Testicular cancer 101
By Cheryl Reid-Simons
It’s the most common cancer in young men between the ages of 20-40, but something most guys aren’t comfortable talking about. That’s why April, designated as Testicular Cancer Awareness Month, is a good time to remind men about the importance of self-exams.
“A lot of young men are not aware they are at risk because they assume cancer impacts older people,” says MultiCare urologist Frank Kim, MD.
Even teenage boys need to be counselled about self-exams.
“It’s the most common cancer next to leukemia in young, adolescent boys,” he says.
Nearly 10,000 men will be diagnosed and almost 400 will die of the disease this year.
The good news is that with early detection, it is very treatable, according to Dr. Kim. But the first step is discovering the malignancy. Dr. Kim recommends doing regular testicular self-exams in the shower, just as women are advised to do breast self-exams.
“The classic presentation is a painless testicular mass,” he says. “Unless you go looking for it, you’re not going to find it.”
Because it is usually painless, self-exams are critical.
What you are feeling for is any hard lumps in the testes themselves.
“If you feel any hardness in the testicle itself, you should seek medical attention,” he says.
More progressed disease will sometimes cause an ache in the scrotum or lower abdomen, and can cause lymph node swelling along the clavicle or above the collar bone.
A hard lump in the testicle should be presumed to be cancerous until proven otherwise, Dr. Kim says. The treatment is surgical removal, possibly followed by chemotherapy, radiation and/or lymph node dissection.
Because the cancer is common in younger men, preserving fertility is often a concern. In some cases, if a patient’s other testicle has been damaged or removed and the cancer is localized, a testicle-sparing surgery could be an option.
But if there is a functioning second testicle, the treatment standard is to remove the cancerous testicle completely. Fertility will be reduced, but not eliminated, and a single functioning testicle usually produces sufficient testosterone so that hormone replacement isn’t required, Dr. Kim says. Younger men usually opt to have a saline prosthetic testicle placed during surgery so their appearance is unaffected.
White men and those with a history of an undescended testicle are at higher risk for testicular cancer, as are men with a family history of the disease.
An undescended testicle that is brought down surgically before puberty raises the risk of testicular cancer by 2-3 times, according to Dr. Kim. An undescended testicle that is not brought down before puberty is five times more likely to develop a malignancy.
Unlike many cancers, there don’t appear to be any environmental risk factors, he says. Prior injury or frequency of ejaculation also won’t increase or decrease your risk.
Learn more about testicular and other urologic cancers.
