|The Testicular Cancer Resource Center|
Adenomatoid Tumor - A very rare, benign tumor of the epididymis. On ultrasound it appears as a well defined, hyperechoic mass separate from the testicle.
Adjuvant therapy - A treatment given in addition to the main treatment (for example, chemotherapy as well as surgery) to try to prevent a cancer from coming back, even though there is no indication that the cancer is still there.
AFP - see Alpha-fetoprotein.
Alopecia - The loss of hair. It is a side-effect of most forms of chemotherapy or radiotherapy used to treat cancer. In the treatment of testicular cancer, the chemotherapy usually causes hairloss about 2 weeks after the start of chemotherapy. During radiation treatments, the patient may lose hair in the area being radiated. It is usually temporary.
Alpha-fetoprotein - AFP is a protein found in the bloodstream of some men with nonseminomatous testicular cancer (It is NEVER present in seminoma patients). The level rises when the cancer is growing and falls when the cancer is shrinking or has been surgically removed, so a blood test can possibly measure the progress of the disease and success of treatment. Because of this behavior, it is referred to as a tumor marker. Elevated levels of AFP occur in 75 per cent of patients with teratocarcinoma, embryonal cell carcinoma, and yolk sac carcinoma. (However, increased levels of AFP are also found in patients with liver diseases, such as cirrhosis, acute and chronic hepatitis and hepatic necrosis. ) The serum half life of AFP is 5 to 7 days, which implies that elevated levels of AFP should fall by one half of the initial level per week and should probably return to normal within 25 to 35 days after surgery if all of the tumor has been removed. The higher the level, though, the longer it will take to return to normal. Please note that AFP is normally less than about 5 ng/ml, but cancer cannot be assumed until it is over 25 ng/ml. Also note that a very small number of people have a naturally high level of this protein in their blood (though less than 25) even though they do not have cancer.
Androgen - A hormone that promotes the development and maintenance of male sex characteristics. The main Androgen is testosterone.
Andrologist - A physician-scientist who performs laboratory evaluations of male fertility. May hold a Ph.D. degree instead of an M.D. Usually affiliated with a fertility treatment center working on in vitro fertilization.
Anemia- A reduction in the number of red blood cells (these carry oxygen). Symptoms of anemia include feeling tired, weak or short of breath.
Antegrade ejaculation - Normal forward ejaculation.
Antiemetic - A medicine that controls or prevents nausea and vomiting.
Aorta - The large artery originating from the left ventricle of the heart. Its branches carry blood to all parts of the body. The lymph nodes most often affected by testicular cancer are located around the aorta and near the kidneys in the retroperitoneum.
Atrophic - Something that has decreased in size or shows evidence of arrested development. Testicles can become atrophic due to disease or cancer or abnormal development.
Azoospermia - Semen containing no sperm, either because the testicles cannot make sperm, there is a blockage in the reproductive tract, or the patient has had a vasectomy.
Benign tumor - A noncancerous growth that does not spread to other parts of the body.
Beta-hCG - see Human Chorionic Gonadotropin (hCG), beta subunit
BEP - BEP is a common combination of chemotherapeutic drugs (Cisplatin, Bleomycin, and Etoposide) used with germ cell tumors.
Biopsy - The removal and examination of a sample of tissue with a microscope to see whether cancer cells are present.
Bleomycin - A mixture of glycoprotein antibiotics derived from a streptomyces (Streptomyces verticillus) and used as an anticancer agent. aka BLENOXANE
Blood Count - The number of red blood cells, white blood cells, and platelets in a sample of blood. This is also called a complete blood count (CBC).
Cancer - A general term for more than 100 diseases in which there is an uncontrolled, abnormal growth of cells. Cancer cells can spread through the bloodstream and lymphatic system to other parts of the body.
Carboplatin - A platinum based anticancer drug similar to Cisplatin with somewhat lower toxicity. Not as effective as Cisplatin for testicular cancer. aka PARAPLATIN
Carcinoma in situ (CIS) - A malignant tumor which has not yet become invasive but is confined to the layer of cells from which it arose. A form of pre-invasive cancer. With regards to testicular cancer, carcinoma in situ may also be called intratubular germ cell neoplasia.
Catheter - A thin flexible tube through which fluids can enter or leave the body.
