HEALTH EDUCATION

Testicular cancer Q&A

What is testicular cancer?
The testicles are two ball-like glands inside the scrotum. They produce sperm and hormones. They are also called testes.
Testicular cancer happens if abnormal cells in one or both of the testes grow uncontrollably.

Early detection is very important. Treatment is very effective and there is a high cure rate. If untreated or detected late, it can spread to other parts of the body — and it may cause death.

Who is most at risk?
Young men are most at risk — most cases occur in men 15-39. It is the most common cancer among men 20-34. Only nine percent of men with testicular cancer are older than 50.

White men are five to 10 times more likely to get it than African-American men. Asian-American, Latino, and Native American men also have higher rates than African-American men, but they have lower rates than white men.

Other factors increase the risk of developing testicular cancer:

• Cryptorchidism — having a testicle that did not descend into the scrotum

•A family history of testicular cancer

• HIV

• Klinefelter’s syndrome — a genetic condition that causes under-developed testicles and other problems

• Having previously had testicular cancer

How common is it?
About 8,000 men are diagnosed with testicular cancer each year in the U.S. About 400 men die from it every year. One out of every 100 cancers in men develops in the testes. The rate of testicular cancer has been increasing — experts have not been able to find reasons for the increase.

What are the symptoms?
The most common symptom is a lump or a swelling in a testicle. Lumps can be as small as a pea. Swellings can feel like irregular thickening on a testicle. Symptoms are often painless. Some may cause discomfort.

Other symptoms, when they occur, may include:

• Ache or pain in the back, groin, lower abdomen, or scrotum

• A change from the usual size or feel of the testicle

• Loss of sex drive

• A sensation of heaviness in the scrotum or bloating in the lower abdomen

• Tenderness, swelling, or lumps in the area around the nipples

Less serious conditions may also cause these symptoms. But you should report any symptoms to your clinician as soon as possible.

Don’t let fear prevent you from seeking care. Only a health care provider can diagnose or rule out cancer. And the sooner cancer is diagnosed and treated, the less likely it is to spread to other parts of your body.

How do I protect myself?
It is recommended that you have your testicles examined by a clinician during your periodic checkups. Ask your clinician how often you should have checkups. Men with risk factors for testicular cancer may be advised to have more frequent exams.

You should also become familiar with the way your testicles normally look and feel. That way you will be more likely to notice any changes.

Some men use testicular self-exams (TSEs) to check their testicles. If you would like to learn how to do a TSE, your clinician can teach you. Lumps and other changes are also noticed during activities such as showering or sex play. Many lumps are not cancerous — they may be caused by injury, infection, or other conditions. But report anything unusual to your clinician as soon as possible.

How is it diagnosed?
Clinicians examine the testes with their hands and use other tests to either diagnose or rule out cancer. The tests may include:

• Blood tests measure certain proteins and enzymes that are put out by cancerous tumors.

• Ultrasound scans use sound waves, instead of x-rays, to produce an image of internal tissues. They can locate and determine the size of a mass in the testicle. Ultrasound is a very safe procedure. An ultrasound is also called a sonogram.

• Surgery is the only way to find out for sure if there is cancer. But it is only performed after other tests show cancer may be present and a doctor is confident that there is cancer. Usually, the entire testicle is removed and tested. Surgical removal of a testicle is called orchidectomy. Rarely, only a biopsy — removal of a small piece of the testicle for testing — is performed. Biopsy is usually only done if a man only has one testicle. Otherwise doctors avoid biopsy because it may spread the cancer.

What are the treatments?
Surgery is the most likely treatment. Chemotherapy and/or radiation therapy are often used as follow-up to the surgery.

Treatment is extremely effective — especially when the cancer is treated early. Your doctor may run more tests to determine which treatments are right for you. Talk with your doctor about your options and be honest about your concerns. Make a list of questions you would like to ask at each appointment. You also may find it helpful to seek a second opinion from another specialist when deciding the best treatment for you.

Will it affect my sexuality?
Not physically. Nearly all — 99 percent — men with testicular cancer have it only in one testicle. After treatment, the remaining testicle produces all the needed hormones that affect masculinity, beard, voice, sex drive, etc. And removal of a testicle does not affect the ability to have an erection.

Some men may have a problem, because they worry about their sexual performance based on their appearance. They feel uncomfortable about the look or feel of their scrotum. They may choose to have an artificial testicle — a prosthesis — put in the scrotum. Discuss this option with your doctor if you are worried about how you will appear and feel.

The one percent of men with cancer in both testicles may take testosterone to maintain their sex drives and masculine attributes.

Will it affect my fertility?
Certain treatments may temporarily or permanently reduce fertility. If you would like to have children biologically after treatment, talk with your doctor. You may choose a treatment that is less likely to affect your fertility long-term. Or you may store some sperm in a sperm bank before treatment to use in the future to impregnate your partner if you do have fertility problems after treatment.

Where can I get more information?
American Cancer Society
www.cancer.org
1-800-ACS-2345

National Cancer Institute
www.cancer.gov
1-800-4-CANCER

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