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Karen Ritter, RN BSN
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Important Facts About Testicular Mesothelioma
- Testicular mesothelioma forms in the lining surrounding the testes, which is composed of two layers: the tunica albuginea and the tunica vaginalis.
- There is limited data available regarding testicular mesothelioma, which is due to the rarity of the cancer.
What Is Testicular Mesothelioma?
Testicular mesothelioma is a cancer of the protective lining around the testes. Each male testicle is covered by two layers of tissue and cells. The inner layer lining is the tunica albuginea and the outer layer is the tunica vaginalis. Testicular mesothelioma cancer is medically referred to as “mesothelioma of the tunica vaginalis testis.”
According to a report published in the American Cancer Society Journals, there have been less than 100 documented cases of testicular mesothelioma. The report also states that the majority of patients were between 55 and 75 years old, while 10% were younger than 25. Researchers are still working to better understand testicular mesothelioma.
How Does Testicular Mesothelioma Develop?
Mesothelioma occurs when mesothelial cells – which line specific membranes surrounding the body’s internal organs, such as the chest, abdomen, heart and testes – become cancerous. Testicular mesothelioma forms due to mutation of cells in the protective lining around the testes.
Typically, healthy mesothelial cells mutate due to irritation caused by asbestos fibers. Once these healthy cells mutate, they begin to replicate uncontrollably and overwhelm healthy tissue within the cavity. If untreated, the disease will eventually spread beyond the cavity and toward vital organs, leading to further health complications.
Mesothelial linings protect organs and allow for safe movement and function. Damage to these linings can affect the health and stability of vital organs.
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Is Asbestos Exposure the Cause of Testicular Mesothelioma?
There is a lack of research regarding the cause of testicular mesothelioma because this type of mesothelioma is especially rare. There aren’t enough cases to evaluate. However, asbestos exposure is the only known cause of the most common types of mesothelioma: pleural mesothelioma, which forms in the lungs; and peritoneal mesothelioma, which forms in the abdomen.
As of now, asbestos is not definitively linked to testicular mesothelioma. Some patients report a history of asbestos exposure, but some do not have any known historical association with asbestos. There is no concrete proof that asbestos fibers can reach the protective lining of the testes.
Two studies provide further insight into the link between asbestos and testicular mesothelioma:
- According to an Italian study, around 27% of testicular mesothelioma cases involved a known history of asbestos exposure.
- In an American study of 74 testicular mesothelioma cases, only 25 (34.2%) involved a known history of asbestos exposure.
Some patients may have been exposed to asbestos without knowing, such as by living near asbestos mines or in a house with deteriorating asbestos components. They may also have been exposed by a family member or friend who worked with or near asbestos materials.
Although asbestos exposure has yet to be explicitly linked to testicular mesothelioma, the microscopic asbestos fibers can become lodged into mesothelial cellular linings. This can cause permanent genetic damage to healthy mesothelial cells.
Symptoms of Testicular Mesothelioma
It is important to know the symptoms of testicular mesothelioma and be aware of the warning signs of this cancer. If you experience any of these symptoms, contact your doctor to undergo a medical assessment.
There are three primary symptoms of testicular mesothelioma:
- Fluid buildup around the testes (hydrocele)
- Groin or testicular pain
- Swelling of one or both testicles
When mesothelioma develops in the testicles, the lining starts to thicken as fluid builds up, which is referred to as “hydrocele.” This is the most common testicular mesothelioma symptom. It can also result in swelling of one or both testicles.
Fluid buildup and tumor accumulation reduce space and restrict the movement of the testes. This can cause pain in the groin and testicular region.
Treatment for Testicular Mesothelioma
Treatment for testicular mesothelioma is similar to the other types of mesothelioma. Surgery is often the most effective treatment method to remove the diseased tissue.
Additional methods like chemotherapy, immunotherapy and radiation can control the growth of the disease or prevent recurrence. These methods are often used in combination with surgery or as a stand-alone treatment if surgery is not an option.
Surgery for Testicular Mesothelioma
Surgery is the most effective method to remove the mesothelioma tumors and any diseased tissue. If the tumors are contained to the testes, surgery is the preferred approach. Once the tumors spread to other organs and tissues, treatment options often become more limited.
The most aggressive surgical option for testicular mesothelioma is inguinal orchiectomy, which is also called an orchidectomy. “Inguinal” is another word for groin. This surgery involves removing one or both testicles, the lining around the testes, and the entire spermatic cord.
If the tumors have reached nearby lymph nodes, then surgeons may perform lymph node dissection. One study of an 81-year-old patient involved recurrence. The patient successfully underwent a right-sided template non-nerve sparing retroperitoneal lymph node dissection.
