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儿童睾丸肿瘤Testicular Tumors (原创)

发表者:孙俊杰 人已读

儿童睾丸肿瘤

睾丸肿瘤出现在男孩,长在睾丸上。可以是良性或者恶性的。深圳市儿童医院泌尿外科孙俊杰

•最常发生在5岁以下的男孩,有时在青春期早期的男孩。

•大多数睾丸肿瘤是良性的,即使不会扩散,也仍然需要手术。

•恶性睾丸肿瘤会扩散(转移)到身体的其他部位,最常见的是肺,肝,淋巴结和中枢神经系统(脑或脊髓)。

症状及病因

什么原因引起了睾丸肿瘤?

睾丸肿瘤的病因仍未可知。已知的就是,他们大多起源于生殖细胞,这些细胞存在于胚胎,形成男性或女性生殖系统的组成细胞。

某些遗传缺陷 包括一些中枢神经系统缺陷,泌尿生殖畸形和脊柱下部的严重畸形 与生殖细胞肿瘤风险增高有关。特别是,隐睾症男孩发生睾丸生殖细胞肿瘤的风险增高。

睾丸肿瘤的症状是什么?

•肿胀

•坚硬

•形态异常,或不规则,睾丸大小

•睾丸疼痛(虽然有些肿瘤是无痛的)

睾丸肿瘤的症状可能类似于其他状况或医疗问题。你儿子的医生会做各种检查来排除这些其它原因。

检查与诊断

我的医生会如何诊断睾丸肿瘤?

大多数睾丸肿瘤起初是被父母或卫生保健者注意到,在男孩的阴囊有不柔软的肿胀。然而,大多数这些阴囊肿块,是由更为常见的问题引起的,比如以下内容:

•疝气

•鞘膜积液

•附睾感染

•睾丸扭转

你孩子的医生通常能够,以包块感觉和是否透光的方式,将睾丸肿瘤从这些比较常见的情况区分出来。除了完整的病史和体格检查,你孩子的医生也可能要进行以下一些检查:

•超声- 要识别肿物是什么,以及是否需要更多的检查或手术,这种成像技术都是最佳方法。超声波用于查看内部工作着的器官,并评估血流。

•计算机断层扫描(也称为CTCAT扫描) - CT扫描可显示身体任何部位详细的图像,包括骨骼,肌肉,脂肪和器官。 CT扫描比一般的X线更为详细。

•磁共振成像(MRI - 使用大磁体,射频和计算机的组合,以产生出体内器官和结构的详细图像的一种诊断项目。

•组织活检 - 从肿瘤取出样品并在显微镜下检查。

•全血细胞计数(血常规) - 测量特定量血液内不同血细胞的大小,数量和成熟度。

•其它血液检查 - 这些可能包括血生化分析,肝、肾功能的评估,以及遗传学研究。

治疗

睾丸肿瘤如何治疗?

睾丸肿瘤,无论良性或恶性,通常需要连同将整个受影响的睾丸切除掉,这个手术被称为睾丸切除术。如果肿瘤是恶性的,你儿子也可能需要接受到以下一项或多项治疗:

•化疗,药物治疗通过干扰肿瘤细胞的生长或繁殖能力而起作用。不同组的药物以不同的方式对抗癌细胞,使肿瘤缩小。化疗可以单独使用,或者与其它治疗联合使用。

Ø化疗是一种全身治疗。它可以通过以下途径给予:

作为药丸服下

注射入肌肉或脂肪组织中

静脉内(直接进入血流;也称为Ⅳ)

鞘内(用针直接穿入脊柱)

Ø化疗可以相当有效地治疗某些癌症的同时,也会有很多副作用,因为这些药剂不能区分健康细胞和癌细胞。能预见这些副作用,可以帮助您和您的护理团队有所准备,并在某些情况下,预防或减轻症状。

•放疗 - 使用从特殊机器发出的高能量射线(放射线)来损坏或杀死癌细胞、使肿瘤缩小。

你的孩子也将接受支持治疗 - 预防和治疗感染,减轻治疗的副作用,减少并发症,治疗过程中使他舒服一些。他也将依照后续随访的时间表,来监测正在进行的治疗反应和可能的后期治疗效果。

睾丸肿瘤患者的长期前景怎么样?

