THERE are three things guaranteed to have people rushing into the GP surgery: severe headaches, chest pain and a new lump or bump in the genital region.
The first worry is that they are having a brain haemorrhage or stroke; the second that they may be about to have a heart attack, and with the third the concern is cancer. Thankfully, for the vast majority of these concerns I can reassure patients that it is not anything dangerous, but for a few this is not the case.
Over the past four years, I have found six cases of testicular cancer in my GP surgery. For these men instead of receiving reassurance, they started on a whirlwind course of investigations, treatment options and planning that I wish they could have been in some way prepared for. Unfortunately, I don’t know that anything prepares you to hear that you have cancer.
What’s my risk?
Testicular cancer affects about 170 men in Ireland each year. This means it is not a particularly common cancer, but it is the most common cancer in men aged 15-34, unlike most cancers which affect older people. But, unlike a lot of other cancers, this one is very treatable.
How would I know?
Most frequently it presents as a painless lump on the testicle and can feel like a small pebble or stone on the ball itself. If you feel something like this get to your doctor. After this visit, you will be referred to a hospital where the first test is often an ultrasound of the scrotum. This involves gel being applied to the scrotum and a small handheld device being placed against the skin. It doesn’t take very long and is completely painless. Often a blood test is also taken to check certain hormonal levels and then you will be (in most cases) sent home. The results of the scan don’t take long to come back and very quickly you will be talking to a urologist (a surgeon who specialises in the kidneys, bladder and genitals) in an outpatients clinic, who will explain what the treatment plan is.
For most people an operation is recommended to remove the affected testicle (this is called and orchidectomy) and if the cancer hasn’t spread this is often the end of treatment (also if you are concerned about only having one testicle after the surgery you can discuss having an artificial one put in to the scrotum so everything looks and feels like it did beforehand). You may also want to discuss freezing sperm samples before the surgery in case there is any problem with fertility following the procedure.
All that sounds scary and it can be. It happens very fast and it can be quite confusing. The good news is that for most men this is the end of their treatment. When testicular cancer hasn’t spread anywhere beyond the testicle surgical removal will be enough in 99% of cases, and even with more advanced cancer, the survival rates are around 80%.
Another question a lot of men struggle with after their diagnosis but don’t talk about is: ‘How will this affect my sex life?’. The good news is it probably won’t. After the removal of one testicle, and when you are healed, the other testicle should be producing a sufficient amount of testosterone. This means that you won’t notice any impact on libido or erectile function, and for most men, the remaining testicle is more than capable of providing normal fertility.
How do I avoid it?
Unfortunately, most of the research shows that testicular cancer isn’t necessarily down to lifestyle problems, which means there’s not a lot you can do to reduce your risk.
What can I do?
Early detection and diagnosis is the single most important thing you can do to reduce your risk. I tell my male patients to check their testicles in the shower once a month or so. You don’t need to be overly worried as this is a rare enough cancer but being familiar with what your own testicles feel like means that if anything does change you will know to get it checked out straight away. Also, never feel embarassed about going to see your doctor about something like this. I would rather reassure 100 patients with a lump that doesn’t mean anything than have one person sit at home and miss the chance to treat this problem early on. I can reassure you that I have explained to many, many people that the lump they felt is completely normal.
That said, if you have a family history of testicular cancer or if you had an undescended testicle as a baby you should be more careful about looking for any changes down below.
The other thing that may have an impact on testicular cancer risk is bodybuilding supplements, particularly steroids. A 2015 study suggested even creatine use could increase your risk.
Basically, if you don’t look for it you’ll never find it until its very advanced and if you do find a lump on your testicles you’d be nuts to delay seeing your doctor…