Recently there came a case of a 23 year old young man who had been diagnosed with Stage 2 Testicular Cancer. The mother of the boy was distraught and he himself didn’t understand what to do. It sets your mind thinking that in today’s world while we talk a lot about awareness about breast cancer, we hardly find anything written about male issues and specifically about Testicular Cancer, something which can be detected early and is highly curable if diagnosed early. There is a need to stop men from getting sick so young and create a difference in their lives.
Male sex hormones and sperm are produced in the testicles. Testicular Cancer, or cancer of the testes, occurs in these organs. It is the most common cancer in men between 15 to 34 years of age with close to 95% cure rate. The second peak occurs after 50 years of age.
Testicular cancer is a very rare cancer among men from the Indian subcontinent, even worldwide. The incidence (newly diagnosed cases) of Testicular Cancer in a year for men from India is less than 1 per 1 Lakh men.
Testicular cancer occurs when cancer cells form in one or both the testicles. These cells then start dividing uncontrollably and form a tumour or lump. Sometimes, these cells may behave like a terrorist and sneak in blood stream and lymph nodes and might even spread to other parts of body, which is known as metastasis.
Although there is no definite reason why someone develops Testicular Cancer but there are certain factors which increase the risk. These risk factors include Cryptorchidism (or undescended testicle i.e. if a testicle has not moved down when a male is born), males born with abnormalities of the penis, kidneys, or testicles, males born with a hernia in the groin, history of testicular cancer in opposite testicle, family history, abnormal testicular development or mumps in which one or both testicles become inflamed. However, having a vasectomy reduces a man’s risk of developing Testicular Cancer.
The good part is that these tumours can be detected easily, like Breast Cancer, only if the boys check their testes regularly for lumps. All men between the age of 15 to 34 years (and even older) should perform self-exams every month. The best place to do a monthly self-exam exam is in the shower as scrotal skin is loose and thin while taking a bath. Check one testicle at a time by holding it between thumbs and fingers of both hands and roll it gently between your fingers. It’s very important to familiarise yourself with tube like structures Epididymis and the spermatic cord that connects on back of testis. If one feels any lump in either testicle or in the scrotum or one has pain in local area or in back, discomfort or feeling of heaviness, change in size, shape or consistency, fluid collection in scrotum, unexplained tiredness or there is trouble getting erection or ejaculation, then please don’t ignore these symptoms.
If the cancer spreads to the lungs, a person may experience coughing, breathing difficulties, swallowing difficulties, swelling in the chest, etc. In case of any of the above symptoms immediately contact an Urologist. Do not feel embarrassed to talk about these symptoms as it may delay the diagnosis. Remember, there are no secrets that time does not reveal, hence it is better to get diagnosed early and get treated completely.
The doctor may conduct several tests to diagnose Testicular Cancer. Blood samples may be drawn to test blood levels of tumour markers such as AFP, HCG, LDH, etc. However, sometimes these blood tests may come back normal, in-spite of cancer being present. An ultrasound of the scrotum may be conducted to reveal the presence and also the size of a tumour. In case of any suspicion of Testicular Cancer, the testicle has to be removed and sent for histopathological examination. There may be various non-cancerous conditions as well as Orchitis or Epididymitis which may also be picked up in these tests. These tests will also tell if it’s a Seminoma or Non-Seminoma Cancer. X-ray or CT scan of chest and abdomen or a whole body PET-CT scan may have to be done to understand the extent of tumour spread in the body. This will help in deciding the further curative options.
The good news is that around 95% of all men with Testicular Cancer make a full recovery after receiving treatment, if diagnosed early.
The treatment may involve surgery, radiotherapy, chemotherapy, or a combination of these modalities depending on the stage of disease. Orchiectomy or surgical removal of the affected testes is usually the first line of treatment. If only one testicle has been removed, chances of reproduction and intimacy with partner should not be affected. Patients whose cancer has spread to their lymph nodes will need radiation therapy (the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells). Chemotherapy is the use of chemicals to destroy and stop the growth of cancer cells. It is usually given to patients with advanced Testicular Cancer.
If by chance cancer is diagnosed, it will never be a feel good moment, but still there is no reason to panic even there is no such thing as an easy cancer. The first emotions experienced may be fear, horror, anxiety, depression, anger or a combination of these. But once you have addressed these emotions and felt them deeply thoroughly, calm down and step away from it. Life may give several sleepy jerks but there is no reason to decapitate your dreams of future. Once you choose hope, anything is possible. Don’t ever let your days be crossed off the calendar one by one. Gather courage, be the captain of your own ship and proceed for treatment. Remember, at the end of the day, your health is your responsibility. Your body is your most precious possession so you and only you have to take care of it. You can’t deposit excuses for not doing self-exams or not getting it treated if by any chance a tumour is diagnosed. So, check your testicles regularly and kiss the cancer good bye.
The writer, Dr. Indu Bansal Agarwal, is a Director & Senior Consultant – Radiation Oncology at Narayana Superspeciality Hospital, Gurugram.