Testicular Cancer

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Posted by kaori 03/02/2009 @ 20:07

Tags : testicular cancer, cancers, diseases, health

News headlines
Charleston Mom Tries to Educate Others About Testicular Cancer - WSAZ-TV
"Which that is my thing, to get the word out about cancer- about young men and boys don't know about," Susie Bratt told WSAZ.com recently. Susie Bratt wants them to know more about testicular cancer. Her son, Andy Bratt was only 23 when fought a short...
Get to know her first - Detroit Free Press
Dear Isadora: A friend of mine, a guy in his 20s like me, was just diagnosed with cancer of the testicle. I'm embarrassed to ask him too many questions. What should I watch out for? Answer: Testicular cancer is the most common cancer in young men in...
Men run to raise testicular cancer awareness (VIDEO) - Sowetan
An estimated 300 men ran across town in speedos in a bid to raise awareness about testicular cancer among men between the ages of 15 and 40. "The objective is to create attention and that was achieved here today and to have fun in our city," said Carel...
Can cancer drugs harm your memory? Patients complain of mental ... - Daily Mail
Swedish research published last year found that men undergoing chemotherapy for testicular cancer also experienced a range of thinking problems. About one in three who had chemotherapy between four and 21 years previously had language problems,...
The Association Risk of Male Subfertility and Testicular Cancer: A ... - Elites TV
By PLoS ONE • on May 16, 2009 An association between male subfertility and an increased risk of testicular cancer has been proposed, but conflicting results of research on this topic have rendered this theory equivocal. To more precisely assess the...
Cancer fight adds weapons - Allentown Morning Call
Dr. Jamie Von Roenn, a medical oncologist at Northwestern Memorial Hospital, gave these examples: -- Germ cell tumors of the testes (testicular cancer) are almost always successfully treated, even when the cancer has metastasized....
German Cultural Centre screened Eierdiebe - The New Nation
The bad news for Martin is he's suffering from testicular cancer, which means one of his tests will have to be removed. While in the hospital, Martin meets Susanne (Julia Hummer), a beautiful patient who is carefully swiping drugs from the clinic for...
Worries about fertility and risk of cancer - Irish Times
It is unlikely that bringing a testicle into the scrotum decreases the risk of testicular cancer, which is four to 10 times greater in an undescended testicle compared with normally descended testicles. Placing the testicle in the scrotum when you are...
Robbie Williams Threatens To Sue Charity Bosses Over Testicular ... - MedIndia
Singer Robbie Williams has threatened to sue cancer charity bosses who intend to use his look-alike for testicular cancer ad campaign. National Testicular Cancer Awareness campaign sponsor Marc Gavin revealed that he had earlier approached Williams to...
Life of promising district judge and prominent lawyer cut short by ... - Austin American-Statesman
Travis County District Judge Scott Ozmun died Friday of complications from testicular cancer after a short term on the bench. By Claire Osborn State district judge and prominent Austin lawyer Scott Ozmun died Friday after a long struggle with...

Testicular cancer

Seminoma of the Testis.jpg

Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system.

In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's risk of testicular cancer is roughly 1 in 250 (four tenths of one percent, or 0.4 percent). It is most common among males aged 15-35 years, particularly those in their mid-twenties. Testicular cancer has one of the highest cure rates of all cancers: in excess of 90 percent; essentially 100 percent if it has not metastasized. Even for the relatively few cases in which malignant cancer has spread widely, chemotherapy offers a cure rate of at least 85 percent today. Not all lumps on the testicles are tumors, and not all tumors are malignant; there are many other conditions such as testicular microlithiasis, epididymal cysts, appendix testis (hydatid of Morgagni), and so on which may be painful but are non-cancerous.

Testicular cancer is most common among whites and rare among men of African descent. Testicular cancer is uncommon in Asia and Africa. Worldwide incidence has doubled since the 1960s, with the highest rates of prevalence in Scandinavia, Germany, and New Zealand.

Incidence among African Americans doubled from 1988 to 2001 with a bias towards seminoma. The lack of significant increase in the incidence of early-stage testicular cancer during this timeframe suggests that the overall increase was not due to heightened awareness of the disease.

Although testicular cancer is most common among men aged 15-40 years, it has three peaks: infancy, ages 25-40 years, and age 60 years.

Germ cell tumors of the testis are the most common cancer in young men between the ages of 15 and 35 years.

A major risk factor for the development of testis cancer is cryptorchidism (undescended testicles). Other risk factors include inguinal hernia, mumps orchitis . Physical activity is associated with decreased risk and sedentary lifestyle is associated with increased risk. Early onset of male characteristics is associated with increased risk. These may reflect endogenous or environmental hormones.

