Testicular cancer is
cancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
that develops in the
testicleThe testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
s, a part of the
maleMale refers to the biological sex of an organism, or part of an organism, which produces small mobile gametes, called spermatozoa. Each spermatozoon can fuse with a larger female gamete or ovum, in the process of fertilization...
reproductive system.
In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. In the UK, approximately 2,000 men are diagnosed each year. Over his lifetime, a man's risk of testicular cancer is roughly 1 in 250 (0.4%). It is the most common cancer in males aged 20–39 years, the period of peak incidence, and is rarely seen before the age of 15 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of 90 percent; essentially 100 percent if it has not spread (
metastasizedMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
). Even for the relatively few cases in which malignant cancer has spread widely, modern
chemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
offers a cure rate of at least 80%. Not all lumps on the testicles are tumors, and not all tumors are malignant; there are many other conditions such as
testicular microlithiasisTesticular microlithiasis is an unusual condition diagnosed on testicular ultrasound. It is found in between 1.5 to 5% of normal males, and may be found in up to 20% of individuals with subfertility. It is an asymptomatic, non-progressive disease...
, epididymal cysts,
appendix testisThe appendix testis is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.-Clinical significance:...
(hydatid of Morgagni), and so on which may be painful but are non-cancerous.
Classification
Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are
germ cell tumorA germ cell tumor is a neoplasm derived from germ cells. Germ cell tumors can be cancerous or non-cancerous tumors. Germ cells normally occur inside the gonads...
s. Most of the remaining 5% are sex cord-gonadal stromal tumours derived from
Leydig cellLeydig cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle. They produce testosterone in the presence of luteinizing hormone...
s or
Sertoli cellA Sertoli cell is a 'nurse' cell of the testes that is part of a seminiferous tubule.It is activated by follicle-stimulating hormone and has FSH-receptor on its membranes.-Functions:...
s. Correct diagnosis is necessary to ensure the most effective and appropriate treatment. To some extent, this can be done via blood tests for
tumor markerA tumor marker is a substance found in the blood, urine, or body tissues that can be elevated in cancer, among other tissue types. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer...
s, but definitive diagnosis requires examination of the
histologyHistology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
of a specimen by a pathologist.
Most pathologists use the
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
Classification system for testicular tumours:
- Germ cell tumours
- Precursor lesions
-
-
- Intratubular germ cell neoplasia
Intratubular germ cell neoplasia, abbreviated ITGCN or IGCN and also known as testicular intratubular germ cell neoplasia and intratubular germ cell neoplasia of the testis, is considered a precursor lesion for many types of testicular germ cell tumors.The common, unspecified variant of the entity...
-
- Unclassified type (carcinoma in situ
Carcinoma in situ is an early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue, usually before penetration through the basement membrane. In other words, the neoplastic cells proliferate in their normal habitat, hence the name "in situ"...
)
- Specifed types
- Tumours of one histologic type (pure forms)
-
- Variant - Seminoma with syncytiotrophoblast
Syncytiotrophoblast is the epithelial covering of the placenta villous tree. It is a unique tissue in that it is a multi-nucleated, terminally differentiated syncytium, extending to 13m^2...
ic cells
- Spermatocytic seminoma
Spermatocytic seminoma is a neoplasm of the testis , and classified as a germ cell tumour.The name of the tumour comes from the similarity between the small cells of the tumour and secondary spermatocytes.-Relation to seminoma:Spermatocytic seminoma is not considered a subtype of seminoma and,...
-
- Variant - spermatocytic seminoma with sarcoma
A sarcoma is a cancer that arises from transformed cells in one of a number of tissues that develop from embryonic mesoderm. Thus, sarcomas include tumors of bone, cartilage, fat, muscle, vascular, and hematopoietic tissues...
- Embryonal carcinoma
Embryonal carcinoma is a relatively uncommon type of germ cell tumour that occurs in the ovaries and testes.-Ovarian embryonal carcinoma:In the ovary, embryonal carcinoma is quite rare, amounting to approximately three percent of ovarian germ cell tumours. The median age at diagnosis is 15 years...
- Yolk sac tumour
- Trophoblast
Trophoblasts are cells forming the outer layer of a blastocyst, which provide nutrients to the embryo and develop into a large part of the placenta. They are formed during the first stage of pregnancy and are the first cells to differentiate from the fertilized egg...
ic tumours
-
- Choriocarcinoma
Choriocarcinoma is a malignant, trophoblastic and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs...
