Men and Cancer
Testicular cancer is highly treatable, but early diagnosis is essential. Rear Adm. Joyce Johnson, D.O., reviews its symptoms and discusses options for its treatment.

Each year, about 7,500 men are diagnosed with testicular cancer in the United States. As women fear breast cancer, men fear testicular cancer. And, as with breast cancer, patients often are the first to recognize a lump that could indicate testicular cancer.

Testicular cancer is most treatable if found early. Ask your physician if he or she recommends a monthly exam to systematically palpate the testes in search of masses or changes in texture.

Be on the lookout for a painless lump or swelling (pain generally suggests inflammation or infection, not cancer). Sometimes men note a general swelling or heaviness in their scrotum. If a patient finds a lump or swelling, a physician might order blood tests to look for tumor markers. An ultrasound can determine the size and specific location of a mass and better characterize it; a solid tissue mass suggests cancer.

If the lump or swelling looks suspicious to the clinician, he or she usually will recommend a biopsy, called an orchiectomy, which involves removing the entire affected testis and examining its tissue under a microscope to look for cancerous cells.

The entire testis is removed in a biopsy because if only part were removed, cancerous cells could be scattered around, which could “seed” the tumor and spread it to other areas. If the other testis is unaffected, it is not removed and could continue to function normally.

Treatment varies based on how advanced the cancer is, how far it has spread (the stage), and what type of cells are found at the biopsy. Options include surgical removal of the affected testis (if not done for the biopsy); radiation therapy (depending upon tumor type); and chemotherapy to kill any cancer cells remaining after surgery or to attack a tumor that has spread too far for surgery to be helpful.

Because testicular cancer generally affects men between the ages of 15 and 39, hormonal balances, sexual function, and the ability to father children are of great concern. If surgery involves removal of lymph nodes, the surgeon can use nerve-sparing techniques to minimize the risk of impotence. Radiation and chemotherapy can reduce sperm count for a year or two. There is a risk these complications could be permanent, and some men choose to bank their sperm before surgery to ensure they can father children in the future.

When it is diagnosed early, testicular cancer has an excellent prognosis. Those at greatest risk for testicular cancer are men who have had it in the past, men with an undescended testicle, and men whose father or brother has had it. If you have any of these risk factors for testicular cancer, be especially vigilant. If you have had testicular cancer, regular follow-up visits are essential.