A testicular mass can be palpated. Because testicular cancer is curable (stage I can have a success rate of >90%) when detected early, experts recommend regular monthly testicular self-examination after a hot shower or bath, when the scrotum is looser. Men should examine each testicle, feeling for pea-shaped lumps. The testicle should normally feel smooth to the touch. Ridges may be felt because of enlarged blood vessels or tumor growth. Additionally the entire testicle may feel hard and bumpy to the touch.The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in asymptomatic adolescent and adult.

The nature of any palpated lump in the scrotum is evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by CT scans, which are used to locate metastases. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. AFP alpha1 feto protein, Beta-HCG, and LDH are the typical markers used to identify testicular cancer. The diagnosis is made by performing an inguinal orchiectomy, surgical excision of the entire testis along with attached structures epididymis and spermatic cord; the resected specimen is evaluated by a pathologist. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum. A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.

The cardinal diagnostic finding in the patient with testis cancer is a mass in the substance of the testis. Unilateral enlargement of the testis with or without pain in the adolescent or young adult male should raise concern for testis cancer.

An incorrect diagnosis is made at the initial examination in up to 25% of patients with testicular tumors and may result in delay in treatment or a suboptimal approach (scrotal incision) for exploration.

The differential diagnosis of testicular cancer requires examining the histology of tissue obtained from an inguinal orchiectomy specimen. Orchiectomy, rather than transcrotal biopsy, is preferred to reduce the risk of spill and thus the risk of metastasis, in the event that the tumor is malignant. For orchiectomy, an inguinal surgical approach is preferred.

Before 1970, the young man with recurrent testicular cancer was destined to have rapid progression and death from disseminated disease. Currently, although 7000 to 8000 new cases of testicular cancer occur in the United States yearly, only 400 men are expected to die of the disease. Much of this improvement is due to advances in adjuvant therapy.

Due to the risk of subsequent metastasis, post-surgical adjuvant therapy may be offered to the patient following orchiectomy. The type of adjuvant therapy depends largely on the histology of the tumor and the stage of progression at the time of surgery. These two factors contribute to the risk of recurrence, including metastasis. Adjuvant treatments may involve chemotherapy, radiotherapy or careful surveillance by frequent CT scans and blood tests by oncologists.

Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors. Most of the remaining 5% derive from Leydig cells or Sertoli cells. Thus, the focus of diagnosis is on determining which germ cell tumor is present. Correct diagnosis is necessary to ensure the most effective and least harmful treatment. To some extent, this can be done via blood tests for tumor markers, but differential diagnosis requires examination of the histology of a specimen by a pathologist.

After removal, a testicular tumor is classified by a pathologist according to its histology.

The three basic types of treatment are surgery, radiation therapy, and chemotherapy.

Surgery is performed by urologists; radiation therapy is administered by radiation oncologists; and chemotherapy is the work of medical oncologists.

In most patients with testicular cancer, the disease is cured readily with minimal long-term morbidity.

While it may be possible, in some cases, to remove testicular cancer tumors from a testis while leaving the testis functional, this is almost never done, as more than 95% of testicular tumors are malignant. Since only one testis is typically required to maintain fertility, hormone production, and other male functions, the afflicted testis is almost always removed completely in a procedure called inguinal orchiectomy. (The testicle is almost never removed through the scrotum; an incision is made beneath the belt line in the inguinal area.) Most notably, since removing the tumor alone does not eliminate the precancerous cells that exist in the testis, it is usually better in the long run to remove the entire testis to prevent another tumor. A plausible exception could be in the case of the second testis later developing cancer as well.

In the case of nonseminomas that appear to be stage I, surgery may be done on the retroperitoneal/Paraaortic lymph nodes (in a separate operation) to accurately determine whether the cancer is in stage I or stage II and to reduce the risk that malignant testicular cancer cells that may have metastasized to lymph nodes in the lower abdomen. This surgery is called Retroperitoneal Lymph Node Dissection (RPLND). However, this approach, while standard in many places, especially the United States, is out of favor due to costs and the high level of expertise required to perform the surgery. The urologist may take extra care in the case of males who have not fathered children, to preserve the nerves involved in ejaculation.

Many patients are instead choosing surveillance, where no further surgery is performed unless tests indicate that the cancer has returned. This approach maintains a high cure rate because of the growing accuracy of surveillance techniques.