-
- Variant - monophasic choriocarcinoma
- Placental site trophoblastic tumour
- Cystic trophoblastic tumour
- Teratoma
A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
-
- Variant - Dermoid cyst
A dermoid cyst is a cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, a dermoid...
- Variant - Epidermoid cyst
An epidermoid cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.-Terminology:...
- Variant - Monodermal teratoma (Carcinoid
Carcinoid is a slow-growing type of neuroendocrine tumor, originating in the cells of the neuroendocrine system.In 2000, the World Health Organization redefined "carcinoid", but this new definition has not been accepted by all practitioners. This has led to some complexity in distinguishing...
, Primitive neuroectodermal tumour (PNET), Nephroblastoma-like tumor, others.
- Variant - Teratomic with somatic
The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
-type malignancy
- Tumours of more than one histologic type (mixed forms)
- Embryonal carcinoma and teratoma
- Teratoma and seminoma
- Choriocarcinoma and teratoma.embryonal carcinoma
- Others
- Sex cord/Gonadal stromal tumours
- Leydig cell tumour
Leydig cell tumour, also Leydig cell tumor , interstitial cell tumour and interstitial cell tumor , is a member of the sex cord-stromal tumour group of ovarian and testicular cancers...
- Sertoli cell tumour
A Sertoli cell tumour, also Sertoli cell tumor , is a Sex cord-gonadal stromal tumor of a specific type that produces Sertoli cells...
- Lipid rich variant
- Scleriosing variant
- Large cell calcifying variant
- Intratubular sertoli cell neoplasia in Peutz-Jeghers syndrome
Peutz–Jeghers syndrome, also known as hereditary intestinal polyposis syndrome, is an autosomal dominant genetic disease characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa...
- Granulosa cell tumour
Granulosa cell tumours are tumours that arise from granulosa cells. These tumours are part of the sex cord-gonadal stromal tumouror non-epithelial group of tumours. Although granulosa cells normally occur only in the ovary, granulosa cell tumours occur in both ovaries and testicles...
- Adult type
- Juvenile type
- Thecoma
Thecomas or theca cell tumors are benign ovarian neoplasms composed only of theca cells. Histogenetically they are classified as sex cord-stromal tumours....
- Fibroma
Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue. The term "fibroblastic" or "fibromatous" is used to describe tumors of the fibrous connective tissue...
- Sex cord/gonadal stromal tunour - incompletely differentiated
- Sex cord/gonadal stromal tumour - mixed types
- Mixed Germ Cell and Sex Cord/Gonadal Stromal Tumours
- Gonadoblastoma
A gonadoblastoma is a complex neoplasm composed of a mixture of gonadal elements, such as large primordial germ cells, immature Sertoli cells or granulosa cells of the sex cord, and gonadal stromal cells.-Associations:...
- Germ cell-sex cord/gonadal stromal tumour, unclassified
- Miscellaneous tumours of the testis
- Carcinoid
Carcinoid is a slow-growing type of neuroendocrine tumor, originating in the cells of the neuroendocrine system.In 2000, the World Health Organization redefined "carcinoid", but this new definition has not been accepted by all practitioners. This has led to some complexity in distinguishing...
- Tumours of ovarian epithelial types
- Serous tumour of borderline malignancy
- Serous carcinoma
In pathology, serous carcinoma is an epithelial malignancy that arises from the lining of a cavity that produces a serum-like fluid .Serous lined cavities include the peritoneum, pericardium and pleural space and tunica vaginalis....
- Well differentiated endometrioid tumour
- Mucinous cystadenoma
Mucinous cystadenoma is a type of tumor in the cystadenoma grouping.There are four major categories of ovarian tumors:1. Epithelial tumors - serous or mucinous cystadenoma/carcinoma, clear cell carcinoma, Brenner tumor...
- Mucinous cystadenocarcinoma
Mucinous cystadenocarcinoma is a type of tumor in the cystadenocarcinoma grouping.It can occur in the breast....
- Brenner tumour
Brenner tumours are uncommon tumours that are part of the surface epithelial-stromal tumour group of ovarian neoplasms.The majority of these tumours are benign...
- Nephroblastoma
- Paraganglioma
A paraganglioma is a rare neuroendocrine neoplasm that may develop at various body sites . About 97% are benign and cured by surgical removal; the remaining 3% are malignant because they are able to produce distant metastases...
