Orchiectomy does not affect sexual function, but some men opt for a saline-filled testicularprosthesis afterwards to restore normal scrotal appearance.Serious Complications and PrognosisSerious complications from testicular cancer are those related to metastasis (e.g., to thebrain and lung, which can be life-threatening) and to treatment. Surgery, radiation therapy,and chemotherapy can significantly interfere with both sexual and reproductive function.Testicular cancer is a disease in which even recurrence is usually highly treatable and,with appropriate treatment, prognosis is often excellent. Most patients can expect a normallifespan. Approximately 90% of disease-related deaths occur during the first 2 years followingcessation of therapy. Disease-free survival of 3 years is considered a cure.Approximately 1in 10 testicular cancer patients will experience a relapse, but if discovered early and appro-priately treated, 99% of these patients can be cured.The 5-year disease-free survival rates for stage I and early stage II seminoma followingtreatment are 98% and 93%, respectively. Even patients with stage III seminoma (stage III)attain a favorable response following orchiectomy and chemotherapy 90% of the time.The 5-year disease-free survival rate for stage I non-seminoma exceeds 95% and for stageII disease, it is 90%. Up to 75% of patients with early non-seminomas are cured by orchiec-tomy alone. Note, however, that not all subtypes of testicular cancer carry an excellentprognosis.Some non-seminomas are much more aggressive than seminomas and do notrespond as readily to radiotherapy. For patients with significant lymphadenopathy or wide-spread metastatic non-seminoma treated with surgery and chemotherapy, the 5-year disease-free survival rate may be as low as 48%. Choriocarcinoma, a rare form of non-seminoma,metastasizes very early in the clinical course of the disease and carries the poorest prognosisof all testicular cancers.Disease Summary Question 1. As stated in the summary above, multidrug chemotherapyis often used to treat patients with advanced testicular cancer and other types of cancer.Why is multidrug chemotherapy often more effective than single drug chemotherapy intreating cancer?
DS74-7Case Study 74 ■Testicular CancerSuggested ReadingsAmerican Cancer Society website. 2008 Cancer Facts and Figures. Available at: downloads/STT/2008CAFFfinalsecured.pdf. Date accessed: February 2008.Davis JW, Schellhammer P. Testicular seminoma. eMedicine website. Available at: www.emedicine.com/med/topic2250.htm. Date accessed: September 2006.Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World JUrol 2004;22:2–14.Eggener SE, Campbell SC. Cancer of the testicle. eMedicineHealth website. Available at:. Date accessed: October2005.
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