Lymph node surgery may also be performed after chemotherapy to remove masses left behind, particularly in the cases of advanced initial cancer or large nonseminomas.

Radiation may be used to treat stage II seminoma cancers, or as adjuvant (preventative) therapy in the case of stage I seminomas, to minimize the likelihood that tiny, non-detectable tumors exist and will spread (in the inguinal and para-aortic lymph nodes). Radiation is never used as a primary therapy for nonseminoma.

As an adjuvant treatment, use of chemotherapy as an alternative to radiation therapy is increasing, because radiation therapy appears to have more significant long-term side effects (for example, internal scarring, increased risks of secondary malignancies, etc.). Two doses, or occasionally a single dose of carboplatin, typically delivered three weeks apart, is proving to be a successful adjuvant treatment, with recurrence rates in the same ranges as those of radiotherapy.

Chemotherapy is the standard treatment for non-seminoma (teratoma) when the cancer has spread to other parts of the body (that is, stage II or III). The standard chemotherapy protocol is three, or sometimes four, rounds of Bleomycin-Etoposide-Cisplatin (BEP). This treatment was developed by Dr. Lawrence Einhorn at Indiana University. An alternative, equally effective treatment involves the use of four cycles of Etoposide-Cisplatin (EP).

While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage I cancers cases (if monitored properly) have essentially a 100% survival rate (which is why prompt action, when testicular cancer is a possibility, is extremely important).

For stage I cancers that have not had any adjuvant (preventative) therapy, close monitoring for at least a year is important, and should include blood tests (in cases of nonseminomas) and CT-scans (in all cases), to ascertain whether the cancer has metastasized (spread to other parts of the body). For other stages, and for those cases in which radiation therapy or chemotherapy was administered, the extent of monitoring (tests) will vary on the basis of the circumstances, but normally should be done for five years (with decreasing intensity). For the first year blood tests for tumor markers should be done monthly, and decreasing to once every three months in the years after. CT scans should be performed once every three months in the first year and decreasing to once every six months thereafter. The high cost of CT scans and the relative danger of the radiation involved both being factors in the relative infrequence with which tests are performed. CT-scans are performed on the abdomen (and sometimes the pelvis) whereas chest x-rays are preferred for the lungs as they give sufficient detail combined with a lower false-positive rate and significantly smaller radiation dose.

A man with one remaining testis can lead a normal life, because the remaining testis takes up the burden of testosterone production and will generally have adequate fertility. However, it is worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm banking may be appropriate for younger men who still plan to have children, since fertility may be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy and/or radiotherapy is done.

Less than five percent of those who have testicular cancer will have it again in the remaining testis. A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and will be infertile, but can lead an otherwise normal life.

Most testicular germ cell tumors have too many chromosomes, and most often they are triploid to tetraploid. An isochromosome 12p (the short arm of chromosome 12 on both sides of the same centromere) is present in about 80 % of the testicular cancers, and also the other cancers usually have extra material from this chromosome arm through other mechanisms of genomic amplification.

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Germ cell tumor

Seminoma.jpg

A germ cell tumor (GCT) is a neoplasm derived from germ cells. Germ cells normally occur inside the gonads (ovary and testis). Germ cell tumors that originate outside the gonads may be birth defects resulting from errors during development of the embryo.

Some investigators suggest that this distribution arises as a consequence of abnormal migration of germ cells during embryogenesis. Others hypothesize a widespread distribution of germ cells to multiple sites during normal embryogenesis, with these cells conveying genetic information or providing regulatory functions at somatic sites.

Extragonadal germ cell tumors were thought initially to be isolated metastases from an undetected primary tumor in a gonad, but it is now known that many germ cell tumors are congenital and originate outside the gonads. The most notable of these is sacrococcygeal teratoma, the single most common tumor diagnosed in babies at birth.

Germ cell tumors are classified by their histology, regardless of location in the body.

The two classes reflect an important clinical difference. Compared to germinomatous tumors, nongerminomatous tumors tend to grow faster, have an earlier mean age at time of diagnosis (~25 years versus ~35 years, in the case of testicular cancers), and have a lower 5 year survival rate. The survival rate for germinomatous tumors is higher in part because these tumors are exquisitely sensitive to radiation, and they also respond well to chemotherapy. The prognosis for nongerminomatous has improved dramatically, however, due to the use of platinum-based chemotherapy regimens.

Mixed germ cell tumors occur in many forms. Among these, a common form is teratoma with endodermal sinus tumor.