- Haematopoietic
Haematopoiesis is the formation of blood cellular components. All cellular blood components are derived from haematopoietic stem cells...
tumours
- Tumours of collecting ducts and rete
Rete testis is an anastomosing network of delicate tubules located in the hilum of the testicle that carries sperm from the seminiferous tubules to the vasa efferentia....
- Adenoma
An adenoma is a benign tumor of glandular origin. Adenomas can grow from many organs including the colon, adrenal glands, pituitary gland, thyroid, prostate, etc. Although these growths are benign, over time they may progress to become malignant, at which point they are called adenocarcinomas...
- Carcinoma
Carcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...
- Tumours of the paratesticular structures
- Adenomatoid tumour
- Malignant
Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
and BenignA benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
Mesothelioma
- Adenocarcinoma
Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Epithelial tissue includes, but is not limited to, the surface layer of skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium can be derived embryologically from...
of the epididymisThe epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
- Papillary cystadenoma of the epididymis
- Melanotic neuroectodermal tumour
- Desmoplastic small round cell tumour
- Mesenchymal tumours of the spermatic cord and testicular adnexae
- Lipoma
A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults...
- Liposarcoma
Liposarcoma is a malignant tumor that arises in fat cells in deep soft tissue, such as that inside the thigh or in the retroperitoneum.They are typically large bulky tumors which tend to have multiple smaller satellites extending beyond the main confines of the tumor.Liposarcomas, like all...
- Rhabdomyosarcoma
A rhabdomyosarcoma is a type of cancer, specifically a sarcoma , in which the cancer cells are thought to arise from skeletal muscle progenitors. It can also be found attached to muscle tissue, wrapped around intestines, or in any anatomic location...
- Aggressive angiomyxoma
Angiomyxoma is a myxomatous tumor involving the blood vessels.It can affect the vulva and other parts of the pelvis.Aggressive angiomyxoma was originally described in 1983, but the term "angiomyxoma" dates back to at least 1952....
- Angiomyofibroblastoma-like tumour (see Myxoma
A myxoma is a tumor of primitive connective tissue. It is the most common primary tumor of the heart in adults, but can also occur in other locations....
)
- Fibromatosis
The term fibromatosis refers to a group of benign soft tissue tumors which have certain characteristics in common, including absence of cytologic and clinical malignant features, a histology consistent with proliferation of well-differentiated fibroblasts, an infiltrative growth pattern, and...
- Fibroma
Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue. The term "fibroblastic" or "fibromatous" is used to describe tumors of the fibrous connective tissue...
- Solitary fibrous tumour
- Others
- Secondary tumours of the testis
Signs and symptoms
One of the first signs of testicular cancer is often a lump or swelling in the testes. The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in asymptomatic adolescent and adults, which means that men should not perform routine testicular self-exams. This practice was encouraged in the past, but current scientific evidence suggests that screening for testicular cancer does not lead to decreased morbidity and mortality. However, the American Cancer Society suggests that some men should examine their testicles monthly, especially if they have a family history of cancer.
Symptoms may also include one or more of the following:
- a lump
In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
in one testis which may or may not be painful
- sharp pain or a dull ache in the lower abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
or scrotum
- a feeling often described as "heaviness" in the scrotum
- breast enlargement (gynecomastia
Gynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"...
) from hormonal effects of β-hCG
- low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
(lumbago) tumor spread to the lymph nodes along the back
It is not very common for testicular cancer to spread to other organs, apart from the lungs. However, if it has, the following symptoms may be present:
- shortness of breath (dyspnea
Dyspnea , shortness of breath , or air hunger, is the subjective symptom of breathlessness.It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations...
), coughA cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
or coughing up blood (hemoptysisHemoptysis or haemoptysis is the expectoration of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs Hemoptysis or haemoptysis ...
) from metastatic spread to the lungs
- a lump in the neck due to metastases to the lymph nodes
Genetic defects
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.
Diagnosis
The main way testicular cancer is diagnosed is via a lump or mass inside the testis. More generally, if a young adult or adolescent has a single enlarged testicle, which may or may not be painful, this should give doctors reason to suspect testicular cancer.
Other conditions may also have symptoms similar to testicular cancer:
- Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
or epididymoorchitisEpididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
- Hematocele
A hematocele is a collection of blood in a body cavity. The term is generally used to refer to the collection of blood in the tunica vaginalis around the testicle. Hematoceles are often more painful than a hydrocele....
