There are certain cancers that are unique to men, arising from the male reproductive tracts. Testicular cancer is one such, predominantly affecting younger men. There is a lack of awareness leading to delayed diagnosis and the cancer reaching an advanced stage compromising survival.
Testicular cancer affects the testicles, the male reproductive organs responsible for producing sperms and the masculinising hormone called testosterone. It predominantly affects men in the 15-35 age group and it is the commonest solid cancer among them. The crude incidence rate is 1 per 100,000 population as per the Madras Metropolitan Cancer Registry at the Cancer Institute (WIA), Adyar, Chennai.
There are no known causes. However, a history of undescended testis and testicular cancer in a first degree relative predisposes one to testicular cancer. Testicular cancer survivors are also at increased risk of a second primary cancer in the opposite testicle. It is not a communicable disease, and there is no way to prevent the occurrence of testicular cancer; thus, awareness of this cancer and early detection is crucial.
It usually presents as a painless enlarging lump of the testis. It may also present as pain or a dragging sensation over the scrotum. Rarely it may also present with symptoms suggestive of metastasis (cancer spread elsewhere) such as fatigue, backache or breathlessness. Evaluation includes performing tests such as an ultrasound of both testes, a CT scan of the abdomen and chest and blood tests to look for increase in markers such as alpha-feto protein, beta C and LDH. Final confirmation is by removal of testis which is both diagnostic and curative (in very early stages).
Testicular cancers can broadly be divided into seminomatous and non-seminomatous — these differ in treatment protocols. Treatment involves removal of the involved testicle by a procedure known as high inguinal orchidectomy. This is followed by chemotherapy, radiotherapy or surgery (retroperitoneal lymph node dissection or RPLND) depending on the type of cancer and stage of the disease. With advances in science, testicular cancer treatment has excellent outcomes. The five-year survival, if detected in the early stages, can be in excess of 95%.
Most patients can have healthy sexual relations despite removal of one testis. The cancer or treatment may lead to infertility, and hence sperm banking is an option to preserve fertility.
Surgery can cause ejaculation to be impaired. Surgeons at the Cancer Institute (WIA), Adayar, routinely perform a procedure called nerve sparing RPLND which preserves ejaculation in a select group of patients undergoing this surgery.
April of every year is designated as testicular cancer month. It is an effort to focus on men’s health and bring about awareness of this cancer and make people aware of the need for testicular self-examination. Testicular cancer month is also an effort to empower survivors and healthcare providers, societies and organisations fighting tirelessly against this life-threatening disease. Testicular self-examination and early diagnosis and treatment are the key.
Testicular self-examination should be performed monthly after taking a warm bath and involves feeling both testis between the thumb and index finger. It is normal for one testis to be slightly larger than the other. One should look for any lumps or irregularities, change in size, shape or texture. Contact a healthcare professional if any of the above is noticed. An annual testicular examination by a healthcare provider is also recommended.
(The author is a Professor at the Department of Surgical Oncology at the Cancer Institute (WIA), Adyar, Chennai)