Chemotherapy - Treatment with anticancer drugs. These may be used singly or in combination to kill or prevent the growth and division of cells. Although aimed at the cancer cells, chemotherapy will also unavoidably affect rapidly dividing normal cells such as in the hair (hair loss), and gut (nausea), blood & bone marrow (anemia or neutropenia), and sperm (infertility) which are usually temporary and reversible.
Chest X-ray - A chest x-ray is an x-ray picture of the upper chest. It is a quick and inexpensive diagnostic tool to detect lung metastases.
Choriocarcinoma - A rare, highly malignant germ cell cancer. When seen as a small component of mixed germ cell tumors, it has little bearing on clinical behavior or outcome. In its pure form, seen in less than 1% of all germ cell tumors, it requires intensive chemotherapy. It can metastasize via the bloodstream to the lungs or central nervous system without affecting the retroperitoneum.
Chylous Ascites - An accumulation of lymphatic fluid in the spaces between tissues and organs in the cavity of the abdomen. This is an uncommon side effect of the RPLND surgery. It cannot be predicted, and the only treatment is to drain the fluid, restrict fats in the diet, and wait for it to go away.
Cisplatin - A platinum based anticancer drug used especially in testicular and ovarian germ cell tumors. aka PLATINOL
Clinical trial - A study conducted with cancer patients to evaluate a new treatment to see if the new treatment is better or worse than existing treatments. Each study is designed to answer scientific questions and to find better ways to help patients.
CNS - Central Nervous System - Extragonadal germ cell tumors can arise in the CNS, often in the pineal gland. Metastatic germ cell tumors can also spread to the CNS.
Colony-stimulating factors - Hormone-like substances that stimulate the production of blood cells. Treatment with colony-stimulating factors (CSF) can help the blood-forming tissue recover from the effects of chemotherapy and radiation therapy. These include granulocyte colony-stimulating factors (G-CSF) such as Neupogen and granulocyte -macrophage colony-stimulating tractors (GM-CSF).
Combination chemotherapy - Treatment with more than one anti-cancer drug at a time. The treatment for testicular cancer uses combination chemotherapy.
Contralateral - Referring to the opposite side of the body, in this case, the other testicle.
Computed tomography (CT Scan) - An X-ray procedure that uses a computer to produce a detailed picture of a cross-section of the body; also called CT scan or CAT scan.
Cryptorchidism - A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum; also called undescended testicles.
Cycle - A cycle is the time period over which the chemotherapy is given, including rest periods. The typical cycle for BEP chemo is 3 weeks long. Cisplatin and Etoposide are given on the first five days, and Bleomycin is given on days 2, 9 and 16. The cycle used for adjuvant chemo after an RPLND might be 4 weeks, with one extra dose of bleomycin.
Cyst - An abnormal sac filled with gas, fluid, or semi-solid material that is lined by a membrane.
Cytotoxic - 'Toxic to cells' - anti-cancer treatment.
Differentiation - The degree to which a tumour resembles normal tissue. In general, the closer the resemblance, the better the prognosis. Well differentiated tumors closely resemble normal tissue.
Disseminated disease - Disease in which the cancerous cells have spread from the tissue of origin to other organs. (AKA: Metastasis)
Ejaculate - The semen and sperm expelled during ejaculation.
Ejaculation - The sudden, forceful discharge of semen.
Embryonal carcinoma - A type of germ cell tumor that tends to form glands or spaces. It usually is found as a component of a mixed germ cell tumor, however, as a pure form it is second in occurrence in TC only to seminoma. On clinical evaluation it is found to have spread beyond the testis in about 30% of cases.
Endodermal Sinus Tumor - see Yolk Sac Tumor
Epidermoid cyst - These are rare, slowly growing masses that are probably not of germ cell origin.
Epididymis - A soft, tubelike structure behind the testicle that collects and carries sperm. Within this organ the developing sperm complete their maturation and develop their powerful swimming capabilities. The matured sperm leave the epididymis through the vas deferens. Sperm may live here for several weeks.
Epididymitis - Inflammation of the epididymis. This is a common problem, usually caused by infection.
Etiology - The cause or possible cause of a disease. For example, smoking is a cause of lung cancer.
Etoposide - An anticancer drug commonly used in combination with other chemotherapeutic drugs. aka VP-16
Extragonadal germ cell tumor - An extragonadal germ cell tumor is a primary germ cell tumor located outside of the testicles (or ovaries). No clinically or ultrasonagraphically detectable testicular abnormalities are present. These tumors usually take the form of a large mass in the anterior mediastinum (in front of the heart), a central nervous system abnormality (a brain tumor), or a retroperitoneal mass. These tumors may not respond as well to therapy as primary testicular tumors.
