Abstract
Testicular cancer is a type of cancer that directly involves the main male reproductive organ, the testes. The testes are basically a loose sack of skin and flesh located below the penis. Testicular cancer is a rare form of cancer only accounting for between 1% and 3% of the total number of cancer cases in the male population in western countries. It is also one of the most curable forms of cancer. Nonetheless, it is still a condition worth reviewing. The research question in this paper asks whether survivors of testicular cancer indeed suffer from a testicular cancer-related comorbidity such as a second malignancy or a cardiovascular disease following the successful completion of their treatments. Numerous studies have been published about this apparent complication. In this paper, 100 randomly selected male patients who have a history of testicular cancer and the successful completion of all treatment regimens for it were examined. The results of the study suggested that second malignancies followed by cardiovascular diseases appear to be a common comorbidity that appears after former testicular patients’ successful completion of their treatment regimens such as radiation and chemo therapy.
Aims
There are many types of cancer. Cancer is a life-threatening disease affecting a significant part of the population not only in the United States but also other developing and third world countries. Testicular cancer is one of the most common types of cancers. Unlike other types of cancer that may affect both males and females, testicular cancer only affects the male as it targets the male reproductive system, particularly the testicles or what is more scientifically known as the testes. The primary goal of this paper is to collect and analyze data regarding the cure rate of testicular cancer and the long term effects of testicular cancer treatments. Using primary research, the researchers will recruit a population of test subjects who have been diagnosed or had a history of testicular cancer. The primary information that the researchers will collect would be whether they were able to cure their cancer; and if yes, what the long term complications of the treatment procedures and processes that they underwent were. There is an abundance of previously-published studies and other literatures published regarding testicular cancer. However, not a lot of them talks about the long term implications of the treatments being used to cure the cancer and its secondary complications. This is why the author of this paper decided to focus on this particular topic concerning testicular cancer. For the record, there are numerous treatments for testicular cancer, one of the most common of which would be chemotherapy and radiation therapy. What is not yet clear is whether these commonly-implemented treatment regimens have a direct correlation with the appearance of other medical conditions following total eradication (to undetectable levels) of testicular cancer cells in the affected areas.
Introduction
In order to understand testicular cancer, one has to be able to understand the anatomy and physiology of the main organ involved: the testes. The testis is the primary organ of the male reproductive system. It is where the sperm cells or the male gametes are manufactured. Anatomically, it is a loose bag of skin and flesh located inferior to the penis. Most non-anatomically-inclined individuals would mistakenly identify the penis as the main organ of the male reproductive system. While it indeed performs an important function in the process or act of reproduction, the main organ would still be the testis. Apart from producing sperm cells, the testes are also responsible for producing male sex hormones such as testosterone, gonadotropic-releasing hormone (GNRH). The latter triggers the release of the luteinizing hormone (LH) and the Follicle Stimulating Hormone (FSH) by the pituitary gland in males. In terms of the rate of occurrence, testicular cancer is rare, especially when compared to the most common types such as colon, liver, and lung cancers. This is why not a lot of studies have been published about it. However, it still affects a significant part of the male population. According to a study published in the England Journal of Medicine, testicular cancer affects men aged 13 years old and above or those who belong to the young adolescent age group. In the said study, the significant changes associated with puberty may be one of the main factors affecting the rise in prevalence rates of the said disease . In the said study, some 16,983 men who were aged at least 13 and had a history of being surgically treated for undescended testis were examined. Their goal was to identify the rate of testicular cancer following surgery for undescended testis. There were a total of 56 cases of testicular cancer identified during follow-up. This translated to a relative risk of 2.23% with a confidence interval of 95%. This meant that there is a significant correlation between young adolescence, history of undescended testis, and the risk of developing testicular cancer. There are other studies that also came up with the same results and findings .
