A 30-year-old engineer at a large aeronautical firm found a lump in one of his testicles. The lump felt swollen and tender to his touch. Taking antibiotics did not change the lump, so when he returned to his provider for follow-up further testing was done. Results of the tests suggested testicular cancer, and the diagnosis was confirmed at the time of surgery.
Cancer strikes young
In otherwise healthy men aged 20 to 35 years old, testicular cancer is the most common type of malignancy. Frequency of the cancer has doubled over the past 40 years and, for unknown reasons, continues to rise — especially in white men. It currently causes 8,000 new cases and 380 deaths every year.
Fortunately for young men, the rate of successful treatment is very good. About 99 percent of men with early cancer without metastases achieve a cure. What’s the catch? Some men with metastatic cancer can be cured as well; but for the highest success rate, the tumor needs to be detected before it has a chance to spread.
Look for these signs
Testicular cancer usually causes a hard, painless lump in a testicle. Symptoms can include pain or a dull ache in the scrotum, scrotal heaviness or swelling, an enlargement or hardening of the testes, or growth of breast tissue. More advanced testicular cancer may cause symptoms such as leg swelling, back pain, cough, coughing up blood or trouble breathing.
I find that men are often reluctant to report a lump or other possible signs of testicular cancer. In one study, the duration of symptoms before diagnosis ranged from 17 to 87 weeks. Since testicular cancers grow quickly, any delay may make a difference in the treatment options that are available and the chances of success.
See your doctor promptly if you find a lump or notice other possible signs of testicular cancer. Your doctor will ask you about your symptoms and perform a physical exam. Special tests may help confirm or deny testicular cancer and check for any signs of spread. These tests may include an ultrasound of the scrotum, chest X-ray, computed tomographic (CT) scan of the abdomen, or blood testing for tumor markers.
Screening for cancer
For early detection, many health professionals recommend monthly testicular self-exams for men starting after puberty. But self-exams have not been shown to reduce the death rate from testicular cancer. Therefore, the American Cancer Society says the choice of whether to perform a monthly self-examination should be made in consultation with your doctor. An evaluation is especially important if you’re at increased risk for testicular cancer.
Who is most at risk?
Besides young age, factors that may increase your odds of getting testicular cancer include white race, infertility, smoking and family history of the disease. If you have a brother with testicular cancer, your risk increases six- to 10-fold. In one study, smoking more than a pack a day for 10 years raised cancer risk twofold.
In addition, having a testicle that did not descend into the scrotum until after age 6, or that never fully descended on its own, can increase the chance of getting testicular cancer.
And as for the popular myths: No consistent link between diet or testicular injury and the cancer has ever been found.
Our engineer was at increased risk for testicular cancer because of white race and a smoking history. Thanks to the tumor’s early detection, however, his chances for recovery are quite good.
For more information: American Cancer Society, www.cancer.org.
Contact Dr. Elizabeth Smoots, a board-certified family physician and fellow of the American Academy of Family Physicians, at doctor@practicalprevention.com.
&Copy; 2008 Elizabeth S. Smoots
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