Extra-testicular - Outside of the testicle. Involving the epididymis, spermatic cord, vas deferens, tunica vaginalis and rete testis. Testicular cancers do not originate here.
Extravasation - Leaking of a chemotherapy drug out of the vein and into the skin
False Negative - A test that shows no evidence of disease when disease is actually present.
False Positive - A test that shows evidence of disease when disease is not actually present.
Fertility - The ability to father children.
Fraction - A term used in radiation oncology where the radiotherapy dose is divided into a number of smaller doses to reduce side effects. For example a planned course of radiotherapy for seminoma may consist of 15 fractions. There is normally one fraction per weekday.
Funiculitis - Inflammation of the spermatic cord.
Germ Cell - In the male the testicular cell that divides to produce the immature sperm cells; in the woman the ovarian cell that divides to form the egg (ovum). The male germ cell remains intact throughout the man's reproductive life; the woman uses up her germ cells at the rate of about one thousand per menstrual cycle, although usually only one egg matures each cycle. 95% of all testicular tumors are germ cell tumors.
Germ Cell Tumor - A tumor arising from germ cells. 95% of all testicular tumors are germ cell tumors. Germ cell tumors in men are classified as either seminomas or nonseminomas.
Germinoma - A germinoma is the female equivalent of seminoma.
Gonad - The gland that makes reproductive cells and "sex" hormones: the testicles, which make sperm and testosterone, and the ovaries, which make eggs (ova) and estrogen.
Gray (Gy) - The modern unit of radiation dosage.
Groin - The area where the thigh joins the abdomen.
Gynecomastia - Excessive development of the breast in the male.
Half Life - The time required for half the amount of a substance (such as a tumor marker) in or introduced into the body to be eliminated or disintegrated by natural processes.
Hernia (inguinal hernia) - Protrusion of the intestines into the scrotum.
High Dose Chemo - High dose chemo uses very high doses of chemotherapy to try to kill the cancer. It is very intense chemo, and is normally associated with a stem cell transplant.
Histology - The study of the appearance and behavior of tissue, usually carried out under a microscope by a pathologist (who is a physician) or a histologist (who is not necessarily a physician)
Hormones - Chemicals produced by certain glands in the body.
Human Chorionic Gonadotropin (hCG), beta subunit - In adults, significant elevation of levels of beta HCG occurs only during pregnancy and in patients with trophoblastic neoplasms or nonseminomatous germ cell tumors. As a result, it is used as a tumor marker. Essentially, 100 per cent of patients with trophoblastic tumors and 40-60 per cent of patients with nonseminomatous germ cell tumors, including all patients with choriocarcinoma, 80% of patients with embryonal carcinoma, and 10-25% of patients with pure seminoma are diagnosed with elevated levels of beta HCG. The serum half life of beta hCG is 24 to 36 hours, which implies that elevated concentrations should return to normal within 5 to 7.5 days after surgery if all tumor is removed. Please note that the normal HCG level is usually less than 5 miu/ml. Also note that the HCG level can become elevated (falsely positive) due to abnormally low levels of testosterone or because of marijuana use.
Hydrocele - A swelling of (part of) the scrotal pouch because of an increased amount of fluid around the testicle/epididymis. Several causes may lead to an increase of the amount of liquid, causing the scrotal pouch to bulge. This condition is harmless, but may cause irritation when the bulge becomes too big. There is no cancer involved, and it does not lead to cancer.
Hyperechoic - A term used to describe a part of an ultrasound image where the echoes are brighter than normal or than the surrounding structures. Hyperechoic structures in the testicle are usually hollow or cystic and are not usually testicular cancer.
Hypoechoic - A term used to describe a part of an ultrasound image where the echoes are not as bright as normal or are less bright than the surrounding structures. Hypoechoic structures in the testicle usually mean there is a solid mass inside the testicle, and that mass is very likely to be cancerous and should be removed.
Ifosfamide - An anticancer drug related to the nitrogen mustards. It is active in a number of cancers, including germ cell cancers. aka IFEX
Immature - Lacking complete growth, differentiation, or development. Rapidly growing malignant tumors show a significant degree of structural abnormality and resemble immature embryonal tissues or stem cells capable of proliferative activity. These cells may be referred to as undifferentiated or immature. In general, the more undifferentiated the tumor, the more malignant its biological behavior, as shown by tumor recurrence, vascular invasion, and metastasis.
