The size of a cricket ball? Absolutely fine if it’s nestling between your bat and pad, but not if it’s squeezing out the side of your jockstrap. It’s amazing how long a man can fool himself about the health of his dangly bits. When a patient presents me with a testicle like that, he invariably says that the one had always been a bit bigger than the other, so he wasn’t too worried. But that’s an extreme example, not many men let testicular cancer get that far.
Here’s the good news: testicular cancer is not a common cancer, affecting one in 500 men with a European pedigree. Lung cancer is 20 times more common. For reasons that are probably hidden in the genes, black men almost never get testicular cancer. But here’s the important bit: age matters and testicular cancer ranks as the most common cancer for men between 25 and 35.
The net is drawn a bit tighter if one of your testicles didn’t ‘drop’ naturally by the time you were two years old. Men with an un-descended testicle are 30 times more likely to get testicular cancer than those without. Doctors actually prefer to talk about mal-descended testicles because there are different degrees of testicular shyness. There is a measurable increase in risk the higher the testicle is lodged in the body.
Adolf Hitler had an un-descended testicle but (un)fortunately it never affected his health. On the other hand, Tour de France winner Lance Armstrong’s were both fine before he lost one to cancer. There is no way to predict testicular cancer.
It’s difficult to know what you would do even if you were told that you were likely to get testicular cancer. It’s rare for surgeons to cut out testicular cancers – they cut out testicles. To do that preemptively, as some women do with double mastectomies, would take nerves of steel, given the excellent chances of a full recovery from testicular cancer and the other things you need your balls for.
So, unlike prostate or colon cancer, it’s up to you to be vigilant. Vigilance with testicular cancer means knowing what shape your balls are in – literally. Not all lumps are cancerous. Dr Craig Nicholls, the man who successfully treated Armstrong, reckons that ‘for every hundred young men who think they feel a mass in their testis, only one or two will have testicular cancer’. The most common lumps are easily treated epididymal cysts.
GPs eliminate some of the false alarms and urologists most of the rest. If you fall into that category, your uneven gonad might be in for nothing worse than a course of antibiotics. If testicular cancer is suspected, though, things start moving frighteningly quickly. If I find a solid mass in the testicle, the patient is sent for an ultrasound immediately to confirm it’s not just a cyst, and we’ll take blood to check for markers. Testicular cancers come in various guises, some of which can be seen in the blood. Having no ‘markers’ isn’t an all-clear but it will give the doctors a baseline against which to measure your blood’s response once you start treatment.
As soon as we’ve got that information you can expect to have an orchidectomy within days. After weeks or months of ignoring an embarrassing swelling, the patient is swiftly steered into the medical fast lane. If you go to your doctor with a cancerous ball on Monday, you will be a testicle short by the Friday; it’s that quick.
Cancer moves fast, so we have to move faster. Days can mean millions of new diseased cells and we must reduce the risk of dissemination to the rest of your body. After that you need to see the oncologist (cancer specialist) to plan your radio or chemotherapy. With early stage cancers the process does move quickly but, bizarrely, the number of people who have to be involved in more serious cases can slow everything down and it’s important not to get stuck with your family doctor. Insist on seeing an urologist if you are unhappy with the time it’s taking to diagnose a lump.
The severity of a cancer is typically measured by its stage of development. There are three stages for testicular cancer, each with sub-categories. Stage 1, when the cancer is still confined to the testicle, is the least severe. This is the best time to discover it and the prospects of making a full recovery in either Stage 1 or 2 are over 90 percent.
I don’t like to use the word ‘cured’, because you can never categorically tell a patient that his cancer is cured. Residual cancer cells can lie dormant for many years. But if you have to get a cancer, testicular cancer is a good one to get – we can treat it very effectively.
Test your Testes
After the offending gonad has been removed, a battery of scans, X-rays and blood tests tell the oncologist if the cancer has escaped from the scrotum. Testicular cancer cells march up the body’s lymphatic system, initially attacking lymph nodes in the lower back and abdomen. Medically, this is still very manageable. After that the cancer spreads quite quickly to remote sites in the body, very often the chest. Most patients are dumbstruck. You are never really prepared to hear that you have cancer. Radiotherapy kills cancerous cells with X-rays and the machine is focused just on the affected areas – a new patch every day. Chemotherapy kills cancer with drugs.
It is basically a cocktail of poisons that rampage through the bloodstream, hunting out and destroying cells which proliferate unusually fast, a defining characteristic of cancer cells. A great plan except that there are some very important cells that share that trait. Bone marrow is one of those and since these cells help fight infection and do all sorts of good things to your blood, chemotherapy scores a bit of an own goal with this one. The more you have, the sicker you get. If survival is touch and go, the oncologist has to balance the cycles of chemo with rests long enough to get your blood back in good shape but not so long that the cancer gets ahead again. While hair loss and temporary damage to your guts will come right, your fertility might not, so patients should consider banking sperm.
Most relapses occur within the first two years after treatment however, and the likelihood of patients relapsing more than five years after treatment is tiny. You can’t change your life style to avoid testicular cancer. Smoking and drinking may kill you in a hundred different ways, but testicular cancer is not one of them. Riding a bike does not cause testicular cancer either. Ball ache perhaps, but not cancer. But you may well change your lifestyle if you survive testicular cancer. For many it means having a different perspective on what’s really important in life.