Check Yourself for Testicular CancerLast updated: Apr 24, 2017
Testicular cancer is the most common cancer in men between the ages of 20 and 39, and the leading cause of cancer-related death in this age group. Despite its high prevalence in young males, testicular cancer is considered to be a modern medical success story with more than 95% of men who are diagnosed being cured. Self-exams are the key to early detection.
Q. Is there one thing you wish everyone knew about testicular cancer?
A. The most important thing is awareness. When testicular cancer is caught early it is highly treatable, but when the signs are ignored or not recognized it can spread to the lymph system, brain, and lungs. Thankfully, if it does spread, it is usually still curable, but may require invasive surgery, chemotherapy, and possibility radiation.
Q. What is the best way to detect testicular cancer?
A. Self-exams are crucial. It is important that all boys get in the habit of examining themselves monthly once they hit puberty. They should also be checked yearly at the pediatrician. After the doctor confirms everything is normal, I advise teenage boys to feel their testicles and scrotum to get an idea of what their normal anatomy is like. If anything starts to feel different they should see their doctor right away. A lot of young healthy people don’t come in for yearly exams, which is why it is so important they examine themselves.
Q. Teenagers or young adults may be reluctant to speak up. How do you encourage them?
A. Most teenage boys are not going to talk to their doctors or parents about testicular health; and they often get embarrassed when a doctor looks “down there.” Our pediatricians do a great job of starting the discussion and telling boys why it is so important to check regularly. We also stress testicular health with the parents.
Q. Is a lump always cancerous?
A. No, a lot of things can cause lumps in the testicles. A physician should explore any lump that is found right away. When lumps are within the testicle itself, they may be cancerous. When lumps are outside the testicle, they are usually not cancerous. However, a doctor should make that distinction. An ultrasound is close to 100 percent accurate at confirming if a lump is within the testicle. When this happens, the next steps are to biopsy or remove the testicle.
Q. A lump is the most common sign of testicular cancer. Are there any other signs? Does testicular cancer cause pain?
A. Unless the tumor is massive, testicular cancer usually does not cause pain or discomfort. Most cancers are detected from painless lumps. A lot of teenagers and parents are not aware that testicular pain could be a sign of a different serious medical condition called testicular torsion—a twisting of the spermatic cord that brings blood to the scrotum and testicles. Torsions need to be fixed within six hours or the boy could lose his testicle.
Q. The prognosis for testicular cancer is bright. How do we treat it?
A. Testicular cancer is the model for how all cancers should be treated. That wasn’t always the case. There was a time when testicular cancers were very deadly. Today, about one-half of new cases are diagnosed in stage I, meaning the tumor is confined to the testicle—we call this localized cancer. The standard of care is to remove the entire testicle and the spermatic cord.
When the cancer has spread, known as metastatic cancer, we use a multimodality approach, which combines surgery, chemotherapy, and radiation. By doing those three things, even people who have the disease spread to their brain have a high success rate.
Q. Are both testicles ever affected?
A. It is extremely rare to have both testicles affected by cancer at the same time. However, men who have had testicular cancer have about a 2 or 3 percent chance of developing cancer on the other side years later.
Q. When one testicle is removed, how does it affect function?
A. All you need is one testicle, thankfully. Having one testicle will not affect your sex drive, ability to become erect, or enjoyment of sex. It also should not affect your production of testosterone, though we do keep a close eye on hormone levels.
Despite this, we still talk to everyone when they are diagnosed about sperm banking. Chemotherapy can cause issues with sperm production or there could be an injury to the remaining healthy testicle.
Q. We recently partnered with MD Anderson Cancer Center. How will this enhance our ability to provide higher-quality care?
A. We are always trying to decrease the amount of chemotherapy that is needed and offer treatments with fewer side effects. As a partner with MD Anderson we have access to select clinical trials, novel therapies, and chemotherapy agents.
Q. What are the risk factors for testicular cancer?
A. Most cases are sporadic. But men who have a condition called cryptorchidism, more commonly known as undescended testicles—when a testicle does not drop to its normal place in the scrotum at birth—have a higher risk of developing testicular cancer. Young men/boys with undescended testicles account for roughly 3 percent of patients we see. Family history and prenatal exposure to hormones may also increase risk. It is very important to do self-exams and that their families be aware.