Implant - A testicular prosthesis. Silicone Gel implants are not available in the US, and the American Urological Association have advised against using these products. A Silicone Elastomer prosthesis may be available, and is endorsed for use by the AUA.
Impotent - Unable to have and maintain an erection.
Infertility - The inability to conceive after a year of unprotected intercourse or the inability to carry a pregnancy to term.
Infusion - Slow and/or prolonged intravenous delivery of a drug or fluids.
Inguinal orchiectomy - Removal of the testicle through an incision in the groin (roughly to the right or left of the pubic bone and a couple of inches below the belt line). Cancerous testicles are always removed through an inguinal incision, never through the scrotum.
Injection - Using a syringe and needle to push fluids or drugs into the body; aka a "shot."
Intra-testicular - Within the testicle. This is where spermatozoa and testosterone are made. This is also where testicular cancers originate.
Intravenous pyelography - X-ray study of the kidneys and urinary tract. Structures are made visible by the injection of a substance that blocks x-rays. Also called IVP.
Klinefelter's syndrome - A genetic abnormality in a male characterized by two X chromosomes and one Y chromosome, infertility, smallness of the testes, and gynecomastia. It is associated with primary mediastinal extragonadal germ cell tumors found during puberty.
Lactate dehydrogenase - The enzyme LDH is found in many body tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells and lungs. It often becomes elevated in advanced cases of testicular cancer. Clinically, it is useful as marker of advanced or bulky disease and, when elevated, as a marker for seminoma.
Laparoscopy - A surgical procedure in which a tiny scope is inserted into the abdomen through a small incision. Its use in testicular cancer is experimental and controversial.
Leydig Cell - The testicular cell that produces the male hormone testosterone. Also referred to as interstitial cells or stromal cells.
Leydig cell tumor - See Sertoli cell tumor.
Local treatment - Treatment that affects the tumor and the area close to it. (Ex: Radiation therapy)
Lymph - A nearly colorless fluid that bathes body tissues and contains cells that help the body fight infection.
Lymph nodes - Small bean-shaped structures located throughout the body along the channels of the lymphatic system: also called lymph glands. Nodes filter circulating lymph and trap bacteria or cancer cells that may travel through the lymphatic system.
Lymphangiography - X-ray study of lymph nodes and lymph vessels made visible by the injection of a special dye. Lymphangiography, when CT scan and serum markers are negative, does not appear to significantly aid in patient management and is not usually done anymore.
Lymphatic system - The tissues and organs--including the bone marrow, spleen, thymus, and lymph nodes--that produce and store cells that fight infection and the network of channels that carry lymph.
Malignant - Cancerous (see Cancer)
Malignant Teratoma, Intermediate - The British Tumor Panel's term for Teratocarcinoma.
Malignant Teratoma, Trophoblastic - The British Tumor Panel's term for Choriocarcinoma.
Malignant Teratoma, Undifferentiated - The British Tumor Panel's term for Embryonal Carcinoma.
Margin - The surgical edge of a pathology specimen. Positive margins means that cancer cells were found at the surgical edge of the specimen, and this implies that cancer was left behind in the body.
Marker - See Tumor Marker.
Mass - A mass usually refers to a lump or a tumor.
Mature - Having completed natural growth and development. Some neoplasms, such as benign tumors and some slowly growing malignant tumors, have a cellular structure and organization similar to normal adult tissues at the site of origin and are said to be well differentiated or mature.
Mediastinum - The centermost part of the chest, between the ribs and spine (front to back) and between the lungs. Testicular cancer can metastasize to the anterior mediastinum - i.e., in front of the heart
Metastasize - To spread from one part of the body to another. When cancer cells metastasize and cause secondary tumors, the cells in the metastatic tumor are like those in the original cancer. In cancer slang, to have "mets" means that the disease has spread.
Microlithiasis - An uncommon condition usually found incidentally during an ultrasound examination of the testes. Microliths are laminated layers of collagenous material that form in the seminiferous tubules and calcify. Some studies indicate that as many as 40% of men with testicular microlithiasis also have or may get a testicular tumor. The condition is usually bilateral and, if one testis is removed because of a tumor, it is recommended that the contralateral testis be regularly monitored by ultrasound.