Teratocarcinoma refers to a germ cell tumor that is a mixture of teratoma with embryonal carcinoma, or with choriocarcinoma, or with both. This kind of mixed germ cell tumor may be known simply as a teratoma with elements of embryonal carcinoma or choriocarcinoma, or simply by ignoring the teratoma component and referring only to its malignant component: embryonal carcinoma and/or choriocarcinoma.

Despite their name, germ cell tumors occur both within and outside the ovary and testis.

In females, germ cell tumors account for 30% of ovarian tumors, but only 1 to 3% of ovarian cancers in North America. In younger women germ cell tumors are more common, thus in patients under the age of 21, 60% of ovarian tumors are of the germ cell type, and up to one-third are malignant. In males, germ cell tumors of the testis occur typically after puberty and are malignant (testicular cancer). In neonates, infants, and children younger than 4 years, the majority of germ cell tumors are sacrococcygeal teratomas.

Males with Klinefelter's syndrome have a 50 times greater risk of germ cell tumors (GSTs). In these persons, GSTs usually contain nonseminomatous elements, present at an earlier age, and seldom are gonadal in location.

The 1997 International Germ Cell Consensus Classification is a tool for estimating the risk of relapse after treatment of malignant germ cell tumor.

A small study of ovarian tumors in girls reports a correlation between cystic and benign tumors and, conversely, solid and malignant tumors. Because the cystic extent of a tumor can be estimated by ultrasound, MRI, or CT scan before surgery, this permits selection of the most appropriate surgical plan to minimize risk of spillage of a malignant tumor.

Germ cell tumors of children are the subject of clinical research by the worldwide Children's Oncology Group (COG), in a number of studies coordinated by Dr. John Cullen, MD.

Intracranial Germ Cell Tumors have been studied through the International CNS GCT Study Group. Under the direction of Jonathan Finlay, the program director, three international treatment studies have been initiated since 1990 with the goal to maintain a high rate of cure while minimizing the late effects of treatment.

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Castration

Mule castration via perineum

Castration (also referred to as: gelding, neutering, fixing, orchiectomy, and orchidectomy) is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles. In common usage the term is usually applied to males, although as a medical term it is applied to both males and females. For more information about female castration, see oophorectomy.

The practice of castration has its roots before recorded human history. Castration was frequently used in certain cultures of Europe, the Middle East, India, Africa and China, for religious or social reasons. After battles in some cases, winners castrated their captives or the corpses of the defeated to symbolise their victory and 'seize' their power, and often to take control of their women. Castrated men — eunuchs — were often admitted to special social classes and were used particularly to staff bureaucracies and palace households: in particular, the harem. Castration also figured in a number of religious cults. Other religions, for example Judaism and Islam, were strongly opposed to the practice. The Leviticus Holiness code, for example, specifically excludes eunuchs or any males with defective genitals from the priesthood, just as castrated animals are excluded from sacrifice.

Eunuchs in China have been known to usurp power in many eras of Chinese history, most notably in the Later Han, late Tang and late Ming Dynasties. Gang Bing, a Ming Dynasty Chinese general and eunuch was notable for his act of self-castration as a display of loyalty to his emperor. There are similar recorded Middle Eastern events.

In ancient times, castration often involved the total removal of all the male genitalia. This involved great danger of death due to bleeding or infection and, in some states, such as the Byzantine Empire, was seen as the same as a death sentence. Removal of only the testicles had much less risk.

In China, castration of a male who entered the caste of eunuchs during imperial times involved the removal of the whole genitalia, that is, the removal of the testes, penis, and scrotum. The removed organs were returned to the eunuch to be interred with him when he died so that, upon rebirth, he could become a whole man again. The penis, testicles, and scrotum were euphemistically termed bǎo (寶) in Mandarin Chinese, which literally means 'precious treasure'. These were preserved in alcohol and kept in a pottery jar by the eunuch.

In modern times, Czech Republic practices castrating convicted sex offenders. According to the reports compiled by Council of Europe, a human-rights forum, central European country castrated at least 94 prisoners in the 10 years up to April 2008. Czech Republic defends procedure as voluntary and effective.

Testicular cancer is generally diagnosed by surgical removal of a tumorous testicle (inguinal orchiectomy), followed by radiation or chemotherapy if a cancerous tumor has metastasized. Unless both testicles are cancerous, only one is removed.

Either surgical removal of both testicles or chemical castration may be carried out in the case of prostate cancer, as hormone testosterone-depletion treatment to slow down the cancer. Similarly, testosterone-depletion treatment (either surgical removal of both testicles or chemical castration) is used to greatly reduce sexual drive or interest in those with sexual drives, obsessions, or behaviors, or any combination of those that may be considered deviant. Castration in humans has been proposed, and sometimes used, as a method of birth control in economically or geographically restricted regions, such as the Chatham Islands in the southwest Pacific.

