Check and Catch Testicular Cancer Early



      “Women are expected to regularly examine themselves for indications of breast cancer,” said my physician during the course of giving me a physical examination. “But when it comes to men examining their testicles for abnormalities, forget it.”
      Testicular cancer is far less common than breast cancer but it is still a concern for doctors, if not for the majority of their male patients. Although rare, it is the most common form of cancer among men aged 20 to 35. This year, about 7,400 Americans will develop testicular cancer, according to the National Cancer Institute.
      Men's general reluctance to focus on possible medical problems is graphically illustrated by their touchiness in this vital — and highly symbolic — area. Real men don't spend a lot of time examining their privates, or so the argument goes. That's a shame, because in about 40 percent of the victims of testicular cancer, the malignancy has spread to other parts of the body by the time it is diagnosed.

      All of us between the ages of 15 and 40 should check our testicles for abnormalities about once a month, and older men should continue to occasionally do so. The shower or bathtub is a good place for this because warm water relaxes both the scrotum and the man. To test, roll each testicle between the thumb and first two fingers of each hand and look for a lump, or nodule, that feels firm but is painless when pressed. A visual exam in front of a mirror is another way to look for abnormalities, and allows a man to more easily locate all of the various components that should be checked.
      Some men mistakenly discount the possibility that a problem exists because their testicles don’t hurt. Tenderness, too, can indicate a problem, and so can swelling of a testicle. Neither of these symptoms should cause initial alarm, however, because there are many possible causes other than cancer.
      For instance, an inguinal hernia can produce swelling in the scrotum that has nothing to do with the testicle, and infection (epididymitis) of the tube that transmits sperm can cause tenderness. The hernia can be repaired surgically if it is severe enough or causes too much discomfort, and epididymitis can be successfully treated with antibiotics.

      Other complications related to the testicles arise now and then and should be reported to a doctor. So should any variation in the glands, which should be smooth-surfaced and slightly spongy, and any persistent sense that things are not right down there. Some victims of testicular cancer do experience outright pain, particularly if a tumor has formed and there's bleeding. Less-common indications of the disease are back pain, weight loss, and enlarged lymph nodes and breasts.
      Most testicular cancers develop in the sperm-producing cells and are classified as seminomas. One common — and alarming — trait is the seminoma's rapid development. The worst tumors can double in size in as little as three weeks, and for this reason early detection is important.

      The progress in treating testicular cancer has been dramatic. In the 1960s, 90 percent of the men with the disease died of it, whereas today 90 percent of them survive. But the incidence of this potential killer is trending upward, for reasons that have yet to be scientifically determined.
      If a malignant testicle is suspected, a testicular ultrasound is conducted. Next comes a blood test for certain proteins produced by cancer cells. If these tests strongly suggest cancer, a biopsy follows. This involves surgical removal of the testicle, a process known as a radical inguinal orchiectomy, and it can be a traumatic experience for a young man worried about his love life and his potency.

      Fortunately, sexual performance is not related to this problem, at least not physiologically, and the remaining testicle isn't affected by the cancer, either, since it is an independent gland. And one testicle is more than capable of producing the requisite number of sperm to pass along the family genes.
      Cancerous cells in a testicle spread quickly, first to the lymph nodes of the abdomen and chest and then throughout the body. But most men whose cancer has progressed this far can still be cured — including the 40 percent who did not detect the cancer in its early stage — by a combination of surgery, radiation and chemotherapy.
      Men with early seminomas receive, after the orchiectomy, X-ray therapy in the pelvic and abdominal areas. The healthy testicle is shielded from radiation, thus preserving its reproductive viability. Lymph nodes are removed from the rear of the abdomen of some testicular cancer patients. If the malignant cells have reached the lymph nodes of the chest and other organs, chemotherapy is used. This does pose a great danger to fertility, and most men are advised to make a deposit in a sperm bank before undergoing treatment.

      Studies suggest that there is a hereditary factor in testicular cancer, and a racial one as well, which has yet to be identified. Caucasian men are seven times more susceptible to this cancer than are African-American men. Although no substances have been clinically associated with the incidence of testicular cancer, scientists believe that environmental conditions are also a factor. The general decline of the earth's environment is probably a factor in the rising incidence of this type of cancer worldwide. 


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