Mixed Germ Cell Tumor - A tumor containing more than one type of germ cell cancer (for example, teratoma and seminoma).
Necrosis - Dead cells. Many germ cell tumors contain necrotic regions. Residual masses after chemotherapy often are composed completely of necrotic tissue.
Neoplasm - Another name for a tumor or cancer.
Nerve sparing - Term used to describe a type of RPLND surgery in which the surgeon saves the nerves that affect ejaculation.
Neupogen - A drug known as a granulocyte colony-stimulating factor (G-CSF). It is often used to stimulate the production of white blood cells during or after chemotherapy.
Neutropenia - Abnormally small amount of white blood cells (that fight infection). Also called leukopenia.
Nomogram - A graphic representation that consists of several lines marked off to scale and arranged in such a way that by using a straightedge to connect known values on two lines an unknown value can be read at the point of intersection with another line. One is used to calculate surface area of a person based on height and weight for the purpose of calculating dosages for chemotherapy.
Nonseminoma - A classification of testicular cancers that arise in specialized sex cells called germ cells. Nonseminomas include embryonal carcinoma, teratoma, teratocarcinoma, choriocarcinoma, and yolk sac tumor. The majority of nonseminomas have more than one cell type and are known as mixed germ cell tumors. The cell type of these tumors is important for estimating the risk of metastases and response to chemotherapy.
Occult metastasis - A metastasis that is hidden. In testicular cancer, tumor markers such as AFP and beta HCG are used to detect occult metastases.
Oligospermia - Having few sperm.
Oncologist - A doctor who specializes in treating cancer. Medical Oncologists specialize in treating cancer with chemotherapy while Radiation Oncologists specialize in treating cancer with high dose radiation.
Orchiectomy - Surgery to remove a testicle. When only one testicle is removed, there is no effect on male hormone production, sexual function, or fertility. Cancerous testicles are always removed through an inguinal incision, never through the scrotum.
Orchiopexy - An operation to lower an undescended testicle and stitch it into the scrotum.
Orchitis - Inflammation of a testis. The disease is marked by pain, swelling, and a feeling of weight. It may have an unknown cause, but is usually due to gonorrhea, syphilis, filarial disease, or tuberculosis.
Para-aortic - "Para" is a prefix meaning besides. The para-aortic lymph nodes are lymph nodes besides the aorta in the retroperitoneum.
Parenchyma - The key elements of an organ essential to its functioning. In other words, the parenchyma is the normal working part of an organ and not the stuff that holds the organ together. The parenchyma of the testis consists of the seminiferous tubules and leydig cells.
Pathologist - A doctor who specializes in the diagnosis of disease by studying cells and tissues removed from the body.
Perineum - The tissue located between the anus and scrotum in the male or between the anus and vaginal opening in the female.
Peripheral neuropathy - A condition of the nervous system that usually begins in the hands and/or feet with symptoms of numbness, tingling, burning and/or weakness. Can be caused by certain anticancer drugs like cisplatin.
PET Scan (Positron Emission Tomography) - A highly specialized and experimental research imaging technique using low-dose radioactive sugar to measure metabolic activity. This technique is very sensitive in picking up active tumour tissue but does not measure the size of it. It may be used after chemotherapy for seminoma to determine if a residual mass is malignant or benign.
Pineal Gland - A small gland in the center of the brain that appears to function primarily as an endocrine gland that produces melatonin. The pineal gland is one of a number of primary sites for extragonadal germ cell tumors, particularly in children.
Placental Alkaline Phosphatase - A tumor marker sometimes used for germ cell cancers, particularly seminoma. However, it is not used very often, and is more likely to be used by a pathologist examining a specimen than in a blood test.
Planning - This consists of individualizing the patient's treatment plan by the study of published literature, consultation with specialist colleagues, calculation of dosages and schedules, and designing the protocol.
Port - (1) A well defined area on the body at which the radiation beam is aimed. For testicular cancer, the port is often referred to as a "hockey stick" or "dog leg" shaped area that includes the retroperitoneal and pelvic lymph nodes. (2) A small plastic or metal container surgically placed under the skin and attached to a central venous catheter inside the body. Blood and fluids can enter or leave the body through the port using a special needle. These devices are expensive and are not free of problems; they should not be implanted without good indications. Normally implantation is performed by a surgeon with experience in this technique, in a operational theatre under local anaesthetic
Primary - The initial tumor or site of cancer.
Prognosis - The probable outcome of a disease; the prospect of recovery.
