Testicular mesothelioma is a cancer of the membrane lining that covers the testicles. This rare disease, also known as mesothelioma of the tunica vaginalis testis, accounts for less than 1 percent of all mesothelioma cases.
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This diagnosis puzzles researchers because most people with mesothelioma can trace their disease to the inhalation or ingestion of asbestos dust or fibers.
Most testicular mesothelioma patients have no history of asbestos exposure. There is limited research on testicular mesothelioma because of the rarity of this diagnosis.
Despite the limited number of known cases, men with this type of cancer have a significantly better prognosis than most people with other forms of mesothelioma. Most studies report median survivals of about 20 to 23 months, and one patient lived 15 years after diagnosis.
There is no set of symptoms unique to testicular mesothelioma. Many people with this cancer initially receive the wrong diagnosis because doctors may mistake it for a more common condition such as a hernia.
The most common symptom is a hydrocele, a buildup of fluid in the scrotum. Men may also notice an abnormal lump inside the scrotum or pain and swelling of the testicles. Typically, testicular mesothelioma is only properly diagnosed during surgery.
The diagnostic process usually starts when someone visits the doctor to discuss a problem with his testicles. The doctor will ask about the patient’s medical history and perform a physical examination.
Next, the doctor will order an ultrasound, a type of imaging scan that is 90 percent accurate for detecting testicular tumors. If a potential tumor is spotted, a CT scan will be performed to determine the stage of the tumor and whether the cancer has spread.
To confirm the tumor is testicular mesothelioma, doctors can collect a blood sample and perform a blood test. They look for mesothelioma tumor markers, or substances released by mesothelioma tumors that help confirm a diagnosis. Tumor markers for testicular mesothelioma include calretinin, cytokeratin 5/6 and Wilms’ tumor gene 1, also known as WT1.
A much more accurate way of confirming a mesothelioma diagnosis is performing a biopsy. This involves removing a tissue sample from the tumor and sending it to the lab for testing. Evaluating the sample with a technique called immunohistochemical staining helps doctors determine if the patient has testicular mesothelioma or another condition.
Testicular mesothelioma treatment typically involves removing a portion of one testicle, or an entire testicle if necessary, depending on the extent of the cancer.
One 2015 study explains the most effective surgery for localized testicular mesotheliomas that have not spread is a radical inguinal orchiectomy. This procedure removes the affected testicle and the entire spermatic chord. If the cancer has spread to nearby lymph nodes, doctors will remove them as well with a surgery called lymphadenectomy.
Surgery may be followed by chemotherapy with cisplatin and pemetrexed. Radiation therapy may be offered next to kill any remaining cancer cells and prevent the cancer from returning. If the cancer is diagnosed at an early stage, chemotherapy and radiation therapy may not be needed after surgery.
In some cases, testicular mesothelioma is a secondary tumor, with the primary tumor located within the peritoneum, the membrane that lines the abdominal cavity. For situations like this, doctors will have to treat the patient for peritoneal mesothelioma as well.
Doctors treat peritoneal mesothelioma with similar techniques to those described above — a combination of surgery and chemotherapy. Radiation therapy is often avoided because of the damage it can cause to vital organs near the tumor. A special technique called HIPEC may also be used. This involves delivering high doses of heated chemotherapy immediately after surgery.
It should be noted that peritoneal and testicular mesothelioma are classified as being clinically aggressive types of cancer. This means they can spread rapidly. In addition, the testicular type tends to recur within a few years, even in cases where tumors are surgically removed.
Because this type of cancer is extremely rare, little is known about how it develops. Most researchers theorize there are two possible points of origin for testicular mesothelioma. The tunica vaginalis, the membrane where the cancer develops, is composed of mesothelial cells, which are present in most of the body's membranous linings. The tunica vaginalis is made up of two layers, known as the parietal (outer) and visceral (inner) layers.
Firm white-yellow nodules can be found on the serosal surface of the tunica vaginalis. The nodules can eventually encase the contents of the scrotum and cause the tunica vaginalis to thicken.
While there is currently no theory to explain how asbestos exposure might cause a primary tumor to develop in the testicles, it is understood that once the asbestos fibers enter the body, they can become lodged in organs and cause inflammation or infection. Eventually, this can result in the development of mesothelioma. The fibers cause cancerous cells to divide abnormally, causing buildup of fluid and the formation of tumors.
Once cells have become cancerous, they are no longer able to regulate their own cycles of growth and division. A primary tumor that develops in the testicle is formed from cancerous cells that divide without restraint, which causes the thickening of the tunica vaginalis and can eventually lead to the formation of tumors.
As with other asbestos-related injuries, legal compensation may be available for men who develop testicular mesothelioma.
In September 2013, a South Carolina jury awarded $38 million to a former millwright who developed testicular mesothelioma. Given the extreme rarity of the cancer, the case may be one of relatively few lawsuits involving the disease, compared with widespread lawsuits for other asbestos-related illnesses.
The plaintiff, Lloyd Strom Garvin, alleged he was exposed to asbestos-laced gaskets and valve packing stemming from the negligence of 13 defendants. He and his wife filed their lawsuit in the South Carolina Court of Common Pleas for Richland County. The jury took only four hours to deliver its verdict following a 12-day trial.
The case is significant, not only for the plaintiff's substantial award, but also because the plaintiff successfully proved his illness was caused by asbestos exposure. Although mesothelioma is caused almost exclusively by asbestos exposure, a small number of cases have been reported with no known exposure to asbestos. Therefore, it's a good idea for all mesothelioma claimants, including those who are diagnosed with testicular mesothelioma, to get a mesothelioma attorney's help when tracing their exposure history.
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