avert them altogether, by aggressively managing their cholesterol levels. "A 20 to 30 percent reduction in cholesterol might not affect a fast-growing tumor, but could have a significant effect on a slow-growing tumor, allowing men to avoid surgery," he says. The study appears in the March issue of The American Journal of Pathology.

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