Prognostic factors - Factors which are associated with a better or worse outcome of the disease. They are not the same as causes. For example, vascular invasion and percentage of embryonal cancer are prognostic factors when predicting whether Stage I nonseminoma will relapse.
Prostate Gland - A gland in the male reproductive system that produces a portion of the semen.
Prosthesis - An artificial replacement for a missing body part. Testicular prostheses are not commonly used in the US anymore due to concerns about the effect of silicone on the body (and the pocketbook of the manufacturer).
Protocol - A detailed treatment plan. For example, the BEP chemotherapy protocol is a specific treatment plan using certain drugs on certain days.
Rad - An old unit of radiation dose now superseded by the Gray. 1 Gray = 100 rads.
Radiation Oncologist - A medically qualified doctor who specializes in the use of irradiation for the treatment of cancer.
Radiation therapy - Treatment with high-energy radiation from X-rays or other sources of radiation. Also known as XRT.
Radiation Physicist - A non-medically qualified person who specializes in the application of physics to plan and deliver irradiation, assisting the radiotherapist in planning and treatment.
Radical (radical orchiectomy) - Surgical attempt to cure disease by taking out the entire specimen and surrounding structures.
Recurrence - Return of symptoms / cancer cells after a period of quiescence/cure.
Refractory - A severe disease that is resistant to treatment. For example, a cisplatin refractory disease no longer responds to cisplatin.
Relapse - Recurrence of disease after apparent recovery.
Rete Testis - A network of tubules that basically connects the seminiferous tubules in the testis to the epididymis.
Retrograde ejaculation - A male fertility problem that allows the sperm to travel into the bladder instead of out the opening on the penis during ejaculation. Retrograde ejaculation may be caused by the severing of the sympathetic nerves during RPLND surgery. The presence of semen in the bladder is harmless; it mixes into the urine and leaves the body with normal urination.
Retroperitoneal Lymph Node Dissection - RPLND - An RPLND is an operation where the lymph nodes surrounding the aorta on the back wall of the abdomen (para-aortic) are removed in order to 1) determine whether cancer has spread outside of the testicle and 2) remove the primary metastatic site(s). The RPLND is a major operation involving an incision from the sternum to the pubic bone. A full bilateral lymphadenectomy involves the removal of all retroperitoneal lymphatic tissue, while Modified versions of the operation only remove left or right sided nodes. A possible side effect of the bilateral procedure is retrograde ejaculation. A nerve sparing technique used with a modified procedure may be used to avoid this problem.
Retroperitoneum - The back of the abdomen where the kidneys lie and the great blood vessels run.
Salvage - Treatment for individuals who don't respond to or who can't take other treatments for a condition.
Sarcoma - A cancer of connective tissues such as bone, cartilage, fat, muscle, nerve sheath, or blood vessels.
Scrotum - The pouch of skin and thin muscles that contains the testicles.
Semen - The fluid portion of the ejaculate consisting of secretions from the seminal vesicles, prostate gland, and several other glands in the male reproductive tract. Semen may also refer to the entire ejaculate, including the sperm.
Semen Analysis - A laboratory test used to assess semen quality:sperm quantity, concentration, morphology (form), and motility. In addition, it measures semen (fluid) volume and whether or not white blood cells are present, indicating an infection.
Seminal Vesicles - Glands in the male reproductive system which produce much of the semen volume.
Seminiferous Tubules - The testicular tubules in which the sperm mature and move toward the epididymis.
Seminoma - A type of testicular cancer that arises from sex cells, or germ cells, at a very early stage in their development. Seminoma is the most common testicular germ cell tumor, accounting for 30-40% of all such tumors. Pure seminoma is very sensitive to radiation treatment.
Sertoli Cell - A testicular cell responsible for nurturing the spermatids (immature sperm). Sertoli cells "trap" high concentrations of androgens necessary for sperm production. They also form tight junctions with other Sertoli cells to form a blood-testis barrier, which prevents any sperm proteins from leaving the testes to provoke an immune response that would sterilize the male. This barrier is one reason why chemotherapy does not wipe out ALL the germ cells in the testes, but it is also why a cancerous testicle must always be removed.
Sertoli Cell Tumor - Leydig cell tumors and Sertoli cell tumors are rare tumors of the testicle. While some of these tumors are malignant, pathologists are usually not able to determine if the tumor is malignant simply by looking at it. As a result, a radical orchiectomy is usually done and is curative without the need for further treatment.
