Testicular Cancer

Testicular Cancer

A feel a month keeps you away from testicular cancer’s punch!!! Before I had testicular cancer, I just lived. Now, I live strong!! Lance Armstrong

Yesterday, I got a very frantic call from a very close friend of mine who wanted to meet me urgently in the late evening around 9 PM. When she came she was completely distraught as her young Engineer boy of 23 years, who had recently got an excellent job in Bangalore, was diagnosed with testicular cancer. After going through his reports, it was a relief that it was a second stage seminoma, which is a highly curable tumor. But it set my mind thinking and I realised that we as doctors talk a lot about awareness about breast cancer but we hardly write anything about male issues and specifically about testicular cancer which can be detected early and is highly curable if diagnosed early. I want to stop men from getting sick so young and I truly want to create a difference in their lives. Hence, I thought about spreading awareness about this tumor.

Male sex hormones and sperm are produced in the testicles. Testicular cancer, or cancer of the testes, occurs in these organs. Testicular cancer is the most common cancer in males 15-34 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 and also worldwide. The incidence (newly diagnosed cases of Cancer in a year) of Testicular Cancer for men from India is less than 1 per 1 lac men.

Testicular cancer or cancer of the testis occurs when cancer cells form in 1 or both testicles. These cells start dividing uncontrollably and form a tumor or lump. Sometimes, these cells may behave like a terrorist and sneak in bloodstream and lymph nodes and may spread to other parts of the body as lymph nodes and lungs, 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 (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. 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 boys are checking their balls regularly for lumps. All men between the ages of 15-34 years of age and even older should do self-exams every month. The best place to do a monthly exam is in the shower as scrotal skin is loose and thin then. Please 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 spermatic cord also, that connects on the 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 cancer does spread 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 please, contact the urologist immediately. Please 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 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 tumor markers as AFP, HCG, LDH. 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 seminomatous or non-seminomatous cancer. X-ray chest or CT scan of chest and abdomen or a whole body PET-CT scan may have to be done to know about the extent of tumor spread in the body and hence to decide regarding further curative options.

The good news is that around 95 percent of all men with testicular cancer make a full recovery after receiving treatment if diagnosed early. The treatment for testicular cancer may involve surgery, radiotherapychemotherapy, or a combination of these modalities depending on the stage of the disease. Orchiectomy or surgical removal of the affected testis is usually the first line of treatment. If only one testicle has been removed, then chances of reproduction and intimacy with a partner should not be affected. Patients whose cancer has spread to their lymph nodes will need radiation therapy i.e. 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 be panicky although there is no such thing as easy cancer. The first emotion may be fear, horror, anxiety, depression, anger or a combination of these. But once you have recognised the feel of these emotions, their texture, their moisture, and the shiver down the back, the quick flash of heat that crosses your brain, then calm down and step away from it. We know life gives several sleepy jerks but there is no reason to decapitate your dreams of the future.  God wants you well. 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 tumor is diagnosed. So, check your testicles regularly and kiss the cancer goodbye.

The writer, Dr. Indu Bansal Agarwal, is a Director & Senior Consultant Radiation Oncology  at Narayana Superspeciality Hospital in Gurugram

 

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