Why Are Young Men at Greater Risk for Testicular Cancer? (podcast)

Often, people will come to us with a mass growing on their testicle. They feel a lump or a bump and come to our office to evaluate it further. Or, they’ll come to a doctor’s office in general and that may prompt additional imaging with something like an ultrasound. That can often identify or differentiate what is suspicious for cancer versus not. It’s usually painless, but people will often notice a rapid growth on their testicle over the course of a matter of weeks. In most cases, there are no symptoms.

Testicular cancer can primarily spread to the lymph nodes, but it can spread to the lungs and, or the liver. Those are very common locations if left untreated.

Like any other cancer that spreads to other parts of the body, people can develop symptoms of unintentional weight loss. They can develop abnormal liver function tests, which are blood tests that we commonly do to check up on the liver. They can develop respiratory problems if they have it spread to the lung.

More often than not, most people don’t have a lot of symptoms of spread other than noticing a lump on their testicle.

Low back pain can occur if there is spread to the bones or if a person gets an enlarged lymph node to the point where it’s creating or pushing up against other structures in the body that can make them feel discomfort.

Shortness of breath can happen if it spreads to the lungs and, or if it’s pushing up against their diaphragm.

Belly pain can occur. Chest pain is less common. Belly pain can simply occur if anything is growing inside the abdomen and pushes up against things. You can have loss of appetite, feelings of early satiety, where you’re getting full really quickly and you’re not eating large amounts of food.

Headaches and confusion can occur if it spreads to the brain. Certainly, that can occur.

For the most part, with rare exceptions, if there are no lumps on your testicle, it’s unlikely that you have testicular cancer even if you’re experiencing any of those other symptoms. The main thing a person can do is self-examination to make sure you don’t have any new growths on your testicle that you didn’t otherwise detect before.

People with an undescended testicle at birth, that’s the most common risk. There continue to be studies to look at exactly which individuals might be at higher risk or which populations. We haven’t gotten a ton of information in that regard. The main thing is if a person has a history of an undescended testicle, even if that’s been surgically corrected, that person remains at risk of developing tumors or growths on their testicle and they should continue to do self-examinations. But in general, everyone in the population, especially people between the ages of 16 to 25, as well as people in their 40s, we have a bimodal distribution of the risk of testicular cancer. It happens and it peaks in those two age categories. When people are in their early 40s as well as in their early 20s, you see a spike in the diagnoses of testicular cancer.

White men are at higher risk for testicular cancer than other ethnic groups, based on the data we have. But even within the population of white men, it remains a relatively uncommon type of cancer.

You can get tumors that grow on your testicle because of the immune suppression that is associated with HIV infection and AIDS. But that is usually related to lymphomas or other things that happen to pop up on the testicle. But they’re not primary testicular cancers, meaning they’re not only in the testicle. They may be in other parts of the body.

The testes are more active in people when they’re younger. They’re producing more testosterone; they’re producing sperm. Testosterone and sperm production are associated with our youth. We don’t have children necessarily when we’re much older. When the testicles are more active, like any other organ in the body, that’s when something might go wrong.

We start with an ultrasound. If a patient comes to us with an abnormal growth on their testicle, one that they didn’t identify before, we’ll order an ultrasound to evaluate it further. If that indicates that there might be a tumor that’s concerning for cancer, we then do some blood tests to look for something called tumor markers.

We also will potentially do a CT scan or some type of imaging to look at their abdomen to make sure there are no enlarged lymph nodes. We would also do some imaging of their chest, either a CT or an X-ray of their chest, to take a look and make sure their lungs look okay.

We start by removing the testicle. We make an incision in the groin and we take the testicle out that way. We don’t take it out from the scrotum. That has to do with the anatomic way that the testicle drains its blood. Once we get a diagnosis from our colleagues in pathology, that can help us decide what further treatment is necessary, if any.

After removal of a testicle, people feel back to their normal selves usually within about a week. We tell them to avoid heavy lifting or straining for up to six weeks, sometimes much sooner, depending on how much of an extensive procedure we had to do to remove their testicle.

For surgeries for testicular cancer that might have spread, we would do abdominal surgery to clean out the lymph nodes in the abdomen. There are some options to do that with laparoscopy, where we put cameras inside the body and use special instruments to avoid having to make a bigger incision. We even use a robot to do that. We connect instruments to a robot and the surgeon controls the robot from the corner of the room.

But typically, testicle removal is an outpatient procedure. People don’t have to stay in the hospital. It’s just a little incision in the groin. We get it out. In the majority of cases, people don’t need additional surgery beyond that.

We talk to people about banking their sperm ahead of time, if we do talk to them about removal of a testicle. This is because folks who do have the diagnosis of testicular cancer are often younger. They’re often not yet in relationships where they’re even thinking about children or maybe they’re just newly married. We talk to them about banking their sperm in the event that they want to have kids in the future. That enables them to do that. It’s not so much because removal of a testicle makes you infertile.

You should be able to father children with a perfectly good testicle on the other side. But the issue is if you have to go through additional treatment, say in the form of chemotherapy. That can be toxic to your sperm as well. Even the remaining testicle may not have viable sperm that can be used to father children.

Regarding testosterone, it is the same thing. Usually, if people have a good testicle on the other side, there should be no effect on their overall testosterone levels.

Chemotherapy is probably the mainstay of treatment for individuals with testicular cancer where we’re either worried about spread or it has spread. Radiation therapy can be used for certain sub-types of testicular cancer. Chemotherapy is probably the most common form of what we call systemic treatment or treatment that gets into your whole body.

Survival rates are quite good. In fact, the earlier we can detect it, the better the survival. When you take all comers with testicular cancer, you’re probably looking at over 80 percent, 85 percent-plus of individuals are cured.

It’s certainly easy to do a periodic self-examination. I don’t think we’ve come up with any specific guidelines on how often it should be done. But particularly in the shower or when things are a little more relaxed and it’s easy to feel your testicles. That is probably the most convenient time for a man to examine himself. Periodic self-examinations are useful.

Testicular cancer will often grow over a matter of weeks. A man will notice if there is something growing there when he’s in the shower and if he’s checking himself on a reasonably regular basis. Doing it monthly is perfectly fine.