Simulation - A process involving special x-ray pictures that are used to plan radiation treatment so that the area to be treated is precisely located and marked for treatment.
Sperm - The microscopic cell that carries the male's genetic information to the female's egg; the male reproductive cell; the male gamete.
Sperm Bank - A place where sperm are kept frozen in liquid nitrogen for later use in artificial insemination.
Sperm Count - The number of sperm in the ejaculate (When given as the number of sperm per milliliter, it is called the sperm concentration or sperm density. )
Sperm Morphology -A semen analysis factor that indicates the number or percentage of sperm in the sample that appear to have been formed normally. Abnormal morphology includes sperm with kinked, doubled, or coiled tails. The higher the percentage of misshapen sperm, the less likely fertilization can take place.
Sperm Motility - The ability of sperm to swim. Poor motility means the sperm have a difficult time swimming toward their goal - the egg.
Spermatic cord - A cord that suspends the testis within the scrotum. It contains the vas deferens and vessels and nerves of the testis.
Spermatocele - A spermatocele is (usually) a small cavity, filled with watery liquid, in the epididymis. A spermatocele does not usually cause pain or discomfort unless it becomes very large, in which case it may cause irritation because it is 'in the way'.
Spermatocytic Seminoma - A preferred term would be "spermatocytoma." This lesion represents a unique entity, distinct from other germ cell tumors. It occurs only in men and never in extragonadal sites. It does not secrete AFP, HCG, or PLAP. It is not found in conjunction with any other germ cell tumor. It occurs almost exclusively in men over the age of 50, and it is almost always benign. Spermatocytomas represent only 2-3% of all testicular tumors. They are bilateral in about 10% of cases.
Staging - Classifying a cancer by looking at the size of the tumor and whether it has spread. Used to decide the best course of treatment. Clinical staging is based upon clinical or radiological evidence, while Pathological staging is based upon histological evidence. In general, the higher the stage, the more extensive the disease / farther the spread.
Stem Cells - Undifferentiated, primitive cells in the bone marrow with the ability both to multiply and to differentiate into all the components of blood and marrow.
Stem Cell Transplant - High dose chemotherapy can severely damage or destroy a patient's bone marrow so that the patient is no longer able to produce needed blood cells. Sometimes destroying the marrow may be a part of treatment for diseases that affect the bone marrow (leukemias and other diseases), or, like in the case of testicular cancer, it may simply be a side effect of treatment. A stem cell transplant allows stem cells that were damaged by treatment to be replaced with healthy stems cells that can produce the blood cells the patient needs.
Sterile - An irreversible condition that prevents conception.
Stomatitis - Sores on the inside lining of the mouth.
Surveillance - Surveillance is the practice of omitting adjuvant radiation, surgery, or chemotherapy in favor of closely watching for evidence of relapse. People choosing surveillance agree to a thorough checkup schedule that may include blood testing for tumor markers, chest X-rays, and CT scans.
Sympathetic Nervous System - The part of the autonomic nervous system that is concerned especially with preparing the body to react to situations of stress or emergency. The nerves that allow normal ejaculation are part of the sympathetic nervous system. If these nerves are cut during the RPLND, normal antegrade ejaculation becomes impossible.
Synctiotrophoblastic Cells - Syncytiotrophoblastic cells are giant cells with multiple nuclei. Together with Cytotrophoblasts, these two cells form choriocarcinoma. Synctiotrophoblastic Giant Cells (STGs) may be found by themselves, in which case they do not constitute choriocarcinoma. STGs produce human chorionic gonadotropin (HCG)
Systemic treatment - Treatment that reaches and affects cells all over the body. (ex: Chemo)
Template - A pattern used as a guide in determining the extent of surgery. In the Retroperitoneal Lymph Node Dissection, different templates are used depending on the location of the primary tumor (right or left testicle).
Teratocarcinoma - A mixed germ cell tumor comprised of embryonal carcinoma and teratoma. It is more differentiated than embryonal carcinoma, but less than teratoma.
