October 2, 2001

When you're young, cancer is probably the last thing on your mind. Yet as world champion cyclist Lance Armstrong and comedian Tom Green can tell you, cancer -- particularly testicular cancer -- can happen to young men. In 1996 Armstrong was diagnosed with advanced testicular cancer that had spread to his lungs and his brain. He was only 25 years old. Following surgery and chemotherapy, he returned to cycling to win one of the most grueling athletic events in the world, the Tour de France, in both 1999 and 2000.

Earlier this year Green, irreverent host of MTV's "The Tom Green Show," was diagnosed with testicular cancer just months away from his 29th birthday. In May he had his affected testicle and some abdominal lymph nodes removed. He has already returned to television, and is producing a one-hour comedy special about his experiences with cancer.

While testicular cancer accounts for only 1 percent of all male tumors, it is the most common cancer found in men between the ages of 15 and 34. For reasons not entirely understood, the incidence of testicular cancer in the United States has doubled since the 1930s and is continuing to climb. Thankfully, if detected early enough, survival rates are extremely high, even up to 90 precent. What do you need to know in order to protect yourself?

Risk factors

There are four main risk factors that greatly increase a man's risk of developing testicular cancer.

• Undescended testicles: If you were born with a testicle which did not descend into the scrotum, that testicle is five times more likely to develop testicular cancer, even following a surgical correction. For reasons not yet understood, the other testicle is also at increased risk.
• Family history: Testicular cancer in your family raises your risk 3 to 12 times.
• Prior testicular tumor: Having had cancer in one testicle increases the risk of cancer in the remaining testicle by roughly 25 times.
• Immunosuppression: A suppressed immune system by any cause (HIV, chemotherapy, etc.) raises the risk of testicular cancer by 50 times.

You may also be at increased risk if you have had an undeveloped testicle, newborn jaundice, childhood mumps, or a childhood inguinal hernia. Furthermore, being Caucasian, sedentary, overweight, or rich and well-educated (no kidding) puts you at an increased risk.

Signs and symptoms

The most common symptom of testicular cancer is the discovery of a testicular nodule or painless testicular swelling. Thirty to 40 percent of patients complain of a dull ache or a heavy sensation in the lower abdomen, anal area, and/or scrotum. In roughly 10 percent of patients, sudden acute pain is the main complaint, and in 5 percent, it is breast enlargement due to hormone production by the tumor. A remaining 10 percent have symptoms related to the spreading of the tumor, including the following: enlarged lymph nodes in the neck; coughing or shortness of breath if the cancer has spread to the lungs; nausea, lack of appetite, and/or vomiting due to intestinal compression; back pain or bone pain if the cancer has spread to the skeleton; or leg swelling due to venous blockage by groin lymph nodes.

Screening

There are two ways to screen for testicular cancer: testicular palpation by your physician and testicular self-examination. There are currently no blood tests that are useful for screening; however, there are blood tests that may be useful once a malignancy is suspected.

Testicular self-examination

The best time to examine your testicles is during or just after a hot shower or bath, when the muscles of the scrotum are relaxed. Use one hand to support each testicle, and the other hand to gently roll the testicle between the pads of your thumb and index finger. You should feel a smooth bump covering the top, back, and bottom of each testicle. This is normal. It is your epididymus, which stores and transports sperm.

Testicles are normally smooth, oval shaped, firm, and rubbery. It is normal for one testicle to be slightly larger than the other, and their average size is 2.3 inches in length and 1.6 inches in width. If you feel any bumps or lumps on your testicles or if they are dramatically different in size, make an appointment to see your doctor right away.

Diagnosis

The first step in diagnosis following the detection of a suspicious testicular mass is a scrotal ultrasound. Scrotal ultrasound is nearly 100 percent accurate in distinguishing between masses arising within the testicle and those arising outside the testicle. By definition, an intra-testicular mass is cancer until proven otherwise. Removing the testicle by a procedure called a radical orchiectomy allows for a definitive diagnosis. A biopsy is not an option because it could theoretically provide the cancer with a route by which to spread. Once diagnosed, there are different types of cancer therapy depending on the type, stage, and spread of the tumor.

The bottom line

If caught early enough, and with appropriate therapy, the cure rate for testicular cancer is almost 100 percent. And unlike so many other cancers, testicular cancer is readily diagnosable from physical examination alone. This, coupled with its fast growth rate (10-30 days to double in size), makes early diagnosis crucial. Take advantage of the accessibility and perform monthly testicular examinations. It may not help you win the Tour de France, but it could save your life.

Related links:

Outside link: The National Cancer Institute's section on testicular cancer

Outside link: The Lance Armstrong Foundation