- Varicocele
Varicocele , also known as varicoscele or varicose seal, is an abnormal enlargement of the vein that is in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis...
Incorrect or mistaken diagnosis can delay access to appropriate treatment; this is thought to occur in up to 25% of cases
The nature of any palpated lump in the
scrotumIn some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
is often evaluated by scrotal
ultrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
, 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
metastasesMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
.
The
differential diagnosisA differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
of testicular cancer requires examining the
histologyHistology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
of tissue obtained from an
inguinal orchiectomyInguinal orchiectomy is a surgical procedure to remove a testicle and the full spermatic cord through an incision in the abdomen. Orchiectomy is one form of castration. The procedure is generally performed by a urologist. Often it is performed as same-day surgery, with the patient returning home...
- that is, surgical excision of the entire testis along with attached structures (
epididymisThe epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
and
spermatic cordThe spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to each testicle.-Contents of spermatic cord:...
). A
biopsyA biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
should not be performed, as it raises the risk of spreading cancer cells into the scrotum.
Inguinal orchiectomy is the preferred method because it lowers the risk of cancer cells escaping. This is because the lymphatic system of the scrotum, through which white blood cells (and, potentially, cancer cells) flow in and out, links to the lower extremities, while that of the testicle links to the back of the abdominal cavity (the
retroperitoneumThe retroperitoneal space is the anatomical space in the abdominal cavity behind the peritoneum. It has no specific delineating anatomical structures...
). A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two routes for cancer cells to spread, while in an inguinal orchiectomy only the retroperitoneal route exists.
Blood tests are also used to identify and measure
tumor markerA tumor marker is a substance found in the blood, urine, or body tissues that can be elevated in cancer, among other tissue types. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer...
s (usually
proteinProteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
s present in the bloodstream) that are specific to testicular cancer.
AFP alpha1 feto proteinAlpha-fetoprotein is a protein that in humans is encoded by the AFP gene....
, Beta-HCG, and
LDHLactate dehydrogenase is an enzyme present in a wide variety of organisms, including plants and animals.Lactate dehydrogenases exist in four distinct enzyme classes. Two of them are cytochrome c-dependent enzymes, each acting on either D-lactate or L-lactate...
are the typical markers used to identify testicular cancer.
Staging
After removal, the testicle is fixed with
Bouin's solutionBouin solution is a compound fixative used in histology. It is composed of picric acid, acetic acid and formaldehyde in an aqueous solution. It is especially good for gastrointestinal tract biopsies because this fixative allows crisper and better nuclear staining than 10% neutral-buffered formalin...
because it better conserves some morphological details such as nuclear conformation. Then the testicular tumor is staged by a pathologist according to the TNM Classification of Malignant Tumors as published in the
AJCCThe American Joint Committee on Cancer is an organization best known for defining and popularizing cancer staging standards, officially the AJCC staging system....
Cancer Staging Manual. Testicular cancer is categorized as being in one of three
stagesThe stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
(which have subclassifications). The size of the tumor in the testis is irrelevant to staging. In broad terms, testicular cancer is staged as follows:
- Stage I: the cancer remains localized to the testis.
- Stage II: the cancer involves the testis and metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
to retroperitonealThe retroperitoneal space is the anatomical space in the abdominal cavity behind the peritoneum. It has no specific delineating anatomical structures...
and/or Paraaortic lymph nodeThe paraaortic lymph nodes are a group of lymph nodes that lie in front of the lumbar vertebral bodies near the aorta...
s (lymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s below the diaphragmIn the anatomy of mammals, the thoracic diaphragm, or simply the diaphragm , is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...
).
- Stage III: the cancer involves the testis and metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
beyond the retroperitonealThe retroperitoneal space is the anatomical space in the abdominal cavity behind the peritoneum. It has no specific delineating anatomical structures...
and Paraaortic lymph nodeThe paraaortic lymph nodes are a group of lymph nodes that lie in front of the lumbar vertebral bodies near the aorta...
s. Stage 3 is further subdivided into non-bulky stage 3 and bulky stage 3.
Further information on the detailed staging system is available on the website of the
American Cancer SocietyThe American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
.