Male-to-female transsexuals often undergo orchiectomy, as do some other transgendered people. Orchiectomy may be performed as a part of more general sex reassignment surgery, either before or during other procedures, but it may also be performed on someone who does not desire, or cannot afford, further surgery.

Involuntary castration also appears in the history of warfare, sometimes used by one side to torture or demoralize their enemies. Even when performed quickly, as by a sword strike, it is excruciatingly painful, because not only the testicles, but also the spermatic cords, are thickly wrapped in nerve fibers and extremely sensitive to impact and injury, but most castrations as punishments were performed as slowly as possible to worsen the intensity of the victim's agony and lengthen its duration. Standard practice in France from the Middle-Ages to the French Revolution was to crush the condemned's testicles in a vise, which burst them as mush from the scrotum, then crunch the spermatic cords with pliers. The condemned was turned upside down in order to maximize the blood flow to his brain after which he was unable to pass out or enter a state of shock until, perhaps, the last few seconds of his ordeal. The condemned was sure to vomit repeatedly with violent convulsions, even well after he had voided the contents of his stomach, but he rarely screamed except for an initial shriek, which immediately silenced, because the pain overwhelmed his ability to breathe. Most men would hang and thrash wildly during and after the crushing of each testicle, and their thrashing would renew upon the crushing of each spermatic cord, This torture method (accompanied by others) was usually reserved for the crime of regicide or attempted regicide. The condemned was mercifully put to death afterwards, but his torture routinely lasted for the better part of a day, witnessed by large crowds. It is interesting to note that, whereas most crowds were instructed to jeer, mock, and ridicule the condemned, and did so even during a disemboweling, and drawing and quartering, most crowds remained silent and stared with shocked expressions as a castration was carried out in this manner. Onlookers, male and female, are recorded to have vomited at the sight of the spectacle. The crushing of the spermatic cords produces a sound, which veterinarians (who routinely perform this castration procedure on anaesthetized, large livestock, such as horses) usually describe as similar to crushing an entire head of frozen celery, wrapped in rubber bands. Castration was also practiced to extinguish opposing male lineages and thus allow the victor to sexually possess the defeated group's women.

Tamerlane was recorded to have castrated Armenian prisoners of war who had fought as allies of the Ottoman Sultan Bayezid I, while others were buried alive.

Edward Gibbon's famous work Decline and Fall of the Roman Empire reports castration of defeated foes at the hands of the Normans. Castration has also been used in modern conflicts, as the Janjaweed militiamen attacking citizens of the Darfur region in Sudan, often castrating villagers and leaving them to bleed to death.

Sima Qian, the famous Chinese historian, was castrated by order of the Han dynasty Emperor Wu for dissent.

Another famous victim of castration was the medieval French philosopher, scholar, teacher, and (later) monk Pierre Abélard, castrated by relatives of his lover, Héloïse.

Bishop Wimund, a 12th century English adventurer and invader of the Scottish coast, was also castrated.

A temporary chemical castration has been studied and developed as a preventive measure and punishment for several repeated sex crimes, such as rape or other sexually related violence. Chemical castration was Alan Turing's punishment when he was convicted of "acts of gross indecency" (homosexual acts) in 1952; it resulted, indirectly, in his suicide.

Physical castration appears to be highly effective as, historically, it results in a 20-year re-offense rate of less than 2.3% vs. 80% in the untreated control group, according to a large 1963 study involving a total of 1036 sex offenders by the German researcher A. Langelüddeke, among others, much lower than what was otherwise expected compared to overall sex offender recidivism rates.

In Europe, when women were not permitted to sing in church or cathedral choirs in the Roman Catholic Church, boys were sometimes castrated to prevent their voices breaking at puberty and to develop a special high voice. The first documents mentioning castrati are Italian church records from the 1550s. In the baroque music era these singers were highly appreciated by Opera composers as well. Famous castrati include Farinelli, Senesino, Carestini, and Caffarelli. Joseph Haydn was almost castrated. The last castrato, and the only one of which recordings are extant, was Alessandro Moreschi (1858-1922) who served in the Sistine Chapel Choir. However, in the late 1800s, the Roman Catholic Church, which had always considered castration to be mutilation of the body and therefore a severe sin, officially condemned the production of castrati; their castrations had been performed clandestinely in contravention of Church law.

