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Small egg cancer

Small egg cancer – malignant damage of testicles – gonads at men. Serve as symptoms of cancer of a small egg: the palpated education, increase and hypostasis of a scrotum, pain. Diagnosis of cancer of a small egg consists in carrying out survey, a diafanoskopiya, ultrasonography of a scrotum, small egg biopsy, definition of tumoral markers. Cancer therapy of a small egg includes performance one - or a bilateral orkhifunikulektomiya, performing radiation therapy and chemotherapy. The forecast of a disease depends on its clinical stage and its histologic type.

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Small egg cancer

Small egg cancer – rather rare oncopathology, a component about 1,5-2% of all malignant tumors revealed at men. In urology 5% of all new growths are the share of cancer of a small egg. At the same time the disease is extremely aggressive, affects mainly young men aged up to 40 years and is among them the most frequent reason of early oncological mortality. More often the unilateral tumor comes to light, is more rare (in 1-2% of cases) - bilateral cancer of testicles.

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Reasons of cancer of testicles

Three age peaks connected with developing of cancer of a small egg are revealed: at boys up to 10 years, 60 years are more senior than young men from 20 to 40 years and elderly people. At children small egg cancer develops in 90% of cases against the background of a malignization of an embryonic good-quality teratoma. At more advanced age scrotum injuries, endocrine diseases (a gipogonadizm, a ginekomastiya, infertility), radiation, etc. can become the factors provoking development of cancer of a small egg. The risk of developing of cancer of a small egg increases at Klaynfelter's syndrome.

Most often cancer of a small egg comes to light at patients with a kriptorkhizm – not omission of glands in a scrotum. Various forms of a kriptorkhizm increase risk of developing of cancer in the neostarted-up small egg by 10 times. At unilateral defeat of a small egg the probability of developing of a tumor of contralateral gland is also high.

Chances of development of cancer of a small egg are higher at men whose relatives of the first degree (the brother, the father) had a similar disease. Small egg cancer by 5 times meets at Europeans, especially residents of Germany and Scandinavia more often; more rare – in the Asian and African countries.

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Classification of cancer of a small egg

By the histologic principle allocate germinogenny (proceeding from a seed epithelium), negerminogenny (arising from a small egg stroma) and the mixed new growths. Germinogenny tumors of a small egg meet in 95% of cases and can be presented seminomy, embryonic cancer, horionkartsinomy, malignant teratomy, etc. About 40% of cases of germinogenny tumors make seminoma; 60% - neseminomny tumors. The sertolioma, a leydigoma, sarcoma belong to tumors of a stroma of a sexual tyazh (negerminogenny).

The defining value for cancer therapy of a small egg has stadirovany diseases by the international TNM criteria.

  • T1 – a tumor in borders of a belochny cover
  • T2 - is noted increase and deformation of a small egg, however the tumor is still limited to a belochny cover
  • T3 – infiltration by a tumor of a belochny cover and germination in small egg appendage fabric
  • T4 – spread of a tumor out of small egg limits with germination of a seed kanatik or fabrics of a scrotum
  • N1 – existence of regionarny metastasises in lymph nodes is found by means of a radiological or radio isotope research
  • N2 – are palpated the increased regionarny lymph nodes
  • M1 – small egg cancer metastasises in the remote bodies come to light (lungs, a liver, a brain, kidneys).
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Symptoms of cancer of testicles

The clinic of cancer of testicles consists of local symptoms and manifestations of metastasis. Consolidation of gland and emergence in it the palpated painless small knot becomes the first symptom of cancer of testicles, as a rule. In a quarter of cases pain in the struck small egg or a scrotum, feeling of weight or dull ache in the bottom of a stomach is noted. The initial symptomatology of cancer of a small egg can remind sharp orkhoepididimit. When progressing cancer of a small egg the scrotum becomes asymmetrically increased and edematous. Further development of clinical manifestations is usually connected with small egg cancer metastasis.

At a sdavleniye of nervous backs back pains can be noted by the increased zabryushinny lymph nodes; at an intestines sdavleniye – intestinal impassability. In case of blockade of lymphatic ways and the lower hollow vein develops and hypostases of the lower extremities. Sdavleniye of mochetochnik can be followed by development of a gidronefroz and a renal failure. Small egg cancer metastasis in lymph nodes of a sredosteniye causes cough and short wind. At development of cancer intoxication nausea, weakness, appetite loss, a kakheksiya is noted.

