Table of Contents
- Testicular mesothelioma is the rarest of the already rare cancers.
- It can be caused by exposure to asbestos and many other risk factors.
- The best treatments are unknown, although surgery is often an option.
- On average, testicular mesothelioma patients live for 20 to 23 months.
Testicular mesothelioma develops in the membrane that covers the testicle, tunica vaginalis. This is the rarest form of mesothelioma, with only about 100 reported cases. Because of its rarity, researchers do not fully understand how testicular mesothelioma develops and can progress in vivo or with the best treatments. Despite the lack of clinical evidence surrounding this disease, patients generally have a better prognosis than those diagnosed with pleural mesothelioma.
- CAUSE // Asbestos, hydrocele, or trauma
- LOCATION // Tunica vaginalis (mucosa of testicles)
- GENERAL SYMPTOMS // Testicular pain
- Swelling in the scrotum
- Tumor or mass of the testicle
- RELATIONSHIP // Surgery,
- PROSECUTION // 20-23 months
Causes Of Testicular Mesothelioma
Three main types of commonly associated with asbestos exposure, but the association is unclear with testicular mesothelioma. Various studies have found that patients diagnosed with this rare form of asbestos cancer have no history of exposure. Some researchers suggest that as few as 41 % of testicular mesothelioma cases can be attributed to this toxin. As for cases that may be related to asbestos, there is no clear evidence of how the asbestos fibers reach the testicles.
In some cases, testicular mesothelioma may be a site of metastasis from primaryperitoneal, which develops in the abdomen lining. There have been no documented cases of secondary tumors developing in tunica vaginalis due to malignant pleural mesothelioma, but the investigators did not rule out the possibility.
Given the limited number of cases, the researchers could identify several other risk factors and potential causes of testicular mesothelioma.
Testicular Mesothelioma Risk Factors
- Past trauma in the groin area
- Long-term hydrocele (swelling due to fluid buildup in the scrotum)
- Hernias (mostly inguinal)
- Past hernia surgery (herniorrhaphy or hernia)
- Age (can develop at any age but is most common in people 55 – 70 years old)
Testicular Mesothelioma Symptoms
As with other forms of the disease, malignant mesothelioma of tunica vaginalis has no specific symptoms that can help with early detection. In most cases, the diagnosis was made by chance during a standard physical exam or another surgical procedure.
Common Testicular Mesothelioma Symptoms
- Pain in the testicles or groin
- A lump or mass on the testicle
- Spermatocele (cyst in the epididymis)
- Swelling due to excess fluid in the scrotum (hydrocele)
- Epididymitis (inflammation of the epididymis)
In the few available studies, researchers have noted that many patients have no symptoms or symptoms that are typically not noticeable enough to seek early medical help. Studies have found that about 56% have hydroceles in patients with presenting symptoms, and another 33% have tumors or masses on the testicles.
As with any mesothelioma, early diagnosis is important to allow for more treatment options. Patients experiencing any of these symptoms should speak to their doctor immediately, especially if they have a history of asbestos exposure.
Diagnosis Of Testicular Mesothelioma
All forms of mesothelioma are difficult to diagnose and are often confused with other conditions, whether common illnesses such as the flu or other cancers. This rare cancer can easily be confused with other testicular cancers, such as testicular or inguinal hernia, for patients with testicular mesothelioma. In many cases, the initial testing that leads to the correct diagnosis happens by chance after an abnormality is discovered during a routine physical exam or another surgical procedure.
X-rays, or medical imaging, are often the first step in the diagnosis. In these cases, doctors may perform a testicular mesothelioma ultrasound to look at abnormalities in the testicles or scrotum. Ultrasound can tell if a patient has any lumps or masses with 90% accuracy, as can a hydrocele. Radiologists may also observe a thickening of the tunica vaginalis, which may help conduct further diagnostic tests. Studies have found that in most cases, patients present with cancer in only one testicle, with only a small number of cases presenting bilaterally.