Background Information
In another study published in the Journal of Clinical Oncology, the researchers examined the treatment-specific risks of second malignancies and cardiovascular disease in 5 year survivors of testicular cancer. The researchers in that study argued that survivors of testicular cancer who underwent testicular cancer-specific treatment procedures tend to be exposed to higher risks of developing second malignancies (e.g. cancer in other body organ systems) and cardiovascular disease . They tested that claim by conducting a nationwide cohort (i.e. a long term study) comprising a total of 2,707 5-year testicular cancer survivors; the subjects were examined based on their likelihood of developing second malignancies and cardiovascular diseases using standardized incidence ratios and absolute excess risks. The results of their study showed that after a follow up tie of 17.6 years, 270 testicular cancer survivors developed second malignancies or cardiovascular diseases. Second malignancies and cardiovascular diseases, in that case, were identified as late treatment complications of testicular cancer. The authors of the said study concluded that radiotherapy and chemotherapy-based treatments for testicular cancer indeed caused an increase in the risk of developing second malignancies and cardiovascular diseases.
Another important question to ask is how curable testicular cancer is. According to a study published in the International Journal of Cancer, testicular cancer is relatively rare because it only accounts for a small percentage, between 1% and 3%, of all cancers affecting the male population in western countries . The objective of the said study, however, was to detect a trend in the incidence rate of testicular cancer in Europe. Their results showed that 12 European countries were able to observe a rising trend in testicular cancer detection and mortality at between 1% and 6% annually. Some 22 countries, on the contrary, showed steadily decreasing testicular cancer detection and mortality rates. A decline in mortality rates basically mean that the curability of the disease is increasing. This is non-coincidentally the same conclusion that the researchers in that study came up with. According to them, “advances in treatment have led to major declines in mortality in many European countries from the mid-1970s which has translated to cohorts of men at successively lower risk of death from the disease” .
Hypothesis and Variables
The hypothesis used in this study is based on the results and outcomes of some of the literatures reviewed about testicular cancer. This paper’s research goal is to verify whether survivors of testicular cancer indeed suffer from a testicular cancer-related comorbidity such as a second malignancy or a cardiovascular disease following the successful completion of their treatments. The author of this paper hypothesizes that testicular cancer treatments such as radiation therapy and chemotherapy increases the risk of comorbidities after their successful completion. Successful completion means that all of the prescribed treatment sessions have been performed and the patient has already been cleared of the cancer by the attending medical team. Just like any other research paper, this one has an independent and dependent variable. The independent variable would be the occurrence of testicular cancer and the use of testicular cancer treatment regimens such as radiation therapy and chemotherapy. The dependent variable, on the other hand, would be the occurrence of comorbidities such as but may not be limited to second malignancies or the occurrence of cancer in other body organ systems, and cardiovascular diseases. Other physical and medical conditions that may be physiologically and anatomically related to testicular cancer may also be identified and then considered as a confirmed case of comorbidity. What the author of this paper expects to find is a direct correlation between the dependent and independent variables, similar to what Belt-Dusebout, Wit and Gletema found in their study about the prevalent risks of testicular cancer treatments. If that would indeed be the main finding, then that would serve as a validation of the research hypothesis.
Methods and Data Gathering Procedures
In order to confirm the hypothesis and answer the research question, 100 randomly selected former male patients of testicular cancer who successfully completed their cancer treatment regimens were recruited and examined. The goal was to check for the correlation between testicular cancer treatments (e.g. chemotherapy and radiation therapy) and the occurrence of comorbidities such as second malignancies and cardiovascular diseases.
The inclusion criteria used in this study was not age-related. The patients were also randomly-selected; however, they still had to be able to satisfy all the elements in the inclusion criteria, the most important of which would be their previous history of testicular cancer and their successful completion of the treatment regimen for the said condition. This also means that they must already be clear of the condition at the time of the research’s implementation.
Prior to the start of the implementation phase, the respondents were asked to sign an informed consent form. The form’s purpose was to serve as a documentation of their voluntary participation in the said study. The said document also contains the gross description of the steps and procedures that they would have to undergo; it also includes their expected roles.
They will be asked to answer a questionnaire. The aim of which would be to determine whether they have been officially diagnosed with any other serious medical condition following the successful completion of their testicular cancer regimen. They were presented with four choices in the questionnaire that was distributed. They could either pick 1) second malignancies (i.e. cancer in any other body organ system aside from the reproductive system), 2) cardiovascular diseases, 3) others, please specify, and 4) none so far. The author of this paper expected to find the highest prevalence rate for second malignancies and cardiovascular diseases, although the possibility that other comorbidity would also appear may not be ruled out.