While Deuteronomy 23:1 expels castrated men from the assembly of Israel, Isaiah 56:3, while not permitting castration still allows an accepting view of eunuchs. However, this verse is seen as a metaphor by classic scholars. In Acts 8:34-39, a eunuch is baptized.

Some followers of early Christianity considered castration as an acceptable way to counter sinful desires of the flesh.

In the case of chemical castration, ongoing regular injections of anti-androgens are required.

Chemical castration seems to have a greater effect on bone density than physical castration. Since the development of teriparatide, this severe bone loss has been able to be reversed in nearly every case. At this time there is a limitation on the use of this medication to 24 months until the long-term use is better evaluated.

With the advent of chemical castration, physical castration is not generally recommended by the medical community unless medically necessary or desired.

A male subject who is castrated before the onset of puberty will retain a high voice, non-muscular build, and small genitals. Castrated boys may grow to be taller than average men because, without the input of hormones, the long bones continue to grow. This extra height is referred to sometimes as the 'eunuchoid' effect. This can be avoided in trans girls (those who transition from boy to girl) by administering estrogen which caps unwanted growth. The person may not develop pubic hair and will have a small sex drive or none at all.

Castrations after the onset of puberty will typically reduce sex drive considerably or eliminate it altogether. Some castrates report mood changes, such as depression or a more serene outlook on life. Without hormone replacement therapy (HRT), typical symptoms (similar to those experienced by menopausal women) include hot flashes; gradual bone density loss, possibly resulting in osteopenia and/or osteoporosis; and potential weight gain or redistribution of body fat to the hips and/or chest. Replacement of testosterone via gel, patches, or injections, can largely reverse these effects, although breast enlargement has also been reported as a possible side effect of testosterone usage. Body strength and muscle mass can decrease somewhat. Body hair sometimes may decrease. Castration prevents male pattern baldness if it is done before hair is lost; however, castration will not restore hair growth after hair has already been lost.

Also, castrates are automatically sterile, because the testes produce sex cells needed for sexual reproduction. Castration necessarily eliminates the risk of testicular cancer.

Historically, eunuchs who additionally underwent a penectomy reportedly suffered from urinary incontinence associated with the removal of the penis, and they had their own specialist doctors.

The concept of castration anxiety plays an important role in psychoanalysis, though in this field the term sometimes refers to removal of penis rather than of testes.

Castration is commonly performed on domestic animals not intended for breeding. Domestic animals are usually castrated in order to avoid unwanted or uncontrolled reproduction; to reduce or prevent other manifestations of sexual behaviour such as territorial behaviour or aggression (e.g. fighting between uncastrated males of a species); or to reduce other consequences of sexual behaviour that may make animal husbandry more difficult, such as boundary/fence/enclosure destruction when attempting to get to nearby females of the species.

Male horses are usually castrated (gelded) using emasculators, because stallions are rather aggressive and troublesome. The same applies to male mules, although they are sterile. Male cattle are castrated to improve muscling and docility for use as oxen.

Breeding individuals are kept entire and used for breeding: they may fetch higher prices when sold.

Livestock may be castrated when used for food in order to increase growth or weight or both of individual male animals and because of the undesirable taste and odor of the meat from sexually mature males. In domestic pigs the taint is caused by androstenone and skatole concentrations stored in the fat tissues of the animal after sexual maturity. It is released when the fat is heated and has a distinct odor and flavor that is widely considered unpalatable to consumers. Consequently, in commercial meat production, male pigs are either castrated shortly after birth or slaughtered before they reach sexual maturity. Recent research in Brazil has shown that castration of pigs is unnecessary because most pigs do not have the 'boar taint'. This is due to many breeds of pigs simply not having the heredity for the boar taint and the fact that pigs are normally slaughtered at a young market weight.

In the case of pets, castration is usually called neutering, and is encouraged to prevent overpopulation of the community by unwanted animals, and to reduced certain diseases such as prostate disease and testicular cancer in male dogs (oophorectomy in female pets is often called spaying). Testicular cancer is rare in dogs, but prostate problems are somewhat common in unaltered male dogs when they get older. Neutered individuals have a much lower risk of developing prostate problems in comparison, except for prostate cancer, for which there is an increased risk.

An incompletely castrated horse is known as a rig. A stag is a late or incompletely castrated male in sheep and cattle.

Methods of veterinary castration include instant surgical removal, the use of an elastrator tool to secure a band around the testicles that disrupts the blood supply, the use of a Burdizzo tool or emasculators to crush the spermatic cords and disrupt the blood supply, pharmacological injections and implants and immunological techniques to inoculate the animal against its own sexual hormones.