Teratoma - (1) Strictly speaking, teratoma is a benign growth. It is an odd sort of tumor in that it is basically composed of a number of different normal types of tissue, growing in abnormal places. I say strictly speaking it is benign, but it can act like a malignant tumor and spread. It is most commonly discussed in the post-chemo situation where the doctors want to remove masses left behind by the chemo because they may have teratoma in them. They do this because any tumor can grow and cause problems later on, plus teratoma tumors can become cancerous themselves, and those cancers are not as easy to treat as germ cell tumors. Because teratoma is made up of normal cells, chemotherapy does not affect it. (2) In the UK, teratoma is synonymous with nonseminoma. Here is a cross reference between the AFIP/World Health Organization and the UK classifications:
|Teratoma||Non seminomatous germ cell tumour|
|teratoma differentiated||mature teratoma|
|malignant teratoma intermediate (MTI)||teratocarcinoma, embryonal carcinoma with teratoma|
|malignant teratoma undifferentiated (MTU)||embryonal carcinoma|
|yolk sac tumour||yolk sac tumor, endodermal sinus tumor|
|malignant teratoma trophoblastic||choriocarcinoma|
Testicular torsion - Twisting of the spermatic cord, cutting off the blood supply to the testicle and causing severe pain. A medical EMERGENCY because the testicle will die after a few hours.
Testis (Testicle)- One of two male reproductive glands located inside the scrotum which are the primary source of the male hormone testosterone. Roughly 4 cm in length, 2.5 cm in diameter, and 10-14 g in weight, but normal testes can be larger or smaller, and it is normal for one testicle (typically the left one) to be slightly larger than the other.
Testosterone - The male hormone responsible for the formation of secondary sex characteristics and for supporting the sex drive. Testosterone is also necessary for spermatogenesis.
Tumor - An abnormal mass of tissue.
Tumor Marker - A substance detectable in the blood or urine that suggests the presence of cancer. 70-80% of patients with testicular cancer have raised marker levels. Treatment of the cancer results in a fall of the markers. Examples are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), placental alkaline phosphatase (PLAP), and lactate dehydrogenase (LDH).
Tunica Albuginea - A white fibrous tissue that encapsulates testis.
Tunica Vaginalis - A double layered pouch derived from the perineum that covers each testis. It is composed of a serous membrane that provides lubrication.
Ultrasound - A diagnostic technique in which high-frequency sound waves are bounced off tissues inside the body, while the echoes are converted into pictures. Tissues of different densities reflect sound waves differently. Most testicular tumors are verified using ultrasound and will appear as solid masses, as opposed to a cyst which will indicate a fluid mass. Ultrasound has a near 100% sensitivity for detecting testicular tumors. However, while the ultrasound is very good at finding testicular tumors, such tumors cannot always be distinguished from benign conditions.
Undescended Testicles - see Cryptorchidism
Urologist - A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males.
Varicocele - This is a complex of dilated veins which surround the testicle, usually on the left side. Varicoceles occurs in approximately 15% of normal males and are usually not important clinically, unless they are associated with infertility. A varicocele feels like a "bag of worms" surrounding the testicle, and may be accompanied by a constant pulling, dragging, or dull pain in the scrotum.
Vascular invasion - Invasion by cancer cells of the lymphatics or veins. It is a sign that the tumour is more likely to have spread. A pathologist determines if vascular invasion is present when they examine the surgically removed cancerous testicle.
Vas deferens - The vas deferens is a small cord about the size of a pencil lead, which carries sperm which have matured from the testicle and epididymis to the ejaculatory ducts near the prostate gland in the urethra.
VeIP - A chemotherapy protocol using Vinblastin, Ifosfamide, and Cisplatin.
Vena Cava - Either of two large veins by which the blood is returned to the right atrium of the heart. The Superior Vena Cava comes from above the heart while the Inferior Vena Cava comes from below the heart. Most testicular tumors in the abdomen appear in the lymph nodes near the Inferior Vena Cava.
Vinblastin - An alkaloid based anticancer drug obtained from the periwinkle plant. aka VELBAN
VIP - A chemotherapy protocol using Etoposide, Ifosfamide, and Cisplatin.
X-ray - High-energy radiation used in low doses to diagnose cancer and in high doses to treat the disease.
Yolk sac carcinoma - A malignant neoplasm occurring in the gonads, in sacrococcygeal teratomas, and in the mediastinum. It produces alpha-fetoprotein and is thought to be derived from primitive endodermal cells. As a pure tumor, the yolk sac tumor is the most common testicular tumor among infants and children up to age 3. A pure yolk sac tumor is extremely rare in adults, but it is seen as a component in a mixed germ cell tumor in about 30% of cases. Also known as an endodermal sinus tumor or infantile embryonal carcinoma.
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