TESTICULAR CANCER
( By JASCAP )

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General

Testicular Cancer

This booklet is for you if you have or someone close to you has Testicular Cancer.

If you are a patient, your doctor or nurse may wish to go through the booklet with you and mark sections that are particularly important for you.

The testicles

The testicles are two small oval-shaped organs suspended below the penis in a pouch of skin called the scrotum. They are part of the male reproductive system. From the start of puberty the cells lining the collecting tubules of the testicles produce sperm.

The collecting tubules inside the testicle join together to form a tube called the epididymis. This tube carries on to the outside of the testicle where it widens. It can be felt as a soft swelling at the back of the testicle. The wider part of the tube is called the spermatic cord. At its end, this forms a short tube called the ejaculatory duct. This duct joins the urethra (the tube from the bladder to the penis) just above the prostate gland.

The testicles also produce the hormone testosterone. This hormone maintains sex drive (libido) in men and is the main cause of the development of male characteristics such as:

a deep voice
beard growth
muscle development
the ability to have an erection.

The structure of the testicle

Lymph fluid from the testicles drains to a group of lymph glands at the back of the abdomen.

The lymph system in the abdomen

What is cancer?

The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells.

Cells in different parts of the body may look and work differently but most reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.

Tumours can be either benign or malignant. Cancer is the name given to a malignant tumour. Doctors can tell if a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.

In a benign tumour the cells do not spread to other parts of the body and so are not cancerous. However, if they continue to grow at the original site, they may cause a problem by pressing on the surrounding organs.

A malignant tumour consists of cancer cells that have the ability to spread beyond the original area. If the tumour is left untreated, it may spread into and destroy surrounding tissue. Sometimes cells break away from the original (primary) cancer. They may spread to other organs in the body through the bloodstream or lymphatic system.

The lymphatic system is part of the immune system - the body's natural defence against infection and disease. It is a complex system made up of organs, such as bone marrow, the thymus, the spleen, and lymph nodes. The lymph nodes (or glands) throughout the body are connected by a network of tiny lymphatic ducts.

When the cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.

It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.

Types of cancer

Carcinomas

The majority of cancers, about 85% (85 in a 100), are carcinomas. They start in the epithelium, which is the covering (or lining) of organs and of the body (the skin). The common forms of breast, lung, prostate and bowel cancer are all carcinomas.

Carcinomas are named after the type of epithelial cell that they started in and the part of the body that is affected. There are four different types of epithelial cells:

squamous cells - that line different parts of the body, such as the mouth, gullet (oesophagus), and the airways
adeno cells - form the lining of all the glands in the body and can be found in organs such as the stomach, ovaries, kidneys and prostate
transitional cells - are only found in the lining of the bladder and parts of the urinary system
basal cells - that are found in one of the layers of the skin.

A cancer that starts in squamous cells is called a squamous cell carcinoma. A cancer that starts in glandular cells is called an adenocarcinoma. Cancers that start in transitional cells are transitional cell carcinomas, and those that start in basal cells are basal cell carcinomas.

Leukaemias and lymphomas

These occur in the tissues where white blood cells (which fight infection in the body) are formed, i.e. the bone marrow and lymphatic system. Leukaemia and lymphoma are quite rare and make up about 6.5% (6.5 in 100) of all cancers.

Sarcomas

Sarcomas are very rare. They are a group of cancers that form in the connective or supportive tissues of the body such as muscle, bone and fatty tissue. They account for less than 1% (1 in 100) of cancers.

Sarcomas are split into two main types:

bone sarcomas - that are found in the bones
soft tissue sarcomas - that develop in the other supportive tissues of the body.

Others forms of cancer

Brain tumours and other very rare forms of cancer make up the remainder of cancers.

Your feelings about having testicular cancer

Most people feel overwhelmed when they are told that they have cancer. Even though the chance of curing testicular cancer is very high, you may still have many different emotions, a feeling of confusion and frequent mood swings. You might not have all the feelings discussed below or experience them in the same order.

These emotions are part of the process that many people go through in trying to come to terms with their illness. Partners, family members and friends often have similar feelings and may need as much support and guidance in coping with their feelings as you do.

Reactions differ from one person to another - there is no right or wrong way to feel.

Some of the common emotional effects are mentioned below. However, reactions vary and people have different emotions at different times.

Our booklet on the emotional effects of cancer discusses the feelings and emotions that you may experience and has advice on how to cope with them.

