Written by: Dr. Christopher Ho Chee Kong
What is the testis?
Testis is an organ found only in males. It is responsible for producing sperm and the hormone called testosterone. Sperm is important to make babies while testosterone is responsible for making a man a man; giving him muscle bulk, facial, hoarse voice, virility, etc.
In 2007, testicular cancer constitutes 0.9% of all cancers in Malaysian men (20th most common cancer). Majority are in the early stage (59.5%). [National Cancer Registry Report 2007, Ministry of Health Malaysia]. Unfortunately, lately we are seeing more coming in late with advanced stages of testicular cancer probably due to reluctance to see doctor or inadequate awareness.
Testicular cancer affects mainly those between 15-40 years old. This is the younger age group men who are at their peak and most productive phase of their life. To be hit by cancer at this prime age is usually a shock for most men and most of them will be in denial. A lot of men do not seek help to protect their ego and because of lack of awareness as this cancer is not common and not much publicity or knowledge has been given out.
Signs and Symptoms
Someone with testicular cancer usually does not have pain. Only 15% will complain of pain at the testis. Most of the time, the complaint will be abnormal enlargement of the testis or he feels a lump in the testis. Usually it affects only one side. There are other causes of enlargement or lump of the testis and this includes hernia (bowel or fat going into the scrotum), hydrocele (abnormal collection of fluids in the testis), or infection (Orchitis). When the cancer has spread elsewhere, it may cause other symptoms. If it has spread to the liver, he may have yellowish discolouration of the skin and eyes (jaundice), bone pain (if spread to the bones), cough with maybe blood in the phlegm (if it has spread to the lungs).
The real cause of testicular cancer is unknown. What happens is that the cells in the testis undergo changes and grow rapidly and abnormally. There are a few high risk factors for developing testicular cancer. This includes undescended testis, previous testicular cancer, someone else in the family having testicular cancer and smoking. There are other factors found to be associated with testicular cancer and this includes infertility and tall men. Masturbation, cycling is not a cause for testicular cancer.
In normal babies, the testis is formed in the abdomen and then descends down to the scrotum so that at birth, the testes are out in the scrotum. Being placed in the scrotum, outside the abdomen, puts it at a lower temperature than the body. This is important for healthy sperm production. In some cases, the testis does not go down to scrotum and gets stucked in the abdomen. This exposes the testis to high body temperature. The cells in the testis can then undergo transformation into abnormal cells which can turn cancerous in the long run.
Diagnosis and Medical Scans
An ultrasound will be needed to confirm the suspicion of testicular cancer. Blood test called tumour markers will then be required. These are alpha fetoprotein (AFP), beta human chorionic gonadotropin (B-hCG) and lactase dehydrogenase (LDH). Not all types of testicular cancer will cause these tumour markers to be raised. The next step to confirm the cancer is not biopsy but removal of the testis. The reason why it is not biopsied is that biopsy may cause the cancer to spread to the scrotum (skin covering the testis) and make treatment more difficult. If necessary, CT scan will then be ordered to look for cancer spread and to stage the disease.
The main treatment is removal of the testis called radical orchidectomy through an incision at the groin region (inguinal). Whether or not further surgery to remove the lymph nodes, radiotherapy or chemotherapy is needed will depend on the type of testicular cancer and whether it has spread elsewhere. If the cancer is only in the testis and has not spread to other parts, surgery to remove the testis is adequate enough. Therefore, it is important to get it detected early. The surgery to remove the testis is simple and can be done in 30 minutes. It can be done as a day-care procedure (come in the morning and go back evening the same day) and most of the time, you can go back to normal activities in a week’s time.
If a man wants to preserve the shape of the scrotum and for psychological reasons, a testicular prosthesis can be inserted. It is silicone based.
If the cancer has not spread, the chances for a 5 year survival rate is 99%. But if the cancer has spread, the chances for 5 year survival rate is 73%. Overall the outcome is a lot more promising compared to other types of cancers.
As in all cancers, please avoid smoking. Also if a baby has undescended testis, it is advisable to get the testis pulled down into the scrotum through surgery (orchidopexy). Other than that, early detection is important. Therefore it is advised that men should check and examine their testis once a month in the shower. Feel for the surface. If there is any abnormality or enlargement, please see a doctor.
Famous sportsmen who had testicular cancer and survived
- Lance Armstrong (cyclist)
In 1996 at the age of 25 he was diagnosed with late-stage testicular cancer which had already spread to his brain, lungs and abdomen. Was cure after treatment and went on to win 7 Tour de France cycling contest.
- Jimmy White (snooker player)
- Bobby Moore (English Footballer)
After surviving testicular cancer, won the World Cup at Wembley in 1966
Dr. Christopher Ho Chee Kong,
MD, MS, MRCSEd, AM, MBU (Cert), FECSM, FICS, FRCSEd, FRCS (Urol) (Glasg) Consultant Urologist
Beacon International Specialist Hospital
Source: Beacon Hospital Malaysia
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