Treatment
Since testicular cancers can spread, patients are usually offered adjuvant treatment - in the form of
chemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
or radiotherapy - after surgery to remove the affected testicle (orchiectomy). The type of adjuvant therapy depends largely on the
histologyHistology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
of the tumor (i.e. the size and shape of its cells under the microscope) and the stage of progression at the time of surgery (i.e how far cells has 'escaped' from the testicle, invaded the sorrounding tissue, or spread to the rest of the body). If the cancer is not particularly advanced, patients may be offered careful surveillance by frequent CT scans and blood tests, in place of adjuvant treatment.
Before 1970, survival rates from testicular cancer were low. Since the introduction of adjuvant chemotherapy, chiefly platinum-based drugs like
cisplatinCisplatin, cisplatinum, or cis-diamminedichloroplatinum is a chemotherapy drug. It is used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors...
and
carboplatinCarboplatin, or cis-Diammineplatinum is a chemotherapy drug used against some forms of cancer...
, the outlook has improved substantially. 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.
In the UK, a similar trend has emerged: since improvements in treatment, survival rates have risen rapidly to cure rates of over 95%.
The three basic types of treatment are
surgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
,
radiation therapyRadiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
, and
chemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
.
Surgery is performed by urologists; radiation therapy is administered by
radiation oncologistA radiation oncologist is a doctor who specializes in the treatment of cancer patients, using radiation therapy as the main modality of treatment. Radiation can be given as a curative modality, either alone or in combination with surgery and/or chemotherapy. It may also be used palliatively, to...
s; and chemotherapy is the work of medical oncologists. In most patients with testicular cancer, the disease is cured readily with minimal long-term morbidity.
Orchiectomy
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 the affected testicle usually contains pre-cancerous cells spread throughout the entire testicle. Thus removing the tumor alone without additional treatment greatly increases the risk that another cancer will form in that testicle . 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 orchiectomyInguinal orchiectomy is a surgical procedure to remove a testicle and the full spermatic cord through an incision in the abdomen. Orchiectomy is one form of castration. The procedure is generally performed by a urologist. Often it is performed as same-day surgery, with the patient returning home...
. (The testicle is almost never removed through the scrotum; an incision is made beneath the belt line in the inguinal area.) In the UK, the procedure is known as a radical orchidectomy.
Retroperitoneal Lymph Node Dissection (RPLND)
In the case of nonseminomas that appear to be stage I, surgery may be done on the
retroperitonealThe retroperitoneal space is the anatomical space in the abdominal cavity behind the peritoneum. It has no specific delineating anatomical structures...
/
ParaaorticThe paraaortic lymph nodes are a group of lymph nodes that lie in front of the lumbar vertebral bodies near the aorta...
lymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s (in a separate operation) to accurately determine whether the cancer is in stage I or stage II and to reduce the risk that
malignantMalignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
testicular cancer cells that may have
metastasizedMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
to lymph nodes in the lower abdomen. This surgery is called
Retroperitoneal Lymph Node DissectionRetroperitoneal 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...
(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 therapy
RadiationIn physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
may be used to treat stage 2 seminoma cancers, or as
adjuvantAn adjuvant is a pharmacological or immunological agent that modifies the effect of other agents, such as a drug or vaccine, while having few if any direct effects when given by itself...
(preventative) therapy in the case of stage 1 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.
Chemotherapy
As an
adjuvantAn adjuvant is a pharmacological or immunological agent that modifies the effect of other agents, such as a drug or vaccine, while having few if any direct effects when given by itself...
treatment, use of
chemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
as an alternative to radiation therapy in the treatment of seminoma 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
carboplatinCarboplatin, or cis-Diammineplatinum is a chemotherapy drug used against some forms of cancer...
, typically delivered three weeks apart, is proving to be a successful
adjuvantAn adjuvant is a pharmacological or immunological agent that modifies the effect of other agents, such as a drug or vaccine, while having few if any direct effects when given by itself...
treatment, with recurrence rates in the same ranges as those of radiotherapy. However, very long term data on the efficacy of adjuvant carboplatin in this setting does not exist. Since seminoma can recur decades after the primary tumor is removed, patients receiving adjuvant chemotherapy should remain vigilant and not assume they are cured 5 years after treatment. The concept of
carboplatinCarboplatin, or cis-Diammineplatinum is a chemotherapy drug used against some forms of cancer...
as a single-dose therapy was developed by Tim Oliver, Professor of Medical Oncology at Barts and The London School of Medicine and Dentistry.