For all forms of cancer, a biopsy is the only way to make a definitive diagnosis. If your doctor suspects testicular mesothelioma or another form of cancer, a biopsy will be the final step in the diagnosis. With a biopsy, doctors can look at the cell type and determine the stage and prognosis. A procedure called immunohistochemistry, a staining technique that looks at antibodies and biomarkers in tissue or fluid samples, can also be used to look for possible similar antigens and proteins. They are seen in blood tests and help make an accurate diagnosis.
Once testicular mesothelioma is confirmed, doctors will likely perform more tests, like a CT scan, to ensure no metastases to other sites. These tests can also determine if tumors in the tunica vaginalis are secondary.
Longevity Of Testicular Mesothelioma
Patients generally face a rather poor prognosis at only 12 to 21 months, and testicular mesothelioma does not improve much. Researchers have found that the average life expectancy is about 20 to 23 months, although some patients have lived many years beyond their prognosis.
Some reports have found a mortality rate of around 53% after two years, but the data are still quite limited, with very few cases. Several factors can affect an individual’s prognosis, such as the stage of the disease, cell type, and age at diagnosis. There have been a few reported cases of benign testicular, but most patients were diagnosed with malignant testicular mesothelioma withepithelial cell type. Fortunately, epithelial mesothelioma is the most common type and responds better to treatment than other common cell types.
Relapse is also a major factor in the patient’s prognosis. Testicular mesothelioma has a relatively high recurrence rate, with some case reports estimating at least 52.5%. More than 60% of relapses occurred within two years of diagnosis and subsequent treatment, with 92.9% of patients relapses occurring within five years of diagnosis. In relapsed cases, the median survival was about 14 months, as most patients experienced distant metastases.
Treatment Of Testicular Mesothelioma
Because there are so few cases, doctors are uncertain about the optimal treatment plan for testicular mesothelioma. Patients typically undergo multimodality therapy, usually surgery, followed by chemotherapy. Occasionally, This may recommend radiation therapy for recurrent cases.
In many reported cases, testicular mesothelioma was localized to one testicle, making resectioning the tumor much easier. Researchers agree surgery is the best first-line treatment for testicular mesothelioma, as long as there is no or limited metastasis. In most reported cases, doctors resort to radical inguinal orchiectomy, a surgical procedure that removes one or both testicles and spermatic cords.
We found a 10.5% recurrence rate with orchiectomy.
THE PATIENT HAS A RECENT RATE RATE OF 35.7% IF THE HYDROCELE IS ONLY REMOVED.
There may also be less radical surgical options for selected patients, such as orchiectomy in the scrotum, removal of only the affected testicle or sometimes both testicles, or septal resection. Testicular. However, recurrence rates between procedures vary widely, with more radical orchiectomy having about a 25% lower recurrence rate than less invasive surgery.
Metastasis may also be affected if surgery remains an option for the patient. Although many cases have seen localized disease, there have also been many reports of distant metastases, particularly with recurrent testicular mesothelioma—astudyfrom the American Cancer Society detailed common sites of metastasis.
Testicular Mesothelioma Metastasis Sites
- Lymph nodes:13.8% of patients
- Lungs:9.7% of patients
- Liver:4.2% of patients
- Pleurisy (pleura):2.7% of patients
- Omentum (part of the peritoneum):2.7% of patients
Chemotherapy can also be used in multimodality therapy with surgery, or this can use alone for patients who are ineligible for surgery because of metastases. In most cases, doctors used the standard chemotherapy combination for mesothelioma of Alimta and cisplatin because research is very limited. Radiation has been used in some cases, but its effectiveness in reducing tumor size and alleviating symptoms varies widely between patients.
In very few cases, there are no clinical trials for patients with testicular mesothelioma. Emerging treatments, such as immunotherapy, are effective in other forms but are currently only available in clinical trials. Hopefully, with further research, doctors will be able better to understand the best treatments for this rare cancer.