Certain animals, such as horses and swine, are usually surgically treated with a scrotal castration (which can be done with the animal standing while sedated and after local anaesthetic has been applied), while others, like dogs and cats, are anaesthetised and recumbent when surgically castrated with a pre-scrotal incision in the case of dogs, or a pre-scrotal or scrotal incision used for cats. Standing castration often is performed in a standing stock. For horses and other equines, side lying castration is an alternative, in which case a perineal approach may be used.

In veterinary practice an "open" castration refers to a castration in which the inguinal tunic is incised and not sutured. A "closed" castration refers to when the procedure is performed so that the inguinal tunic is sutured together after incision.

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Simon Shakeshaft

Simon Andrew "Shakey" Shakeshaft (born on 25 February 1965) is a leading campaigner for the awareness raising of testicular cancer in the UK.

Shakeshaft was born in South Wales, United Kingdom. Educated in Hereford, he attended The Bishop of Hereford Bluecoat High School and the Herefordshire College of Technology. After returning to education as a mature student and gained a BSc (Hons) allowing to work as a physiotherapist. He eventually worked as the senior physiotherapist for 15 years in the Football League for Hereford United, Exeter City and Shrewsbury Town as well as the English FA.

After being diagnosed for the second time, on 1 May 2002, whilst working for Shrewsbury Town, with testicular cancer, the first time had been 14 years previously, he became a campaigner for awareness raising of the disease, particularly in the male dominated world of professional football in England. What makes his efforts remarkable is that they were started only weeks after testicular surgery, and during extensive chemotherapy through 2002. His efforts continued during 2003, on behalf of the "Keep Your Eye On The Ball" awareness campaign in football and the Everyman Campaign but had to undergo more treatment for testicular cancer that had metastasized to his lungs. His awareness and fundraising work continued tirelessly throughout his illness and subsequent recouperation.

At the end of 2005 he undertook a "Ground Hop Challenge" attempting to visit all the professional football clubs in the top five leagues of the English game, as well as Cardiff's Millennium Stadium, The Dragons Lair, home to Sky One's Dream Team, imaginary Premiership side, Harchester United and finishing at the new home of Arsenal F.C., the Emirates Stadium. The project actually took him, 13 months to complete, travelling 25,800 miles and visited a total of 120 grounds. The main purpose of the Ground Hop was giving male cancer awareness talks to over 1,000 playing and coaching staff at various clubs and getting this awareness message to over 125,000 supporters through clubs media channels, such as match day programmes and websites. His achievements were recognised by the PFA/FA when he was presented the individual supporters award of the Keep Your Eye On The Ball Campaign, by former Liverpool and England goalkeeper and current National Goalkeeping Coach Ray Clemence. He later appeared on ITV's GMTV to talk about the Ground Hop experience and support national volunteers.

During 2006 he joined forces with other testicular cancer survivors, including Philly Morris and the established checkemlads.com awareness website, to continue and expand the awareness drive to other sports, the media/television and the music industry. Having suffered further setbacks in his health battles in March 2005 and more recently and significantly, July 2007, with the diagnosis of another cancer, chronic lymphocytic leukemia, he continues to this day giving awareness talks all over the country, especially targeting football clubs, county associations and other football organisations. During the summer of 2008 he along with Philly Morris and their friend and another testicular cancer survivor Mike Riley MBE were rewarded with their awareness raising efforts when checkemlads became a registered charity, giving so much more recognition and credibility to the crusade of these three men.

In 2006 he added "television actor" to his C.V., but unable to get away from the world of football, even if imaginary, when he appeared in the cult Sky One drama Dream Team's 10th series as the team physiotherapist, unsurprisingly playing himself, or better known by his nickname Shakey. Again he played a physiotherapist in the Kamal directed Bollywood 2007 football movie Dhan Dhana Goal as well as appearing as an extra in a number of other productions, including the BBC drama Silent Witness. When working in behind the camera rather than in front of it he is credit with providing physiotherapy cover for cast members and models, with credits including Nike football adverts and the box office blockbuster Mamma Mia! The Movie but missed out on the part in the Gorilla (Cadbury) advert to seasoned primate actor Garon Michael.

He is the Managing Director of e-commerce business Heroes & Legends and now recognised in the field of sports memorabilia as a leading researcher and authenticator of genuine match worn players football shirts. In 2008 along with former Dream Team cast members Darren "Tyson" White and Alex Sexy Lawler, he helped form Forward Dash Limited, a company that intends to raise money for local charitable causes, playing charity football matches around the UK with a team of other former Harchester United cast members.