Chemotherapy for Testicular Mesothelioma
Chemotherapy is a common treatment method for mesothelioma and other types of cancer. Cisplatin and pemetrexed are two chemotherapy drugs approved by the U.S. Food and Drug Administration for the treatment of pleural mesothelioma.
According to a report in Molecular and Clinical Oncology, cisplatin and pemetrexed were used as chemotherapy for a specific case of testicular mesothelioma. The chemotherapy drugs were administered on the first day of a 28-day cycle for a total of six chemotherapy cycles.
After six months of chemotherapy, the patient was stable and exhibited no signs of recurrence or metastasis. The success of the chemotherapy may have been enhanced by initial testicular mesothelioma surgery.
According to this report, chemotherapy was an essential component of the patient’s treatment success. The patient showed no signs of local recurrence or metastasis for three years.
Due to the limited number of testicular mesothelioma cases, research and data on the effects of chemotherapy is limited. Through further research, specialists will be able to better understand this rare and complex disease.
Immunotherapy for Testicular Mesothelioma
Immunotherapy for mesothelioma is more frequently recommended. There is no reported data on using immunotherapy specifically for testicular mesothelioma due to the rarity of this cancer, but there are significant benefits to immunotherapy in general compared to other therapies.
The primary benefit of immunotherapy is that it promotes the immune system’s response to cancer cells and does not damage healthy cells like chemotherapy and radiation. Patients also often experience fewer side effects from immunotherapy than chemotherapy.
Checkpoint inhibitors are the most common types of immunotherapy drugs. The FDA has approved Opdivo and Yervoy, both checkpoint inhibitors, for pleural mesothelioma immunotherapy treatment.
Radiation Therapy for Testicular Mesothelioma
Radiation is not often used for testicular mesothelioma treatment due to the rare nature of this cancer and the lack of data supporting the benefits. However, radiation may help to prevent disease recurrence or slow the growth of tumors.
The risks of radiation include damage to other vital organs. Specialists sometimes do not recommend radiation to prevent further health complications, such as damage to healthy organs and tissues.
Additional Treatment Methods for Testicular Mesothelioma
Specialists often use a multimodal approach for treating mesothelioma. This includes a combination of different treatment options, which often leads to the most effective results.
The most common treatment combination is surgery and chemotherapy. Another combination is chemotherapy and immunotherapy.
Another treatment method is palliative care, which is an approach intended to relieve pain and reduce symptoms of mesothelioma.
Testicular Mesothelioma Prognosis and Survival Rates
Since this type of mesothelioma is so rare, prognosis and survival rates are based on limited data. In one study in the Singapore Medical Journal, the 2-year survival rate following diagnosis was 46%.
The University of Maryland Medical Center confirmed this statistic with its own data:
- The median survival is around 23 months.
- The survival times range from two months to more than five years.
- As with the other types of mesothelioma, survival depends heavily on how early patients are diagnosed and begin treatment.
Long-term survival is possible. If you have testicular mesothelioma, we can help you find the best medical care and treatment options for your needs. You can request to speak with one of our patient advocates whenever you’re comfortable.
Sources & Author
- Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. BioMed Central. Retrieved from: https://ehjournal.biomedcentral.com/articles/10.1186/s12940-019-0512-4. Accessed: 07/15/2020.
- The testicles. Canadian Cancer Society. Retrieved from: https://www.cancer.ca/en/cancer-information/cancer-type/testicular/testicular-cancer/the-testicles/?region=on. Accessed: 07/15/2020.
- Malignant Mesothelioma of the Tunica Vaginalis Testis. University of Maryland Medical Center. Retrieved from: https://meridian.allenpress.com/aplm/article/136/1/113/65053/Malignant-Mesothelioma-of-the-Tunica-Vaginalis?searchresult=1. Accessed: 10/02/2023.
- Two Case Reports of Benign Testicular Mesothelioma and Review of the Literature. Hindawi. Retrieved from: https://www.hindawi.com/journals/crionm/2017/5419635/. Accessed: 07/15/2020.
- Malignant mesothelioma of the tunica vaginalis testis: A case report and literature review. Molecular and Clinical Oncology. Retrieved from: https://www.spandidos-publications.com/10.3892/mco.2017.1450. Accessed: 07/15/2020.
- Signs and Symptoms of Mesothelioma. Moffitt Cancer Center. Retrieved from: https://moffitt.org/cancers/mesothelioma/symptoms/. Accessed: 07/15/2020.
- Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature. Case Reports in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/37933307/. Accessed: 11/13/2023.