Shock and disbelief
Fear and uncertainty
Denial
Anger
Blame and guilt
Resentment
Withdrawal and isolation

Shock and disbelief

'I can't believe it' / 'It can't be true'

This is often the immediate reaction when cancer is diagnosed. You may feel numb and unable to believe what is happening or to express any emotion. You may find that you can take in only a small amount of information and so you have to keep asking the same questions again and again, or you need to be told the same bits of information repeatedly. This need for repetition is a common reaction to shock.

Some people may find that their feelings of disbelief make it difficult for them to talk about their illness with their family and friends. Other people may feel an overwhelming urge to discuss it with those around them.

You might find our booklet on talking about your cancer helpful.

Fear and uncertainty

'Am I going to die?'/ 'Will I be in pain?'

Cancer is a frightening word surrounded by fears and myths. One of the greatest fears people have when they are diagnosed is 'Am I going to die?'

In fact, many cancers are curable if caught at an early enough stage. When a cancer is not completely curable, modern treatments often mean that it can be controlled for years and many patients can live an almost normal life.

'Will I be in pain?' and 'Will any pain be unbearable?' are other common fears. In fact, some people with cancer have no pain at all. If you do have pain, there are many modern drugs and other techniques which are very successful at relieving it or keeping it under control. Our information on controlling cancer pain describes these methods.

Many people are anxious about their treatment: whether or not it will work and how to cope with possible side effects. It is best to discuss your individual treatment and possible outcomes in detail with your doctor.

Some people are afraid of the hospital itself. It can be a frightening place, especially if you have never been in one before, but talk about your fears to your doctor or nurse. They should be able to reassure you.

You may find that doctors cannot answer your questions fully, or that their answers sound vague. For example, it is often impossible for them to say for certain that they have completely removed the tumour. Doctors know approximately how many people will benefit from a certain treatment, but cannot predict the future for a particular person. Many people find this uncertainty hard to live with.

Uncertainty about the future can cause a lot of tension, but fears may be worse than the reality. Gaining some knowledge about your illness can be reassuring. Discussing what you have found out with your family and friends can help to relieve some of the worry.

Denial

'There's nothing really wrong with me' / I haven't got cancer'

Many people cope with their illness by not wanting to know anything about it, or not wanting to talk about it. If that's the way you feel, then just say quite firmly to the people around you that you would prefer not to talk about your illness, at least for the time being.

Sometimes, however, it is the other way round. You may find that it is your family and friends who are denying your illness. They may appear to ignore the fact that you have cancer, perhaps by playing down your anxieties and symptoms or deliberately changing the subject. If this upsets or hurts you because you want them to support you by sharing what you feel, try telling them. Start perhaps by reassuring them that you do know what is happening and that it will help you if you can talk to them about your illness.

Anger

'Why me of all people?' / 'And why right now?'

Anger can hide other feelings, such as fear or sadness. You may direct your anger at the people who are closest to you and at the doctors and nurses who are caring for you.

It is understandable that you may be deeply upset by many aspects of your illness and there is no need to feel guilty about your angry thoughts or irritable moods. However, relatives and friends may not always realise that your anger is really directed at your illness and not against them. If you can, it may be helpful to tell them this at a time when you are not feeling quite so angry. If you would find that difficult, perhaps you could show them this booklet.

Blame and guilt

'If I hadn't... this would never have happened'

Sometimes people blame themselves or other people for their illness, trying to find reasons to explain why it should have happened to them. This may be because we often feel better if we know why something has happened. However, since in most cases it is impossible to know exactly what has caused a person‟s cancer there is no reason for you to feel that you are to blame.

Resentment

'It's all right for you - you haven't got to put up with this'

Understandably, you may be feeling resentful and miserable because you have cancer while other people are well. Similar feelings of resentment may crop up from time to time during the course of your illness and treatment for a variety of reasons. Relatives too can sometimes resent the changes that your illness makes to their lives.

It is usually helpful to bring these feelings out into the open so that they can be discussed. Keeping your resentment to yourself can make everyone feel angry and guilty.

Withdrawal and isolation

'Please leave me alone'

There may be times during your illness when you want to be left alone to sort out your thoughts and emotions. This can be hard for your family and friends who want to share this difficult time with you. It will make it easier for them to cope, however, if you reassure them that although you may not feel like discussing your illness at the moment, you will talk to them about it when you are ready.

Sometimes depression can stop you wanting to talk. If you or your family think you may be depressed, discuss this with your GP. They can prescribe antidepressant drugs for you, or refer you to a doctor or counsellor who specialises in the emotional problems of people with cancer.

 
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