DEAR DR. DONOHUE: What are the chances of cure for testicular cancer? Is there a treatment for it? I have been given the choice of surgery or just living with it until the end. – J.G.

ANSWER: Cancer of the testicles can strike at any age, but it most frequently does so between the ages of 20 and 35. This year more than 7,000 cases of it will occur in North America, and it will cause 350 deaths.

There are diverse types of testicular cancer, so my remarks do not apply to all such cancers, only to the more common varieties.

In most cases, the cancer begins as a painless lump that a man accidentally feels. Because the symptoms at first are few to none, the lump often is ignored, and that gives the cancer a chance to spread. Ultrasound pictures or scans of the lump can identify it as cancer or as harmless.

Once the diagnosis of cancer is made, doctors usually advise removal of the involved testicle. If the cancer is confined to the testicle and if its appearance under a microscope suggests it can be treated effectively, then a number of options are open to a patient after removal of the testicle.

A surgeon can remove all lymph nodes adjacent to the testicle to rid the body of any cancer cells that might be hiding in them. Or the doctor can suggest radiation of the cancer site, for most testicular cancers are sensitive to radiation. Sometimes both surgery and radiation are the route taken. A fourth choice is close surveillance. The doctor carefully outlines a schedule of exams to detect any cancer return after the testicle is removed. If the cancer does return, this generally occurs within seven months and rarely occurs after two years. If return takes place, then treatment is given at that time.

If the cancer has spread to distant sites, chemotherapy becomes the program of choice.

The cure rate for early-detected, minimally aggressive testicular cancers approaches 99 percent.

DEAR DR. DONOHUE: Please tell us what’s with an itch. What causes it? Why does scratching make it go away? (I am not referring to an itch to go to Reno.) There is $10,000 riding on your answer, so it had better be good and honest. – V.M.

ANSWER: A release of body chemicals, including histamine, kinins and proteases, activates nerve endings that produce the itch sensation. What causes the outpouring of those chemicals is sometimes difficult to identify. A mosquito bite, an allergy and a change in the environmental temperature are some examples of things that lead to discharge of the itch chemicals.

Scratching is almost a reflex action. Scratching activates other nerve endings. Those endings override the itch-conducting nerves, and a moment of blissful respite follows.

This topic deserves a more in-depth treatment, but space allows me only to scratch the surface.

With so much riding on this answer, I am entering the witness protection program and assuming a new identity in an undisclosed city.

DEAR DR. DONOHUE: I am asking this question for my sister, who is 80. For almost her whole life she has had pain in her body. Doctors have told her that she suffers from an illness called osteopoikilosis, but no one has ever told her what this is. Does an illness with this name exist? What causes it? – K.M.

ANSWER: Osteopoikilosis (OS-tee-oh-poi-kill-OH-suss) is more a curiosity than an illness. An X-ray of bones discloses spots of bone that are denser than the surrounding bone. The spots are small, less than 1 cm (0.4 inches).

From what I can glean from the medical literature, they cause no symptoms and indicate no trouble. They should not be responsible for your sister’s pain.

The cause of this unusual condition is unknown.

In candor, I admit my ignorance. I had never heard of osteopoikilosis before your letter. If there are doctors conversant with this oddity, please send me more information so I can pass it on to K.M. and her sister.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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