Summary about Disease
Non-seminomatous germ cell tumors (NSGCTs) are a type of cancer that arises from germ cells, the cells that develop into sperm or eggs. These tumors typically occur in the testicles (testicular NSGCTs) but can also develop in other parts of the body, such as the retroperitoneum (area behind the abdominal cavity), mediastinum (chest cavity), or brain. NSGCTs are more aggressive than seminomas (another type of germ cell tumor) and tend to occur in younger men, typically between the ages of 20 and 40. The main types of NSGCTs include embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Mixed germ cell tumors, containing more than one type, are common.
Symptoms
Symptoms vary depending on the location of the tumor. For testicular NSGCTs, common symptoms include:
A lump or swelling in the testicle
Pain or discomfort in the testicle or scrotum
A heavy feeling in the scrotum
Enlargement or tenderness of the breasts (gynecomastia) If the tumor has spread (metastasized), symptoms may include:
Back pain
Abdominal pain
Cough
Shortness of breath
Swollen lymph nodes
Causes
The exact cause of NSGCTs is not fully understood. Risk factors include:
Cryptorchidism (undescended testicle): This is the most well-established risk factor.
Family history of testicular cancer: Having a father or brother with testicular cancer increases the risk.
Klinefelter syndrome: A genetic condition where males have an extra X chromosome.
Prior testicular cancer: Having had testicular cancer in one testicle increases the risk of developing it in the other.
Race: White men are more likely to develop testicular cancer than men of other races.
Medicine Used
Treatment for NSGCTs typically involves a combination of:
Surgery (Orchiectomy): Removal of the affected testicle.
Chemotherapy: Commonly used chemotherapy regimens include BEP (bleomycin, etoposide, and cisplatin), EP (etoposide and cisplatin), or VIP (etoposide, ifosfamide, and cisplatin).
Radiation Therapy: Radiation is used selectively in specific cases.
Retroperitoneal Lymph Node Dissection (RPLND): Surgical removal of lymph nodes in the retroperitoneum, often performed after chemotherapy to remove any residual tumor. The specific treatment plan depends on the stage of the cancer, the tumor markers in blood (AFP, beta-HCG, LDH), and the overall health of the patient.
Is Communicable
No, NSGCTs are not communicable. They are not caused by an infectious agent and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent NSGCTs since the exact cause is unknown. However, men can perform regular self-exams of their testicles to detect any abnormalities early. Men with risk factors, such as cryptorchidism or a family history of testicular cancer, should discuss screening options with their doctor.
How long does an outbreak last?
NSGCTs do not have an "outbreak" in the sense of an infectious disease. The disease progresses until it is diagnosed and treated. The duration of symptoms before diagnosis can vary greatly from weeks to months. Untreated, the disease can spread rapidly.
How is it diagnosed?
Diagnosis typically involves:
Physical exam: Examining the testicles for lumps or swelling.
Ultrasound: Imaging of the testicles to visualize any abnormalities.
Blood tests: Measuring tumor markers, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Elevated levels of these markers can indicate the presence of an NSGCT.
CT scans: Used to assess the extent of the disease and check for spread to other parts of the body, such as the lungs, liver, or lymph nodes.
Biopsy: Rarely performed on the testicle itself due to the risk of spreading the cancer. Diagnosis is usually made after orchiectomy.
Timeline of Symptoms
The timeline of symptoms can vary. Some men may notice a lump or swelling in their testicle and seek medical attention immediately. Others may experience subtle symptoms, such as a heavy feeling or mild discomfort, and delay seeking medical care. If the cancer spreads, systemic symptoms like back pain, cough, or shortness of breath can develop over weeks to months.
Important Considerations
Early detection is crucial for successful treatment.
Self-examination of the testicles is recommended, especially for men with risk factors.
Treatment can be highly effective, with high cure rates, particularly when the cancer is diagnosed early.
Fertility preservation should be discussed with patients before treatment, as chemotherapy and surgery can affect fertility. Sperm banking may be an option.
Long-term follow-up is important to monitor for recurrence.
Psychological support should be provided to patients and their families to cope with the emotional challenges of a cancer diagnosis and treatment.