testicular cancer: common in young men

April is National Testicular Cancer Awareness Month, a reminder for men to check in with their primary care provider if they discovered an abnormal growth (shape or feel) in their testicles. We talked to Alex Belshoff, M.D., a urologist with The Queen’s Health System, about what testicular cancer is, when to see your doctor, treatment options, risks, and side effects.

what is testicular cancer?
Testicular cancer affects one or both of a man’s testicles. According to the American Cancer Society, about one in every 250 males will develop testicular cancer during their lifetime. The three most common cancers found in men are prostate, lung, and colon cancer.

Although it’s considered relatively rare, testicular cancer is most common in young and middle-aged men — the average age of diagnosis is 33. If the cancer is detected early, it can be treated successfully. Scientists have identified a few risk factors related to testicular cancer, such as family history, HIV infection, race/ethnicity, and more. However, the most common risk factor is a testicle that hasn’t dropped into the scrotum.

“Before males are born, their testes are in their abdomen. When they are born, the testes drop into the scrotum. One of the risk factors of testicular cancer is if the testicles are still in the abdomen,” says Dr. Belshoff. “One of the most important things to know is if you don’t have two testicles, and no one has ever explained that to you before, that’s certainly something you should bring up with your doctor.”

testing and diagnosing testicular cancer
Most men will see their doctor after discovering abnormalities when they self-examine themselves, sometimes because they’re experiencing pain. When a male sees his doctor, the doctor will conduct a test to make a diagnosis or request further testing.

During the initial test, the doctor will gently feel the patient’s testicles for swelling and tenderness and the size and location of any lumps. The doctor will also examine the patient’s abdomen, lymph nodes, and other body parts to look for signs that the cancer may have spread. If a lump or other sign of testicular cancer is found, the doctor may order an ultrasound or a blood test. Unlike most cancers, a biopsy is rarely done for a testicular tumor because it might cause the cancer to spread.

If the doctor believes the cancer has metastasized or spread to other organs or bones, they might order an X-ray, CT, MRI, PET, or bone scan.

“With things like testicular cancer that are highly curable, I’m reminded of that saying, ‘You can put things off until tomorrow, but tomorrow may never come,’” says Brian Wu, M.D., medical director at HMSA. “Don’t put things off until tomorrow. Make an appointment with your primary care provider for a comprehensive annual checkup.”

testicular cancer treatment options 
Testicular cancer is curable. Few patients die from this disease if it’s treated early. 

Treatment options for testicular cancer vary depending on the type and stage. The most common treatment is surgery (radical inguinal orchiectomy). During this surgery, the patient’s urologist makes an incision above the pubic area to remove the testicle from the scrotum and removes the tumor and spermatic cord (a cord-like structure in the male reproductive system), and ties them off to prevent the cancer from spreading to the rest of the body. Other treatment options include radiation therapy, chemotherapy, high-dose chemotherapy, and stem cell transplant.

Post-treatment care often includes follow-up appointments and self-examinations.

treatment risks and side effects
Men who are diagnosed with the cancer may have concerns about their ability to have sex if they have surgery. Having one testicle removed surgically does not affect a man’s ability to get an erection and have sex; he’s affected only if both testicles are removed.

When both testicles are removed, sperm can’t be made and testosterone production drops, which can decrease a man’s sex drive and his ability to have erections.

It’s important for testicular cancer patients to discuss their diagnosis, treatment options, risks, and side effects with their doctor and care team before deciding on the next steps. A testicular cancer patient may feel pressured to decide quickly on a treatment, but they should process the information and ask their care team questions before deciding.

Watch this video featuring Dr. Belshoff and Dr. Wu discussing testicular cancer and the importance of seeing your doctor annually.