Testicular Mesothelioma

Testicular Mesothelioma Symptoms

As with other forms of the disease, malignant mesothelioma of the tunica vaginalis does not have specific symptoms that can aid early detection. In most instances, a diagnosis has been made incidentally during a standard physical exam or another surgical procedure.

In the few studies available, researchers have noted many patients are asymptomatic or the common symptoms aren’t noticeable enough to seek medical help early on. For patients who do present symptoms, studies have found about 56% experience hydrocele and another 33% have a lump or mass on the testes.

Like with any form of mesothelioma, early diagnosis is crucial to allow for more, curative treatment options. Patients experiencing any of these symptoms should talk to their doctor right away, especially if they have a history of asbestos exposure.

Diagnosis of Testicular Mesothelioma

All forms of mesothelioma are difficult to diagnose and often confused for other conditions, whether common ailments like the flu or other cancers. For testicular mesothelioma patients, the rare cancer can easily be confused for other testicular cancers, like rete testis adenocarcinoma, or an inguinal hernia. In many instances, initial testing leading to a proper diagnosis occurs by chance after an irregularity is found during a routine physical examination or during another surgical procedure.

Radiology, or medical imaging, is typically the first step in diagnosis. In these cases, doctors may perform a testicular mesothelioma ultrasound to observe any irregularities in the testes or scrotum. The ultrasound can show if the patient has any lumps or masses with 90% accuracy, as well as hydrocele. Radiologists may also observe thickening of the tunica vaginalis, which can help prompt further diagnostic tests. Studies have found that in most cases, the patient often only presents cancer in one testicle, with only a handful of instances with bilateral presentation.

For all forms of cancer, a biopsy is the only way to get a definitive diagnosis. If the doctor suspects testicular mesothelioma or another form of cancer, the biopsy will be the last step of the diagnostic process. With the biopsy, doctors can look at the cell type, and determine staging and prognosis. A process known as immunohistochemistry, a staining technique to look at antibodies and biomarkers in the tissue or fluid sample, may also be used to find similar antigens and proteins that could be seen in the 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 there is no metastasis to other sites. These tests can also determine if the tumors in the tunica vaginalis are secondary tumors themselves.

Testicular Mesothelioma Life Expectancy

Mesothelioma patients overall face a rather grim prognosis of just 12 to 21 months, and testicular mesothelioma isn’t much improved. Researchers have found the median life expectancy to be about 20 to 23 months, though some patients have lived many years beyond their prognosis.

Some reports have found a mortality rate of about 53% after two years, but data is still rather limited with so few cases. A number of factors can influence an individual’s prognosis, like the stage of the disease, cell type and age at diagnosis. There have been a few reported instances of benign testicular mesothelioma, but the majority of patients are diagnosed with malignant testicular mesothelioma with the epithelial cell type. Fortunately, epithelioid mesothelioma is the most common and responds better to treatment than the other common cell types.

Recurrence is also a large factor in a patient’s prognosis. Testicular mesothelioma has a rather high recurrence rate, with some case reports estimating at least 52.5%. More than 60% of recurrences occur within two years after diagnosis and subsequent treatment, with 92.9% of patients with recurrence occurring within five years following diagnosis. In instances of recurrence, median survival was about 14 months, since most patients experienced distant metastasis.

Treating Testicular Mesothelioma

Since there are so few cases, doctors are unsure of the optimal treatment plan for testicular mesothelioma. Patients typically undergo multimodal therapy, most often surgery followed by chemotherapy. Occasionally, radiation therapy might be recommended for instances of recurrence.

In many reported cases, testicular mesothelioma is localized to one testicle, making it much easier to resect tumors. Researchers agree surgery is the best first-line treatment for testicular mesothelioma, as long as there is no or limited metastasis. In the majority of the case reports, doctors applied radical inguinal orchiectomy, a surgical procedure that removes one or both testicles and the spermatic cord.

There may also be less radical surgical options for select patients, like a scrotal orchiectomy, which only removes the affected testicles or sometimes both testicles, or resection of just the hydrocele wall. However, recurrence rates between the procedures vary greatly, with the more radical orchiectomy having an approximately 25% lower recurrence rate than less invasive surgeries.

Metastasis can also impact if surgery is still an option for patients. Though many cases have seen localized disease, there have also been many reports of distant metastasis, especially with recurrent testicular mesothelioma. A study from the American Cancer Society detailed the common sites of metastasis.

Chemotherapy might also be used in a multimodal treatment with surgery, or may be applied individually for patients who are not eligible for surgery because of metastasis. In most instances, doctors used the standard chemotherapy combination for mesothelioma of alimta and cisplatin, since research is so limited. Radiation has been used in a few cases, but its efficacy in reducing tumor size and alleviating symptoms varied widely among patients.

With so few cases, there aren’t clinical trials available for testicular mesothelioma patients. Emerging treatments, like immunotherapy, have proven effective in other forms of mesothelioma, but are only available in clinical trials for now. Hopefully, with further research, doctors will be able to get a better understanding of the best treatment practices for this rare cancer.