良性睾丸肿瘤的预后通常是非常好的,就算有小的长期并发症。如果仍然存在一个睾丸,生育功能将被保留,所以你的儿子仍然能够生孩子。

恶性肿瘤的预后因人而异,变化很大,在很大程度上取决于疾病的严重程度。及时就医和积极治疗是很重要的。持续的后续随访也是同等重要的,用以监测放疗和化疗的副作用,以及第二恶性肿瘤。

Testicular Tumors in Children

Testicular tumors are growths on the testicle that can occur in boys. They can be benign or malignant.

·         They occur most often in boys under age 5 and sometimes in boys who experience puberty early.

·         Most testicular tumors are benign and, though they do not spread, still require an operation.

·         Malignant testicular tumors can spread (metastasize) to other parts of the body, most commonly the lungs, liver, lymph nodes and central nervous system (brain or spinal cord).

Symptoms & Causes

What causes testicular tumors?

The cause of testicular tumors is unknown. What is known is that most of them originate in the germ cells, the cells in the embryo that become the cells that make up the male or female reproductive system.

Certain inherited defects — including some central nervous system defects, genitourinary tract malformations and major malformations of the lower spine — have been associated with an increased risk for germ cell tumors. Specifically, boys with undescended testicles have an increased risk of developing testicular germ cell tumors.

What are the symptoms of a testicular tumor?

·         swelling

·         hardness

·         abnormal shape, or irregularity in, testicular size

·         testicular pain (although some tumors are painless)

The symptoms of testicular tumors may resemble other conditions or medical problems. Your son's physicians will do various tests to rule out these other causes.

Testing & Diagnosis

How will my physician diagnose a testicular tumor?

Most testicular tumors are first noticed by a parent or health care provider as non-tender swellings in a boy's scrotum. Most of these scrotal masses, however, result from far more common problems, such as the following:

·         hernia

·         hydrocele

·         infection of the epididymis

·         testicular torsion

Your child's doctor will usually be able to distinguish a testicular tumor from these more common conditions by the way the mass feels and if a light shines through it or not. In addition to a complete medical history and physical examination, your child's doctor may also want to perform some combination of the following tests:

·         Ultrasound (also called sonography)- This imaging technique is the best way to identify what the mass is and whether more tests or an operation are needed. Ultrasounds are used to view internal organs as they function, and to assess blood flow.

·         Computerized tomography scan (also called a CT or CAT scan)- A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

·         Magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

·         Biopsy- a sample of tissue is removed from the tumor and examined under a microscope.

·         Complete blood count (CBC)- a measurement of the size, number and maturity of different blood cells in a specific amount of blood.

·         Additional blood tests- These may include blood chemistry analyses, evaluation of liver and kidney functions and genetic studies.

Treatments

How are testicular tumors treated?

Testicular tumors, whether benign or malignant, are usually removed along with the entire affected testicle in a procedure known as orchiectomy. If the tumor is malignant, your son may also need to receive one or more of the following treatments:

·         Chemotherapy- a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone or in conjunction with other therapy.

o    Chemotherapy is a whole-body treatment. It can be given:

§  as a pill to swallow

§  as an injection into the muscle or fat tissue

§  intravenously (directly to the bloodstream; also called IV)

§  intrathecally (directly into the spinal column with a needle)

o    While chemotherapy can be quite effective in treating certain cancers, there can be many side effects, since the agents don't distinguish between healthy cells and cancer cells. Being able to anticipate these side effects can help you and your care team prepare, and, in some cases, prevent or alleviate symptoms.

·         Radiation therapy- a treatment using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.

Your child will also receive supportive care - treatment to prevent and treat infections, alleviate side effects of treatments, reduce complications and keep him comfortable during treatment. He will also be placed on a schedule of continual follow-up care to monitor ongoing response to treatment and possible late effects of treatment.

What is the long-term outlook for patients with a testicular tumor?

The prognosis for benign testicular tumors is usually very good, with minimal if any long-term complications. If one testicle remains, fertility will be preserved, so your son will still be able to father children.

The prognosis for a malignant tumor can vary greatly from individual to individual and depends heavily on the extent of the disease. Prompt medical attention and aggressive therapy are important. Continual follow-up care is equally essential to monitor for side effects of radiation and chemotherapy, as well as second malignancies.

中山大学附属第一医院小儿外科

孙俊杰医生

Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University

Dr. SUN Junjie

 

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发表于:2015-05-25 11:12

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