American Medical Association Family Medical Guide - American Medical Association [549]
Although nonseminomas grow more rapidly than seminomas and often spread before they are detected, the cure rate is high. Because nonseminomas do not respond as well to radiation therapy, surgical removal of the lymph nodes is often necessary after the cancer has spread beyond the testicle. Treatment of nonseminomas also can include multidrug chemotherapy. Men who have a stage II nonseminoma who have had surgery to remove the affected testicle and lymph nodes may need no further treatment. However, some doctors recommend a short course of multidrug chemotherapy to reduce the risk of recurrence. Most stage III nonseminomas can be treated effectively with chemotherapy.
The condition of men who have been treated for cancer of the testicle is carefully monitored for at least 2 years after treatment to make sure the cancer has not recurred. The disease recurs in about 10 to 15 percent of men who have been treated for stage I testicular cancer. If the cancer recurs, it is treated with chemotherapy.
After a man has been cancer-free for 3 years, cancer of the testicle seldom recurs. Men who have been treated for cancer in one testicle have about a 1 percent chance of developing cancer in the remaining testicle. If cancer develops in the second testicle, it is usually a new tumor rather than the result of cancer cells that have spread from the first tumor. After treatment for testicular cancer, men should continue to perform monthly testicle self-examinations.
Torsion of the Testicle
Each testicle is suspended in the scrotum by a spermatic cord that consists of the vas deferens, nerves, and blood vessels. In torsion of the testicle, one of the testicles becomes twisted on the spermatic cord, cutting off blood flow to and from the testicle. The condition is rare, and the cause is usually unknown. Although testicular torsion develops most often during adolescence, it can occur at any age.
In some cases of testicular torsion, the testicle untwists by itself. However, if the testicle does not return to its usual position naturally, and the condition is not treated within 4 to 8 hours, the sperm-producing parts of the testicle or the entire testicle can be permanently damaged, and the tissue may die (gangrene; see page 601). For this reason, torsion of the testicle is a medical emergency.
Torsion of the testicle
Each testicle is suspended in the scrotum by a spermatic cord. In torsion of the testicle, a testicle becomes twisted on the spermatic cord, cutting off blood flow to and from the testicle.
Pain from an injury, inflammation, or testicular cancer can sometimes resemble torsion of the testicle. Even if the problem seems to have cleared up on its own, it is important to see your doctor right away to rule out other possible problems.
Symptoms and Diagnosis
The main symptom of testicular torsion is sudden, severe pain in the groin area. One side of the scrotum is swollen and can be red and tender, and the affected testicle may rest higher than usual or may lie horizontally in the scrotum. Other possible symptoms include fever, light-headedness, fainting, and nausea and vomiting. A diagnosis of testicular torsion is based on the symptoms and a physical examination, including an examination of the testicles.
WARNING!
Testicle Strangulation
If the spermatic cord becomes twisted, blood flow to and from the testicle can be blocked. The lack of blood can permanently damage the testicle. If you have sudden, severe pain in your groin, along with other symptoms of testicular torsion, see your doctor immediately or go directly to the nearest hospital emergency department. Prompt medical treatment can help prevent permanent damage to the testicle.
Injury to the Testicles
Because the testicles are suspended outside the body in the scrotum, they are vulnerable to injury. A direct blow to the testicles can cause extreme pain that spreads from the testicles to the lower abdomen and may be accompanied by dizziness, sweating, and nausea. The pain results when