Meet our doctors: Urologist Jonathan Yamzon on curing testicular cancer
Testicular cancer is the most common form of cancer in men 15 to 34 years old. Yet it accounts for only 1 percent of all cancers in men in the United States. According to the American Cancer Society, about 8,800 men are diagnosed with testicular cancer each year, and about 380 men die of the disease. However, if detected early, the disease has an overall five-year survival rate of 96 percent. For Stage 1 patients, the five-year survival rate is an astonishing 99 percent.
Here, urologist Jonathan Yamzon, M.D., assistant clinical professor and surgeon in City of Hope’s Division of Urology and Urologic Oncology, discusses how early detection and the use of advanced treatment options can help cure men of this rare disease and allow them to lead healthy, normal lives.
What is testicular cancer?
Testicular cancer occurs when cells in the testicles grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the testicle. If the disease spreads, it is still called testicular cancer.
The most common types of testicular cancer form in germ cells, where sperm is made. They fall into two categories: seminomas and nonseminomas. Seminomas are slow-growing and tend to stay within the testicle. Nonseminomas are faster-growing, tend to spread outside the testicle and strike younger men. More than 90 percent of testicular cancers begin in the germ cells.
What causes testicular cancer and who is most at risk?
Experts don't know what causes testicular cancer. But some factors, such as having an undescended testicle, may increase a man's risk for this cancer. Other factors that may increase the risk of testicular cancer include an atrophic testicle and a history of testicular cancer in the family. Sometimes small clusters of calcium formed in the testicles (microlithiasis) and infertility are thought to be associated with testis cancer, but not necessarily a risk factor.
Testicular cancer is not only rare, accounting for only 1 percent of all cancers that occur in men, it is also one of the most curable forms of cancer. It is the most common cancer in American males between the ages of 15 and 34, with Caucasian men having a higher incidence.
How is testicular cancer diagnosed?
Most men find testicular cancer by chance or during a self-exam. Or a doctor may find it during a routine physical exam.
It most commonly presents with a firm and sometimes painful mass on the testicle. Often times, men will only notice the mass when they experience inadvertent trauma to the testicle, such as during physical activities. And even when noticed, there appears to be an average delay of six months from discovery of the mass to when a doctor is seen. Here at City of Hope, we see men present with advanced disease who have experienced delayed diagnosis, attributing their symptoms to other causes.
To assure correct diagnosis, a physical examination, testicular ultrasound, blood work for serum tumor markers unique to germ cell tumor and a computed tomography (CT) scan are obtained to determine the extent of disease. Once diagnosed, the affected testicle is then surgically removed. Surgery is the only way to know for sure if it is testicular cancer and what kind of cancer it is. This information also helps in planning any other treatment that may be needed.
How is testicular cancer treated and are there any new developments in treating the disease?
City of Hope brings together highly skilled specialists and the latest treatment options – some found only here – for men in every stage of testicular cancer. The urologic oncologic surgical team is among the most experienced in the country and we have excellent success rates using a range of advanced technologies. For some men, surgery to remove the testicle may be all the treatment they need. The type and stage of cancer will determine if more treatment is needed. Treatment after surgery may include chemotherapy or radiation therapy, or both.
An increasing option for some early-stage testicular cancer patients is active surveillance which requires intensive monitoring to make sure any relapse of the disease is caught and treated right away. Men whose tumor marker profiles normalize after surgical removal of the testicle and do not show evidence of disease on a CT scan are eligible for this approach. Approximately 80 percent of men with tumor marker normalization and a negative CT scan are cured with removal of the testicle alone.
Can testicular cancer treatment affect a man’s fertility?
Testicular cancer treatments can certainly affect one’s fertility. Chemotherapy can cause dysfunction of the remaining testicle, leading to poor production of sperm. Surgical removal of affected lymph nodes (i.e., retroperitoneal lymph node dissection) can compromise a unique set of nerves that control coordinated muscle function necessary for ejaculation and normal conception.
Surgery should be carried out at a specialized high-volume center to minimize this potential complication. Prior to commencement of treatment, we recommend men participate in sperm banking in the event they experience post-treatment infertility.
What advice do you have for patients recently diagnosed with testicular cancer?
Successful outcomes for testicular cancer are predicated on an accurate diagnosis, staging, treatments and follow-up. If you are found to have a testicular mass, ask your doctor for a referral to see a urologist. He or she can obtain the appropriate tests and even remove the affected testicle. Additional therapies (e.g., chemotherapy and/or surgery) can be carried out by multidisciplinary teams at specialized centers like City of Hope.
Surgical intervention, specifically after chemotherapy, are very technically challenging and should be performed at high-volume centers by a urologic oncologist.
Why did you choose urology and urologic oncology as your specialty?
Urology offered the best combination of medical and surgical practice. During my training, I was inspired by mentors who were world-renowned experts in urologic oncology, and whose drive has been to improve treatments in urologic cancer. I want to continue this mission.
What inspires you to do the work you do?
I am inspired by my patients. I am amazed at the strength, courage and perseverance embodied by my patients who face the fight against cancer, and I am humbled and honored to help them through their enduring journey.
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