Chemotherapy is the standard treatment for non-seminoma when the cancer has spread to other parts of the body (that is, stage 2B or 3). The standard chemotherapy protocol is three, or sometimes four, rounds of
BleomycinBleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anticancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. It works by causing breaks in DNA...
-
EtoposideEtoposide phosphate is an anti-cancer agent. It is known in the laboratory as a topoisomerase poison. Etoposide is often incorrectly referred to as a topoisomerase inhibitor in order to avoid using the term "poison" in a clinical setting...
-
CisplatinCisplatin, cisplatinum, or cis-diamminedichloroplatinum is a chemotherapy drug. It is used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors...
(BEP). Bleomycin, etoposide and cisplatin (BEP) as a first-line treatment was first reported by Professor
Michael PeckhamSir Michael Peckham is a British oncologist and artist. As a cancer physician he is best known for his contribution to the treatment of testicular cancer...
in 1983. The landmark trial published in 1987 which established BEP as the optimum treatment was conducted by Dr.
Lawrence EinhornDr. Lawrence Einhorn is a Distinguished Professor of Medicine at Indiana University School of Medicine and an oncologist.- Overview :Dr. Einhorn pioneered the development of the life-saving medical treatment in 1974 for testicular cancer, increasing the survival rate from 10% to 95% .Dr. Einhorn...
at
Indiana UniversityIndiana University is a multi-campus public university system in the state of Indiana, United States. Indiana University has a combined student body of more than 100,000 students, including approximately 42,000 students enrolled at the Indiana University Bloomington campus and approximately 37,000...
. An alternative, equally effective treatment involves the use of four cycles of
EtoposideEtoposide phosphate is an anti-cancer agent. It is known in the laboratory as a topoisomerase poison. Etoposide is often incorrectly referred to as a topoisomerase inhibitor in order to avoid using the term "poison" in a clinical setting...
-
CisplatinCisplatin, cisplatinum, or cis-diamminedichloroplatinum is a chemotherapy drug. It is used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors...
(EP).
While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage 1 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).
Prognosis
In the
New England Journal of MedicineThe New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
, treatment of testicular cancer has been called one of the success stories of modern medicine, with sustained response to treatment in more than 90% of cases, regardless of stage. Because of advances in chemotherapy, cure rates now approach 85% overall, with better than 95% for localized disease and 80% for metastatic disease—the best response by any solid tumor.
Surveillance
For many patients with stage I cancer, adjuvant (preventative) therapy following surgery may not be appropriate and patients will undergo surveillance instead. The form this surveillance takes, e.g. the type and frequency of investigations and the length time it should continue, will depend on the type of cancer (non-seminoma or
seminoma), but the aim is to avoid unnecessary treatments in the many patients who are cured by their surgery, and ensure that any relapses with
metastasesMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
(secondary cancers) are detected early and cured. This approach ensures that chemotherapy and or radiotherapy is only given to the patients that need it. The number of patients ultimately cured is the same using surveillance as post-operative “adjuvant” treatments, but the patients have to be prepared to follow a prolonged series of visits and tests.
For both non-seminomas and seminomas, surveillance tests generally include physical examination, blood tests for tumour markers, chest x-rays and CT scanning. However, the requirements of a surveillance programme differ according to the type of disease since, for seminoma patients, relapses can occur later and blood tests are not as good at indicating relapse.
CT scans are performed on the abdomen (and sometimes the pelvis) and also the chest in some hospitals. Chest x-rays are increasingly preferred for the lungs as they give sufficient detail combined with a lower false-positive rate and significantly smaller radiation dose than CT.
The frequency of CT scans during surveillance should ensure that relapses are detected at an early stage while minimising the radiation exposure.
For patients treated for stage I non-seminoma, a randomised trial (
Medical Research CouncilThe Medical Research Council is a publicly-funded agency responsible for co-ordinating and funding medical research in the United Kingdom. It is one of seven Research Councils in the UK and is answerable to, although politically independent from, the Department for Business, Innovation and Skills...
TE08) showed that, when combined with the standard surveillance tests described above, 2 CT scans at 3 and 12 months were as good as 5 over 2 years in detecting relapse at an early stage.
For patients treated for stage I seminoma who choose surveillance rather than undergoing adjuvant therapy, there have been no randomised trials to determine the optimum frequency of scans and visits, and the schedules vary very widely across the world, and within individual countries. In the UK there is an ongoing clinical trial called TRISST. This is assessing how often scans should take place and whether
magnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) can be used instead of CT scans. MRI is being investigated because it does not expose the patient to radiation and so, if it is shown to be as good at detecting relapses, it may be preferable to CT. It is possible that one or more centres in Canada may join the trial in the next year or so.
