October 2, 2001
Testicular cancer is easily diagnosed and
By Jonathan Freedhoff, M.D.
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
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?
There are four main risk factors that greatly increase a man's
risk of developing testicular cancer.
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.
history: Testicular cancer in your family raises your
risk 3 to 12 times.
testicular tumor: Having had cancer in one testicle increases
the risk of cancer in the remaining testicle by roughly 25
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.
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
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.
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.
Outside link: The National Cancer Institute's section
on testicular cancer
Outside link: The
Lance Armstrong Foundation