When testes get cancer

How often do you check your testes for abnormalities? Although cancer of the testes is rare, the number of men getting it is increasing and so are the deaths.

Testicular cancer starts with a painless lump that is often confused with an inflammation of the tubes that ferry sperm out of the testis, an illness called epididymitis, or inflammation of the testes usually from an infection called orchitis.

Most men, owing to their poor healthcare-seeking behaviour, are likely to ignore the painless lump until it is too big and cancer has spread, and some will be on antibiotics for long to treat a disease that would otherwise require surgery or chemotherapy or radiotherapy.

Dr Asim Jamal, the head of medical oncology at Aga Khan University Hospital says part of the reason that Kenyans are dying from the easily treatable cancer is the hesitancy to seek treatment for a disease affecting a private organ. “Any cancer that involves a sexual organ has a lot of hesitancy. And in some cases, if a man is told that treatment involves removal of the testicles, many do not go back to the hospital until it’s too late,” he says.

Testicular tumours are also rare hence some doctors are not keen to investigate if a lump is cancerous.

An infection in the testes tends to be painful while cancer is not, at least not at first. As the cancer grows and spreads, a patient will start experiencing abdominal pains, coughs if the disease has gone to the lungs, and back or bone pain.

There will also be a sudden sensation in the groin, swelling of neck glands, and breast enlargement. In some men, the nipples become tender, and milk-like liquid comes out of the breasts.

A normal testicle should be oval and have a regular surface.

“It should look and feel homogeneous and freely movable. It should not be irregular, or have any distortion,” Dr Asim says.

A lump in the testicle should immediately be followed by tests to see if the tumour is cancerous and if the disease has spread. The tests include an ultrasound of the testes, blood tests, an X-ray of the chest and lymph nodes, and a CT scan of the abdomen.

The diseased testis is then surgically removed. Doctors do not recommend partial removal of the testis. It must be removed in a wholesome manner to avoid the cancerous cells from spilling into the scrotum.

“A biopsy is not done because the blood tests will show if one has testicular cancer or not,” Dr Asim says, adding that appropriate removal, a clean scoop-out, of the testes helps cancer not to spread.

The stage of cancer will dictate the treatment. After removal of the testicle, not all testicular cancers require chemotherapy and radiotherapy treatments.

Some men will not require any treatment after surgery while others will be healed after only one cycle of chemotherapy, unlike other cancers which require six cycles and above.

“Testicular tumours are highly treatable. Due to effective chemo drugs, hardly anybody dies from testicular tumours in developed countries, even if the cancer has advanced,” says Dr Asim.

“Even if the cancer recurs, aggressive chemo drugs are given and the patient responds well.”

However, in Kenya, the deaths are higher because of lack of access to proper treatments and failure to follow up on treatment because of fear or myths.

One of the myths is that many sexual encounters reduce the chances of getting testicular cancer.

“There is no evidence that a high frequency of sexual activity will reduce the cancer or the risk,” Dr Asim says.

The fear of losing sexual ability and being infertile also holds back men from seeking treatment.

Testicle removal and some chemotherapy drugs can affect fertility, but it does not cause erectile dysfunction {inability to get an erection}. Ejaculation may also be an issue after treatment with sperm output being low.

“Before treatment, men should harvest their sperms and preserve them so that they can get children later on. It is recommended that sperm harvesting is done before surgery when both testes are intact and the yield is high,” says the associate professor of medicine. In cases where sperm harvesting cannot be done before the surgery, it can be picked before chemotherapy and radiotherapy treatment.

“In IVF {in vitro fertilisation} nowadays it easy to make a baby with very few sperms. Volumes do not matter. A man who has testicular cancer cannot transmit it to his son, hence it safe to preserve sperms for future use,” he adds.

Undescended testicle

Testicular cancer mostly affects men aged 15 and 35, but no man is exempt from getting it.

Boys with undescended testicles [testicle that has not moved into scrotum] are at a higher risk of getting testicular cancer.

“Undescended testes increase the risk of getting testicular cancer. The cancer does not only occur on the side of the undescended testes,” he says.

There are two types of undescended testicles: inguinal and abdominal. The risk of getting testicular cancer is higher if a boy has or had abdominal undescended testicle. Therefore, a regular check-up should be done.

Because some kinds of testicular cancer have about a 30 percent chance of recurrence, survivors must do follow-up blood tests, X-rays and CT scans every three months in the first year, four months the second year, six months the third year, and then yearly thereafter.

“This is important because the earlier the relapse is detected, the less aggressive the chemotherapy as a more advanced disease means stronger drugs which have harsher side effects,” he says.

There is no hard rule on how often you should check your testis.

“Every man should get used to doing a proper full body self-exam after every six months to have a feel of how his body is and see if there are any changes,” Dr Asim says.