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Chorionic gonadotropin

Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the trophoblast (part of the placenta). Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans. hCG may have additional functions, for instance it is thought that it affects the immune tolerance of the pregnancy. Early pregnancy testing generally is based on the detection or measurement of hCG. more...

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The drugs Pregnyl®, Follutein®, and Ovidrel® use chorionic gonadoptropin as the active ingredient in their product. These preparations are used in assisted conception in lieu of luteinizing hormone to trigger ovulation.

Structure

hCG is a glycoprotein composed of 237 amino acids with a molecular mass of 36.7 kDa. It is heterodimeric, with an α (alpha) subunit identical to that of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). Its β (beta) subunit is unique to hCG.

Function

hCG promotes the maintenance of the corpus luteum and causes it to secrete the hormone progesterone. Progesterone enriches the uterus with a thick lining of blood vessels and capillaries so that it can sustain the growing fetus.

Because of its similarity to LH and FSH, hCG can also be used clinically to induce ovulation in the ovaries as well as testosterone production in the testes. As the most abundant biological source is women who are presently pregnant, some organizations collect urine from gravidae to extract hCG for use in fertility treatment.

Pregnancy testing

Pregnancy tests measure the levels of hCG in the blood or urine to indicate the presence or absence of a fertilized egg. In particular, most pregnancy tests employ an antibody that is specific to the β-subunit of hCG (βhCG). This is important so that tests do not make false positives by confusing hCG with LH and FSH. (The latter two are always present at varying levels in the body, while hCG levels are negligible except during pregnancy.) The urine test is a chromatographic immunoassay that can detect levels of βhCG as low as 25-100 mIU/ml. The urine should be the first urine of the morning when hCG levels are highest. If the specific gravity of the urine is above 1.015, the urine should be diluted. The serum test, using 2-4 mL of venous blood, is a radioimmunoassay (RIA) that can detect βhCG levels as low as 5 mIU/ml and allows quantitation of the βhCG concentration. The ability to quantitate the βhCG level is useful in the evaluation of ectopic pregnancy and in monitoring germ cell and trophoblastic tumors.

Hydatiform moles ("molar pregnancy") may produce high levels of βhCG, despite the absence of an embryo. This can lead to false positive readings of pregnancy tests.

Tumor marker

βhCG is also secreted by some cancers including teratomas, choriocarcinomas and islet cell tumors. When a patient is suspected of harboring a teratoma (often found in the testes and ovaries but also in the brain as a dysgerminoma), a physician may consider measuring βhCG. Elevated levels cannot prove the presence of a tumor, and low levels do not rule it out (an exception is in males who do not naturally produce βhCG). Nevertheless, elevated βhCG levels fall after successful treatment (e.g. surgical intervention or chemotherapy), and a recurrence can often be detected by the finding of rising levels.

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Testicular cancer
From Gale Encyclopedia of Medicine, 4/6/01 by Cindy L. Jones

Definition

Testicular cancer is a cancerous growth occurring in the male gonads, or testes. The testes are located outside the body cavity, in the scrotum.

Description

Although testicular cancer is a rare type of cancer, it often grows very quickly. It is the most common type of cancer to occur in young males, with most cases occurring in men under the age of 30 years. Recent advances in treatment, however, have made testicular cancer very manageable and curable. Testicular cancer is more prevalent in males whose testes have not descended into the scrotum. There are several cell types present in the testes, any of which can be involved in cancer. The two basic subtypes of testicular cancer are the seminomas and the non-seminomas. Although the incidence of testicular cancer has been increasing for the past 40 years, its cause is unknown.

Causes & symptoms

Testicular cancer usually shows no early symptoms. It is suspected when a mass is felt in the testes, although a testicular mass does not necessarily mean cancer. It is important for men to perform periodic examinations of their testes in order to detect any mass at an early stage. In advanced cases, or metastatic testicular cancer, symptoms include lower back pain and discomfort, difficulty in urinating, a cough, and breathing difficulties. A feeling of heaviness in the testes is also common and there is sometimes pain.

No cause for testicular cancer has been identified. Exposure of the fetus to certain chemicals or an individual's exposure to environmental estrogens may cause changes in cells that could lead to testicular cancer. As of yet, however, there is no conclusive evidence to name a cause. Higher rates of testicular cancer occur in men with HIV infection, suggesting that the two may also be related. Studies examining the relationship of testicular trauma, such as may occur with bike riding, and the occurrence of testicular cancer found that trauma does not contribute to testicular cancer.