For more advanced stages of testicular cancer, and for those cases in which radiation therapy or chemotherapy was administered, the extent of monitoring (tests) after treatment will vary on the basis of the circumstances, but normally should be done for five years in uncomplicated cases and for longer in those with higher risks of relapse.
Fertility
A man with one remaining testis can lead a normal life, because the remaining testis takes up the burden of
testosteroneTestosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
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
chemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
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 testiclesCastration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
will normally have to take hormone supplements (in particular,
testosteroneTestosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
, which is created in the testicles), and will be infertile, but can lead an otherwise normal life.
Epidemiology
Testicular cancer is most common among Caucasian men 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
ScandinaviaScandinavia is a cultural, historical and ethno-linguistic region in northern Europe that includes the three kingdoms of Denmark, Norway and Sweden, characterized by their common ethno-cultural heritage and language. Modern Norway and Sweden proper are situated on the Scandinavian Peninsula,...
,
GermanyGermany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
, and
New ZealandNew Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
.
Incidence among African Americans doubled from 1988 to 2001 with a bias towards
seminomaA germinoma is a type of germ cell tumor which is not differentiated upon examination. It may be benign or malignant.-Classification:The term germinoma most often has referred to a tumor in the brain that has a histology identical to two other tumors: dysgerminoma in the ovary and seminoma in the...
. 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 through the age of four as
teratomaA teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
s and yolk sac tumors, ages 25–40 years as post-pubertal seminomas and nonseminomas, and from age 60 as spermatocytic seminomas.
Germ cell tumorA germ cell tumor is a neoplasm derived from germ cells. Germ cell tumors can be cancerous or non-cancerous tumors. Germ cells normally occur inside the gonads...
s 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
cryptorchidismCryptorchidism is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at...
(undescended testicles). It is generally believed that the presence of a tumor contributes to cryptorchidism; when cryptorchidism occurs in conjunction with a tumor then the tumor tends to be large. Other risk factors include
inguinal herniaAn inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. They are very common , and their repair is one of the most frequently performed surgical operations....
,
mumpsMumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
orchitisOrchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
.
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
hormoneA hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s.
In other animals
Testicular tumors occur also in animals. In
horseThe horse is one of two extant subspecies of Equus ferus, or the wild horse. It is a single-hooved mammal belonging to the taxonomic family Equidae. The horse has evolved over the past 45 to 55 million years from a small multi-toed creature into the large, single-toed animal of today...
s, these include interstitial cell tumors and teratomas. Typically, the former are found in older
stallionA Stallion is a male horse.Stallion may also refer to:* Stallion , an American pop rock group* Stallion , a figure in the Gobot toyline* Stallion , a character in the console role-playing game series...
s (affected stallions may become extremely vicious, suggesting excessive production of
androgenAndrogen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...
), and the latter are found in young horses and are large.
Notable people who had testicular cancer
- Lance Armstrong
Lance Edward Armstrong is an American former professional road racing cyclist who won the Tour de France a record seven consecutive times, after having survived testicular cancer. He is also the founder and chairman of the Lance Armstrong Foundation for cancer research and support...
, American former professional road racing cyclist
- Niklas Axelsson
Niklas Axelsson is a Swedish professional road racing cyclist. Axelsson's finished sixth during the 1999 Giro d'Italia and third in the 2000 edition of Giro di Lombardia....
, Swedish professional road racing cyclist
- Jake Burton Carpenter
Jake Burton Carpenter , also known as Jake Burton, is an American snowboarder and founder of Burton Snowboards. He grew up in Cedarhurst, New York.- Biography :...
, founder of Burton Snowboards
- Bob Champion
Robert "Bob" Champion MBE was born in Guisborough, in the north of England, on 4 June 1948. He is an English jump jockey who won the 1981 Grand National on Aldaniti. His triumph was made into a film Champions, with John Hurt portraying Champion...
, English jump jockey
- Aaron Cruden
Aaron Cruden is a World Cup winning New Zealand rugby union player, who currently plays for Manawatu Turbos in the National Provincial Championship, Chiefs in the Super 15 Competition and is an All Blacks international. Cruden's position is first five-eighth/fly-half...
