Risks and Signs of Testicular Cancer

By Deborah Jeanne Sergeant

Oncologist Chunkit Fung.
Oncologist Chunkit Fung.

Estimates for testicular cancer are approximately 9,310 new cases diagnosed and 400 deaths, according to the American Cancer Society. About one out of every 250 men will develop testicular cancer at some point during their lifetime.

Unlike many cancers, it strikes mostly young and middle-aged men at an average of age 33. Only 6 percent of cases are in children and teenagers and men over age 55 comprise only 8 percent. Also uncommon is its high likelihood of successful treatment. As with most cancers, early detection and treatment improves the chances of good outcome.

“Some men may notice a painless lump or swelling in either testicle,” said Kent Chevli, urologist and president of Western NY Urology Associates. “There’s sometimes discomfort, pain or heaviness without any swelling. Occasionally, patients have build-up of fluid in the scrotum or lower abdominal achiness.”

He added that rarer forms of testicular cancer secrete hormones that can cause breast tenderness or growth. Only advanced testicular cancer can cause pain elsewhere, including the back and chest, and shortness of breath.

“It’s not uncommon for a man to think he hurt himself by bumping a testicle and it still hurts, but a tumor is what causes the discomfort,” Chevli said.

Chevli added that it’s more than 95 percent curable overall.

“We’re very fortunate that this has a very high cure rate, that it will never come back,” he said. “With most men, we do find them early, but even at later stages, they’re highly curable.”

The reason is that testicular cancer is very sensitive to chemotherapy, even in the advanced stage; however, the severity and cost of treatment increases if the disease has advanced.

Most doctors recommend removal of the diseased testicle, as European doctors have attempted testicle-sparing approaches with little success. Sparing the testicle increases the chances of the cancer spreading to the lymph nodes.

Chunkit Fung, oncologist with Wilmot Cancer Institute in Rochester, listed long-term side effects to include hearing impairment, increased risk of metabolic syndrome, cardiovascular disease, peripheral neuropathy and infertility.

“We always talk with the guys about the potential side effects,” Fung said. “The challenge is you can modify the dose of chemotherapy. There’s nothing we can do at this point to avoid these side effects.”

For some early-stage testicular cancer, patients may receive surgery without undergoing chemotherapy or receive radiation instead of chemotherapy.

Although men can still father children with one testicle, the chemotherapy may cause infertility, and it can affect the nerves that cause semen to ejaculate (although erections still occur).

Risk factors include a non-descended testicle at birth, a factor for one out of 1,000 boys. Fung said that the testicle that had not descended is at exceptionally higher risk than in other patients and even the normal testicle has an elevated risk.

Caucasian ancestry is also a risk factor.

A man with a previous testicular cancer has a higher risk in developing cancer in the remaining testicle, which is why banking sperm is a good idea for men who still hope to father children after treatment for testicular cancer.

“I think that they are ashamed,” Fung said. “They let the problem go on too long, and not talk with their doctor about any swelling or enlargement. Some have a 15 centimeter mass in the testicle they’ve told no one about.

“I don’t want them to be ashamed of this but get medical attention as early as they can. It’s a very curable cancer. The earlier you find it, the less aggressive treatment you will need.”

Both Chevli and Fung recommend monthly self exams, which like women’s self breast exams, can be easily performed in the shower with a soapy hand. Any bumps, irregularities, increase in size or hardness should be seen by a health care provider.

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