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Old 01-17-2008, 05:12 PM
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Default Testicular Cancer: Self-Exams at Home

Who Gets Testicular Cancer?

Testicular cancer usually affects men from age 20 to 39. Testicular cancer is uncommon: about 8,250 cases were diagnosed in 2006, with about 370 deaths. This represents only 1 percent of all cancer diagnoses. However, testicular cancer is the most common cancer in men between the ages of 15 and 34.
Risk Factors for Testicular Cancer

Certain risk factors increase the chances of developing testicular cancer:
  • Cryptorchidism. In this condition, one or both testicles never fully descend into the scrotum in childhood. The testicle remains in the abdomen or high up in the groin, where it's more prone to developing cancer, for reasons that are not yet understood.
  • Previous testicular cancer
  • Family history of testicular cancer
  • White men get testicular cancer about five times more often than African-American men, for reasons that are not yet understood.
Testicular Cancer: Self-Exams for Screening?

Although common sense suggests routine testicular cancer self-exams should catch it earlier, this has not been definitively established.
"There is no evidence that self-exams detect testicular cancer at an earlier stage," says Durado Brooks, MD, director of colon and prostate cancer prevention programs for the American Cancer Society. Large clinical trials on this issue have simply not been done.
Self-exams also carry risks, Brooks adds, including "increased anxiety, and the risk of undergoing unnecessary medical procedures." For these reasons, the American Cancer Society does not recommend self-exams for testicular cancer detection, says Brooks.
The U.S. Preventive Services Task Force also does not recommend testicular cancer self-exams. At the same time, "we don't state that men should not do self-exams," says Brooks.
Some experts consider testicular cancer self-exams beneficial. "Self-exam is, I think, an important aspect of early detection," according to Joel Sheinfeld, MD, deputy chief of the urology service at Memorial Sloan-Kettering Cancer Center in New York City.
Most important, experts say, is to recognize and respond to possible symptoms of testicular cancer. "Men are usually aware there's something wrong," says Lance Pagliaro, MD, a medical oncologist with M.D. Anderson Cancer Center in Houston, Texas. "The problem comes in how the man reacts to it."
Recognizing the Symptoms of Testicular Cancer

Most testicular cancers are discovered by the men who have them. The most common symptom of testicular cancer is a painless mass (lump) in one testicle. Other symptoms to look for:
  • Testicular discomfort, pain or swelling.
  • Any change in size or the usual "feel" of the testicle
  • A sensation of heaviness in the scrotum
  • Dull aching in the abdomen, back, or groin
If you have any of these symptoms, you should call your doctor immediately.
Testicular Cancer: Delay Can Be Dangerous

Many men delay seeking a doctor's evaluation after first noticing the symptoms of testicular cancer.
"There's often a significant lag time, sometimes a very long time, between the first symptoms and when men come in," says Brooks.
"And that's sad," says Pagliaro, because "their chance of cure is not as good as it could be."
In one study, most men with a delayed diagnosis of testicular cancer gave one of several reasons for the delay:
  • They were unaware of the symptoms of testicular cancer;
  • They were afraid that their testicular swelling was due to a sexually transmitted infection, or
  • They were too embarrassed to seek medical attention.
"These are often teenagers or young men with plenty of other things going on in their lives," adds Pagliaro. "For us, it's about educating them about the possibility [of testicular cancer] and the need to see a doctor immediately" if symptoms are present, he adds.
Testicular Cancer: How to Perform a Testicular Self-Exam

Perform the exam after taking a warm shower, so the scrotal skin is more relaxed.
  1. Locate the testicle in the scrotal sac.
  2. Hold the testicle gently but firmly and roll it between your fingers. You should feel the entire surface of the testicle.
  3. Examine one testicle, then the other.
No official guidelines suggest how frequently you should perform testicular cancer self-exams, although some physicians recommend once a month.
If you do feel something abnormal on a testicular cancer self-exam, don't wait--let your doctor know!
Testicular Cancer: Diagnosis

Simple tests at a physician's office can quickly and accurately determine if testicular cancer is likely.
Testicular Ultrasound
Doctors frequently perform this test for any abnormal symptoms in the testicle. Ultrasound allows a view inside the scrotum and testicles. Testicular cancer usually looks different (more solid) than other causes of testicular swelling.
Blood Tests: AFP, hCG, LDH
Most testicular cancers release chemicals at abnormal levels into the bloodstream. These tumor markers include:
  • Alpha fetoprotein, or AFP
  • Beta-human chorionic gonadotropin, or B-hCG
  • Lactate dehydrogenase, or LDH
Elevated levels of these chemicals suggest, but don't prove, the presence of testicular cancer. Also, the absence of elevated levels of these hormones in a patient with a testicular mass does not rule out the presence of a tumor. The pattern of elevation, when present, can help in determining what kind of testicular cancer might be there. Tumor marker levels should fall during treatment, documenting response to therapy.
Biopsy
A biopsy is the only way to reach a definitive testicular cancer diagnosis. In a biopsy, a surgeon removes tissue and a pathologist examines it under a microscope. This usually requires removal of the entire testicle (orchiectomy). Orchiectomy is done because taking only a small tissue sample could spread testicular cancer elsewhere.
Treatment for Testicular Cancer

Treatment for testicular cancer varies widely, depending on the exact type of cancer and the extent of spread.
Orchiectomy, done for diagnosis, removes most or all testicular cancer. What comes next depends on the stage (spread) of cancer. The stage is determined by further tests, and possibly additional surgery.
Treatment can include:
  • Chemotherapy
  • Radiation therapy
  • Retroperitoneal lymph node dissection (RPLND), a major surgery to detect and remove any cancer that has spread.
Each man's cancer should be considered unique – and his treatment should too.
Survival Odds for Testicular Cancer

Sheinfeld provides the best news of all for testicular cancer patients. "Fortunately, this is a highly curable disease, even in advanced stages, assuming timely and appropriate treatment," he says. Keep in mind these facts:
  • A higher percentage of people survive testicular cancer than almost any other cancer.
  • Among those diagnosed most recently, as many as 96 percent survive five years after their diagnosis.
  • Even in patients with testicular cancer that has spread widely (metastasized), 70 to 80 percent can expect to be completely cured with modern treatments.
At the same time, "It is important to treat it meticulously and with great caution," adds Sheinfeld. Part of this caution must include close follow-up after treatment. Two to five percent of testicular cancer survivors will develop cancer in the other testicle within 25 years after diagnosis.
Lance Armstrong's Story

When world-class cyclist Lance Armstrong announced he had testicular cancer in 1996, doctors found it had already spread to his lungs and brain. After rigorous treatment including brain surgery and chemotherapy, Armstrong returned to cycling and won seven Tour de France titles.
Armstrong is the poster guy for surviving testicular cancer. But Armstrong himself points out that he's also an example of what not to do.
Lance told an interviewer he believed he might have had testicular discomfort as early as three years before his diagnosis. At the press conference announcing his diagnosis of testicular cancer, Armstrong had this to say:
"Had I been more aware of the symptoms, I believe I would have seen a doctor before my condition had advanced to this stage."
Listen to Lance. Know the symptoms of testicular cancer. Perform regular testicular cancer self-exams, if you choose. And if you notice anything abnormal, see your doctor right away.
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