Negerminogenny forms of cancer of a small egg can initiate disgormonalny manifestations. In these cases at boys the ginekomastiya, a premature masculinization (a girsutizm, a voice mutation, a makrogenitosomiya, frequent erections) quite often develops. At adults hormonal and active cancer of testicles can be followed by decrease in a libido, impotence, feminization.

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Diagnosis of cancer of testicles

Stage-by-stage diagnosis of cancer of testicles includes fizikalny inspection, a diafanoskopiya, ultrasonic diagnostics (ultrasonography of a scrotum), a research of tumoral markers, a small egg biopsy with a morphological research of fabrics.

Primary inspection at suspicion of cancer of testicles begins with a palpation of bodies of a scrotum (for detection of primary tumor), a stomach, inguinal and supraclavicular area (for the purpose of detection of the palpated lymph nodes), chest glands (for identification of a ginekomastiya).

By means of a diafanoskopiya – raying of fabrics of a scrotum the light source possible to differentiate a small egg appendage cyst, the gidrotsel and the spermatotsel from a tumor. Performing ultrasonography of bodies of a scrotum aims at definition of localization of cancer of a small egg, its size and degree of an invasion, and also an exception of defeat of counterlateral gland. High sensitivity and specificity at diagnosis of tumors of a small egg MRT allowing to differentiate seminy and neseminomny types of cancer has.

Definition of serumal markers is a significant factor of diagnostics, a stadirovaniye and the forecast of cancer of a small egg. At suspicion of cancer of a small egg need to investigate AFP (a-fetoprotein), HGCh (a horionichesky gonadotrophin), LDG (laktatdegidrogenaza), PAP (placentary alkaline phosphatase). Increase in level of markers is registered at 51% of patients with small egg cancer, however the negative result also does not exclude existence of a tumor.

The remote metastasises of cancer of a small egg can be found when performing ultrasonography of an abdominal cavity and kidneys, a X-ray analysis of a thorax, MPT and KT of a brain, an osteostsintigrafiya.

Final morphological verification of the diagnosis is carried out during an open biopsy of a small egg through pakhovy access. Usually in the course of diagnostic operation the urgent morphological research of a bioptat is conducted and at confirmation of cancer of a small egg removal of a gonad together with a seed kanatik is made (orkhifunikulektomiya).

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Cancer therapy of testicles

The possibility of organ-preserving operation at cancer of a small egg is considered at a bilateral tumor or defeat of the only gland. After a small egg resection performing adjyuvantny radiation therapy is shown to all patients.

As the standard of surgical cancer therapy of a small egg serves the orkhiektomiya, if necessary with a zabryushinny limfadenektomiya. Removal of seminomny tumors of T1-T2 of stages is supplemented with radiation therapy; at T3-T4 seminoma stages, and also at neseminomny cancer of a small egg purpose of system chemotherapy is required. In case of a bilateral orkhifunikulektomiya or low level of testosterone to patients gormonozamestitelny therapy is appointed.

Complex cancer therapy of a small egg (orkhiektomiya, radiotheraphy, chemotherapy) can be led to temporary or long infertility and impotence. Therefore inspection at the andrologist with assessment of level of hormones (testosterone, LG, FSG) and spermograms is recommended to patients of fertile age before cancer therapy of a small egg. At intention further to have children prior to treatment the man can resort to a sperm cryopreservation.

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Forecast and prevention of cancer of a small egg

The multiple-factor analysis of the forecast considers a clinical stage of cancer of a small egg, tumors, the correct and full complex of the carried-out treatment. So, at stages of cancer of a small egg of T1-T2 recovery at 90-95% of patients is possible. The worst forecast should be expected at an angiolimfatichesky invasion of a tumor, existence of metastasises.

Prevention of cancer of a small egg consists in timely elimination of a kriptorkhizm, the prevention of injuries of a scrotum, an exception of radiation of genitals. Timely detection of cancer of a small egg is promoted by regular self-inspection and the early address to the urologist-andrologist at detection of any changes.

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Small egg cancer - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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