, New Zealand Rugby Union player
- Colin Curtis
Colin Benedict Curtis is a Major League Baseball outfielder for the New York Yankees.-Minor leagues:...
, MLB outfielder for the New York Yankees
- Kevin Curtis
-St. Louis Rams:Curtis was drafted by the St. Louis Rams in the 3rd round of the 2003 NFL Draft. Curtis was inactive for the first five games of 2003 after suffering a broken fibula in the final preseason game at Buffalo. In 2004, Curtis played in all but one game, totaling 32 catches for 421...
, American NFL football wide receiver
- Tyson Edwards, former AFL player for the Adelaide Crows
- Tom Green
Michael Thomas "Tom" Green is a Canadian actor, rapper, writer, comedian, talk show host and media personality. Best known for his shock humour brand of comedy, Green found mainstream prominence via his MTV television show The Tom Green Show...
, Canadian actor, rapper, comedian, and talk show host
- Neil Harris, English footballer
- John Hartson
John Hartson is a former Welsh international footballer who played as a striker, best known for his spells with West Ham and Celtic. Hartson also featured prominently for Wales, earning 51 caps until his international retirement in 2006...
, former Welsh footballer
- Markel Irizar
Markel Irizar Aranburu is a Spanish professional road bicycle racer for UCI ProTour team . Like team founder Lance Armstrong, Irizar is a testicular cancer survivor.- Palmares :2002...
, Spanish professional road bicycle racer
- Sébastien Joly
Sébastien Joly is a French professional road racing cyclist. Since 2001, Joly has been a professional rider. In 2006, he joined the on the UCI ProTour. He was diagnosed with testicular cancer on June 25, 2007, the day of his 28th birthday. He underwent an operation and then completed radiotherapy...
, French professional road racing cyclist
- Phil Kessel
Philip Joseph Kessel, Jr. is an American professional ice hockey forward, and an alternate captain for the Toronto Maple Leafs of the National Hockey League . Kessel is a product of USA Hockey's National Development Team and became that program's all-time leader for goals and points in his final...
, American professional ice hockey forward
- John Kruk
John Martin Kruk is a former Major League Baseball player and current baseball analyst for ESPN.-Early life and career:...
, American former major league baseball player
- Mark Latham
Mark William Latham , an author and former Australian politician, was leader of the Federal Parliamentary Australian Labor Party and Leader of the Opposition from December 2003 to January 2005....
, former leader of the Federal Parliamentary Australian Labor Party and Leader of the Opposition
- Michael Lowell, former major league baseball third baseman
- Billy Mayfair
William Fred Mayfair is an American professional golfer who plays on the PGA Tour .-Early years and amateur career:Mayfair was born in Phoenix, Arizona. Before his fifteenth birthday, he had won a number of junior golf tournaments. In 1981, he was on the cover of Boys' Life magazine as "golf's...
, American PGA professional golfer
- Robert Schwentke
Robert Schwentke is a German film director best known for the films Tattoo and Flightplan.He was a graduate of Columbia College Hollywood in 1992....
, German film director
- Craig Moore
Craig Andrew Moore , is a retired Australian soccer defender.Moore is best known for his two spells with Scottish Premier Division / Scottish Premier League club Rangers...
, former Australian footballer
- Gunnar Nilsson
Gunnar Nilsson was a Swedish racing driver, born in Helsingborg. Before entering Formula One, he won the 1975 British Formula Three Championship....
, (20 November 1948 – 20 October 1978), Swedish racing driver
- Pete Postlethwaite
Peter William "Pete" Postlethwaite, OBE, was an English stage, film and television actor.After minor television appearances including in The Professionals, Postlethwaite's first success came with the film Distant Voices, Still Lives in 1988. He played a mysterious lawyer, Mr...
, English actor
- Chris Reason
Chris Reason is a senior reporter for Seven News in Sydney, New South Wales, Australia.-Career:Chris began his career in newspapers - first The Redland Times then The Sun in Brisbane. He has also worked for Nine Network in the Gold Coast for a year.Reason came to Seven News in 1990 in Brisbane as a...
, Australian television news reporter
- Scott Schoeneweis
Scott David Schoeneweis is an American Major League Baseball left-handed relief pitcher who is currently a free agent.In the five seasons from 2003–07, Schoeneweis allowed only one home run to left-handed batters...
, American Major League Baseball left-handed relief pitcher
External links