Data Analysis (including Graphs)
The table below summarizes the results and findings of the research that was conducted. The question used in the questionnaire was “Below is a list of comorbidities often associated with testicular cancer treatment. Among the choices that are listed below, choose the one that best applies to your medical condition following the successful completion of your testicular cancer treatment regimen”.
The results showed that 46% of the respondent population said that they reported second malignancies following the successful completion of their testicular cancer treatment regimen. This, as can be observed, was the most prevalent choice of comorbidity among the respondents. This meant that testicular cancer patients who were able to be cleared of the disease would still have to be routinely checked for the possibility of developing secondary malignancies. The respondents were not asked to specify what type of malignancy they were diagnosed with after their testicular cancer treatment completion. However, what is clear is that those who ticked this answer were not suffering from a reoccurrence of testicular cancer because it was clearly stated that their second malignancy should not be, in any way, related to their reproductive system. The second most prevalent comorbidity was cardiovascular disease. The table above shows that some 19% of the 100 people examined in the study was diagnosed with cardiovascular disease sometime after their successful completion of their respective testicular cancer treatment regimen. The next would be the others. It represented only 12% of the total sample population. One observable finding, however, was that those who chose this as the answer were only reporting of conditions that are only minor and or not totally related to testicular cancer. And lastly, some 23% of the sample population said that they did not suffer from any comorbidity following the successful completion of their testicular cancer treatment regimen.
Below is a graph that simplifies the results and findings obtained from the study.
The graph shows basically the same thing about the hypothesis and the answer to the research question. What the said results and findings suggest is that patients whose testicular cancer cases have been successfully treated are at an increased risk of developing medical conditions like second malignancies or other cancers, and cardiovascular diseases. It is worth noting, however, that there is a significant part of the population who did not report any comorbidity following their successful completion of testicular cancer treatment regimens.
Conclusions and Evaluations
Based solely on the results and findings of this study, second malignancies followed by cardiovascular diseases appear to be a common comorbidity that appears after former testicular patients’ successful completion of their treatment regimens such as radiation and chemo therapy. This confirms the validity of the research hypothesis that was posted earlier—the one that suggests that survivors of testicular cancer indeed suffer from a testicular cancer-related comorbidity such as a second malignancy or a cardiovascular disease following the successful completion of their treatments. It is worth noting that this hypothesis is supported by the literatures and now, by the primary research findings of this paper.
In terms of the evaluation of the research, however, it is worth noting that the number of respondents in this paper was fairly limited compared to the size of respondent population being used in other clinical studies. This means that the external validity of the research may be considerably lower compared to other studies. Additionally, it did not factor in other factors that may have affected the prevalence rate of the comorbidities that were reviewed. For example, the researchers did not determine whether the real cause of the high prevalence rate of the cardiovascular diseases were the testicular cancer history itself or the patient’s lack of exercise or poor diet, among other factors that could lead to the similar outcome. Based on whether the research question or the hypothesis was answered and confirmed, however, the answer would be a yes.
Works Cited
Altena, R., et al. "Longitudinal changes in cardiac function after cisplatin-based chemotherapy for testicular cancer." Annals of Oncology (2011): 408. Print.
Belt-Dusebout, A., et al. "Treatment-Specific Risks of Second Malignancies and Cardiovascular Disease in 5-Year Survivors of Testicular Cancer." American Society of Clinical Oncology (2007): 4370-4378. Print.
Bray, F., et al. "Trends in testicular cancer incidence and mortality in 22 European countries: Continuing increases in incidence and declines in mortality." International Journal of Cancer (2006): 3099-3111. Print.
Haugnes, H., et al. "Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study." Journal of Clinical Oncology (2010): 01. Print.
Pettersson, A., et al. "Age at Surgery for Undescended Testis and Risk of Testicular Cancer." New England Journal of Medicine (2007): 1835-1841. Print.
