Testicular cancer - a young man's disease, but highly curable

September 8, 1999
Web posted at: 3:16 PM EDT (1916 GMT)

In this story: Relatively rare, but on the rise What causes testicular cancer? What are the signs of possible testicular cancer? The importance of self examination How is testicular cancer diagnosed? How is the cancer treated? RELATEDS

By Daniel Hayes, MD

(WebMD) -- Testicular cancer is the most common form of cancer in men between the ages of 20 and 40. It's also one of the most curable. Approximately 90 percent of newly diagnosed testicular cancer cases are curable, according to the National Cancer Institute, and men can up their odds of successful recovery even more through education and self-examination.

Relatively rare, but on the rise

According to the American Cancer Society, about 7,500 new cases of testicular cancer are reported each year in the United States, causing about 300 deaths. The disease is rarely seen before puberty or in old age. It occurs at a rate of about 4 cases per 100,000 men. While the disease represents only about 1 percent of all cancers in men, its incidence has more than doubled in the past 30 years. "That's a very significant increase," says Celestia Higano, M.D., associate professor of medicine and urology at the University of Washington School of Medicine. The reason for the increase is unclear.

What causes testicular cancer?

The cause of testicular cancer is unknown. While some men believe physical injury is a cause, this is untrue. It is suspected that variations in hormones during fetal development and abnormalities in chromosomes may contribute to changes in the normal testicular cells. Doctors have learned, however, that some factors can increase the risk of testicular cancer developing. These factors include failure of the testicles to descend into the scrotum by age three or having a direct relative (father or grandfather) with the disease.

What are the signs of possible testicular cancer?

Walter Reynolds, M.D., a urologist in private practice in Portland, Oregon, and one of the doctors who treated Tour de France winner Lance Armstrong, explains, "The typical finding, which is sometimes discovered by a sexual partner, is a non-painful, non-tender testicular mass. A lot of men come to see a urologist for lumps in their scrotum that turn out to be noncancerous. As long as [they] can separate the mass from the testicle, it's not a testicular cancer."

Symptoms also include feeling heaviness or a dull ache in the lower abdomen or a pain in the scrotum. Anything out of the ordinary should be reported to your doctor so he or she can do a thorough examination.

The importance of self-examination

Boys, beginning at age 15, and men can increase their chances of early detection through self-examination, says Higano. She says a good place to perform the exam is in the shower when the scrotum and overlying skin are relaxed. A self-examination should be performed monthly.

Benefits of self-examination are controversial. But Craig Nichols, M.D., chairman of the hematology-oncology department at the Oregon Health Sciences Center in Portland, is convinced that self-examination helps shorten treatment and can make chemotherapy less aggressive. Reynolds agrees. "Men should examine themselves regularly so that they will notice any change in the future," he says. "They should get used to feeling the contents of their scrotum."

In a self-examination, each testicle should be felt for about 30 seconds with a gentle rolling motion as it is held between the thumb and fingers of both hands. A healthy testicle has the consistency of Jell-O. What you don't want to feel is a nodule or hardness. Even if you do feel a lump, don't panic. Lumps on the testicle can be caused by other conditions, such as a hernia, cyst or enlarged blood vessel. In addition, don't be alarmed if you feel a firm, coiled tube leaving the back of the testicle. This tube is called the epididymis, and it's supposed to be there. Other abnormalities should be reported to your doctor.

Higano is in favor of better efforts to educate youth. "We teach health care at various times in elementary and high schools," she says. "Why aren't we spending some time talking about cancer?...It boggles my mind that we aren't doing more in the schools."

How is testicular cancer diagnosed?

Your doctor will likely perform a manual examination of the suspected mass and may order an ultrasound test. This short and painless test uses sound waves to distinguish between normal and abnormal testicular structures. Other tests that may be used to help get an accurate diagnosis include a chest X-ray, a CT scan and an MRI. There are also blood tests that are useful in diagnosis. One of them, called the HCG test, was used to monitor testicular cancer survivor Lance Armstrong's progress in 1997. Armstrong, who won the arduous Tour de France bicycle race this past July, has been public regarding his second chance at life after being successfully treated for testicular cancer.

How is the cancer treated?

If testicular cancer is detected, the affected testicle is usually removed. This allows for the most complete diagnosis and treatment, says Higano. The remaining testicle can usually supply adequate levels of the male hormone, testosterone, as well as sperm. In some cases, spread of the cancer beyond the testicle requires further surgery, radiation therapy and chemotherapy. These therapies can cause some men to become infertile. A recurrence of testicular cancer following treatment is possible, but the chances of a cure are still excellent.

Reynolds says the case of Lance Armstrong is a model of hope. Reynolds says that even though Armstrong presented with multiple growths of testicular cancer in his lungs, "he got his chemotherapy and he's cured!"

RELATEDS AT :

Testicular Cancer and Testicular Self Examination

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RELATED SITES:

American Medical Association: Understanding and Detecting Testicular Cancer
National Cancer Institute
American Cancer Society

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