Ajay Nangia, MD, professor of urology at University of Kansas Medical Center, with a practice at the University of Kansas Hospital, both in Kansas City. He is a leading male infertility specialist.
Women learn early about breast cancer. It’s got ribbons and races. But men tend to know almost nothing about testicular cancer…and some of what they think they know is actually wrong—which could be putting their health and even their lives in danger. Here’s the truth regarding four common myths about this male cancer…
Myth #1: Testicular cancer is mostly a problem for older men.
Truth: Not even in the ballpark. Even though prostate cancer rates rise with age, especially after age 60, the majority of the approximately 8,850 cases of testicular cancer diagnosed each year in the US are found in men ages 15 to 40. It’s the most common cancer to strike young men. It does occur in older men, though—about 7% of new cases are in men over age 55.
Myth #2: Testicular cancer is less “serious” than other types of cancers.
Truth: Testicular cancer does have a relatively high cure rate—even if the cancer has spread. The five-year survival rate is 95%. When caught early and localized to the testicles, it’s 99%. If it has spread to nearby tissue and/or lymph nodes, the survival rate is 96%. Even if the cancer has spread to other parts of the body, the five-year survival rate is 73%.
But these reassuring statistics mask the bigger truth that this is indeed a serious cancer. For starters, testicular cancer can’t be easily diagnosed via a biopsy—the removal of a tiny piece of a potentially cancerous tissue for testing—because it could cause the cancer to spread. Note: Biopsies do not cause most other types of cancer to spread.
So if symptoms (see below) or a physical exam lead to a suspicion of testicular cancer, and serum tumor marker blood tests and testicular ultrasound also point to cancer, an accurate diagnosis often involves removing the entire affected testicle—a procedure called radical inguinal orchiectomy.
That’s traumatic enough…leaving men self-conscious about their altered appearance. Then there’s chemotherapy or radiation, and sometimes a second surgery to remove nearby lymph nodes.
What’s more, both the cancer itself and treatment (especially chemotherapy) can lead to infertility—even in the 97% of cases in which only one testicle is removed. As a result, men who may wish to father children in the future are advised to bank sperm before treatment—or if they haven’t, to wait for a year or two after chemo before attempting impregnation to reduce the likelihood of having DNA-damaged sperm.
Finally, sexual performance may be affected. Treatment often leads to low testosterone levels, which can increase the risk for high cholesterol and high blood pressure—and erectile dysfunction.
Myth #3: Injuring your testicles ups your chances of getting testicular cancer.
Truth: There’s no evidence that a swift kick or some other assault you-know-where impacts your testicular cancer risk. Nor will certain sexual practices, having a vasectomy or infection with human papillomavirus (HPV) increase your risk.
What are the risk factors? There’s a strong genetic link, so family history matters. Being born with an undescended testicle also is a risk factor. Sophisticated new genetic tests can help identify, for example, the risk that a man born with undescended testicles actually has of developing the cancer. Unfortunately, there are no preventive steps a man can take.
Myth #4: Testicular self-exams are a waste of time and effort.
Truth: This is where there’s some disagreement. The US Preventive Services Task Force (USPSTF), an independent panel of national experts that makes recommendations about health-screening practices, has concluded from a review of studies that the benefit of self-exams is small. But I, along with many other doctors in the field, disagree. The USPSTF’s rationale is that there’s no evidence that self-examination is effective at reducing mortality. Even without screening, if testicular cancer is discovered, “current treatment options provide very favorable health outcomes.” But I see men who are dealing with the aftermath of testicular cancer, chemotherapy and/or surgery, and who are infertile and regret not having frozen their sperm. Plus, what harm is there in doing something that’s free and can be handled, so to speak, in the shower?
Testicular self-exams are easy and painless. The hardest part is remembering to do it once a month. Here are some guidelines from the Testicular Cancer Society…
1. Do the exam during or right after a warm shower or bath, when the scrotum is most relaxed and easy to examine by hand.
2. Use both hands to examine each testicle. Place your index and middle fingers on the underside and your thumbs on top. Firmly yet gently roll the testicle between your thumbs and fingers to check for surface or texture irregularities (see below).
3. Find the epididymis, a ropelike structure on the back of the testicle. Become familiar with how it feels so you won’t mistake it for a lump.
4. If you do the exam outside the shower, stand in front of a mirror and check for any visible swelling of the skin on your scrotum. It’s not essential but provides an additional check.
5. If you notice irregularities or changes in your testicles, make an appointment to see your doctor as soon as possible.
Testicular cancer is often diagnosed when a man notices something unusual and goes to his doctor. If you have any of these signs, it’s best to get checked out…
• A painless lump or swelling, usually hard, on the surface of either testicle.
• A dull ache in the lower abdomen or in the groin—especially if it lasts for more than an hour. It could be something else such as an infection or a physical twisting, but it’s worth checking out, even going to the ER. Most guys wait too long—hours, days or even months!
• A sudden buildup of fluid in the scrotum, forming a soft or hard swelling.
• Pain or discomfort in a testicle or in the scrotum.