Married to Tracey, they have one daughter Georgia and live in Hertfordshire, England.

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Philly Morris

Philly Morris

Philly Morris (born 13 July 1972, Heswall, Merseyside) is a leading campaigner for testicular cancer awareness for young men in the UK.

Philly left Pensby High School in 1988 to undertake a YTS placement at Hull City . chose to become a studio hand in the "attic" recording studio in Liverpool. After two years of training and undertaking roles as a musician, roadie and studio hand with such bands as The La's and The Real People, he decided to follow a boyhood dream and join the armed forces. Phil joined the RCT regiment in 1990, based in Bunde in Northern Germany.

Phil saw campaign service in Northern Ireland, after a stint in Bosnia. He went on to become the first Army boxer to wear the newly formed RLC colours in 1993 and to play football for the corps ; he was also in the British RLC downhill skiing championships in 1994.

After the death of a close army friend just days after he had signed up to stay in the army for another 5 years, he decided he would leave the army as soon as he could in 1996.

Phil soon went back to his childhood love of drums, joining Duncan Ross to form DeltaRest and also playing drums for The Other. He also roadied for Clipper Cartel.

After having two types of testicular cancer he set up the UK's most famous testicular cancer website checkemlads.com with the help of well known musicians Steve White and Paul Weller in April 2003. During this time Philly also helped to raise awareness of testosterone replacement, with long-time campaigner and cancer survivor Nick O'Hara Smith, in men who had lost a testicle or testicles to injury or cancer, a subject which had been widely ignored until Nick exerted pressure on health authorities. Philly works alongside his close friend Mick Riley MBE, who also survived cancer of the testicles in 1998, and another testicular cancer survivor and awareness campaigner in the world of professional football/TV and the media, Simon Shakeshaft. Morris and Riley hail from the same area in Merseyside, shared a room in the army and were in the same boxing team in Germany, and both had the same cancer within 5 years of each other; the chances of this are around 560,000:1, which still baffles leading cancer experts today. As of the middle of 2008, checkemlads.com became a registered charity with all three becoming Directors and Trustees, a tribute to the hard work and efforts of Morris and his crusade to raise awareness of this young man's cancer, five and half years ago.

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Retroperitoneal Lymph Node Dissection

Retroperitoneal Lymph Node Dissection, commonly referred to as RPLND, is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the navel. While laparoscopic methods may be used, they have been considered less effective by some surgeons.

Testicular cancer spreads in a well-known pattern, and the lymph nodes in the retroperitoneum are a primary landing site during spread of the disease. Examining the removed lymphatic tissue will determine the extent of spread of any malignant disease and if no malignant tissue is found, the cancer may be more accurately considered as a stage I cancer, limited to the testis.

The procedure is becoming standard treatment for clinical stage I and II non-seminomatous germ cell tumors (NSGCTT) because of the low mortality and relapse rate with this procedure, as compared with the alternative, which is observation. Also, NSGCTT is considered more aggressive than seminomas, the "other" kind of testicular cancer. Seminomas are also much more sensitive to radiation than NSGCTT's, so the noninvasive radiation treatment is often preferred over RPLND.

The potential problems in RPLND have mostly to do with nerves: sympathetic nerves running parallel to the spinal cord may be damaged or severed during the procedure, which can result in infertility, an inability to ejaculate, or the inability to have an erection. This is why most often, a nerve-sparing technique is used where possible. A less invasive form using laparoscopic techniques (L-RPLND) exists, which is more costly, time-consuming, and requires special equipment that not every hospital may have. Open RPLND (O-RPLND), which is performed by opening the abdomen to get inside, has more room for problems, but is an equally effective way to remove the lymph nodes. Disadvantages of an open RPLND include longer recovery time, sometimes with physiotherapy required to help the patient regain the ability to walk after being bed-bound. As with any major surgery, infection is a possibility, and bowel obstructions and adhesions are another possible side effect.

There are different schools of thought about the need to perform RPLND after orchiectomy, and it depends on the type of tumour, and what stage it is in. Most American Doctors recommend surgery, whereas in Europe, chemotherapy is more often used. An RPLND may be performed to remove non-malignant tumour remnants which persist after chemotherapy; without further treatment these may once more become malignant, and may be resistant to the combination of chemotherapy previously used.

Chemotherapy before RPLND is considered an effective approach, because it is possible that it suffices and no relapse occurs. However, in the event that the cancer does recur, chemotherapy can complicate surgery.

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Source : Wikipedia