Diagnosis

Once a mass is identified in the testes, the abdomen and other areas of the body are felt (palpated) to check for additional masses. A computed tomography scan (CT scan) of the abdomen and pelvis, as well as chest x rays, are performed to determine if the cancer has spread to other areas of the body. Sometimes the lymphatic vessels are also examined by x ray (lymphangiogram). There are some blood tests that are also helpful, including serum alpha-fetoprotein (AFP) and beta-subunit human chorionic gonadotropin (beta-hCG). These tests will allow the oncologist to stage the tumor, or determine the type, extent, and severity of the cancer. These blood tests can also be used to monitor the progress of treatment and check for recurrences of testicular cancer. A tissue sample (biopsy) will also be taken to confirm the diagnosis of cancer.

Treatment

Treatment for testicular cancer depends upon the stage of the cancer. However, the first line of treatment is usually surgery to remove the mass. If the cancer has spread to other parts of the body, surgery is followed by chemotherapy, using anti-cancer drugs such cisplatin, bleomycin, vincristine, etoposide, and methotrexate. Radiation therapy may also be used to treat testicular cancer.

Alternative treatment

No alternative treatments are known for testicular cancer. However, alternative therapies may be helpful to support the person undergoing conventional treatment for testicular cancer. Dietary modifications emphasizing whole foods and healthy fats, nutritional supplementation, acupuncture, Chinese and western botanical medicine, and homeopathy can strengthen the person and assist with recovery from surgery, chemotherapy, or radiation.

Prognosis

The cure rate for testicular cancer that hasn't spread (non-metastatic) is 95%. This high cure rate for testicular cancer that is caught early makes self-examination extremely important. The most common type of testicular cancer, seminoma, has an overall five-year survival rate of 80-90%. Choriocarcinomas, a non-seminomatous type, are rare but have a poorer prognosis. Patients cured of testicular cancer, however, need to be seen frequently because they are at a greater risk for developing additional cancers later in life, especially leukemias. This may be due to treatment procedures.

Prevention

Since the causes of testicular cancer are unknown, it is difficult to give specific measures to prevent it. One theory is that testicular cancer is related to exposure to environmental estrogens, such as insecticides and byproducts of the plastics industry. It is possible that avoidance of these products may decrease the risk of this type of cancer. Many types of cancers are associated with smoking. Stopping or cutting back on smoking decreases the risk of many cancers, and may also decrease the risk of testicular cancer. Other suspected causes for testicular cancer occur prenatally; one of these is smoking during pregnancy. Long term studies are underway to investigate this possibility.

Key Terms

Cisplatin
A metal-based drug used to treat cancer.
Environmental estrogen
Compounds found in pesticides and industrial chemicals that have an estrogen-like effect in the body. It is suspected by some scientists that these compounds may cause some cancers.
HIV
The virus that is associated with AIDS, or acquired immunodeficiency syndrome.
Metastatic testicular cancer
Testicular cancer that has spread to other parts of the body.

Further Reading

For Your Information

    Books

  • Garnick, M.B., et al. "Cancer of the Testis." In Cancer Manual. 9th ed. Boston, MA: American Cancer Society, 1996.
  • Kassabian, V.S., and S.D. Graham. "Urologic and Male Genital Cancers." In Clinical Oncology, 2nd ed. Atlanta, GA: American Cancer Society, 1995.

    Periodicals

  • Ginsburg, J. "Unanswered Questions in Carcinoma of the Testis." The Lancet 349 (June 21, 1997): 1785-1786.
  • "Metastatic Testicular Cancer." Clinical Reference Systems (December 1994): 1052.
  • Parker, L. "Causes of Testicular Cancer." The Lancet 350 (September 20, 1997): 827-829.
  • "Presence May Indicate Need for HIV Screening." AIDS Weekly Plus (June 3, 1996): 21.
  • "Secondary Cancers Afflict Men Treated for Testicular Cancer." Cancer Weekly Plus (October 20, 1997): 14.

    Organizations

  • National Cancer Institute. Cancer Information Service. (800) 4-CANCER.

    Other

  • Quackwatch: Questionable Cancer Therapies. http://www.quackwatch.com.
  • Cancer Care News. http://www.cancercarinc.org.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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