by Leandrae T. Lapinig
If there’s a cancer that is unheard of by most Filipinos, it’s testicular cancer. Unlike other forms of cancers, it strikes mostly young people. In fact, in Great Britain, a 9-year-old boy was diagnosed with testicular cancer and he is considered to be one of the youngest in the world battling the disease.
Although testicular cancer is rare – as it accounts for just under one percent of cancers and ranks 26th for cancer incidence in men – studies showed the annual incidence increased 1.80-fold over 25 years: from 37,231 in 1990 to 66,833 new cases in 2016.
Experts say testicular cancer may appear at any age but tend to occur in three distinct age groups. Generally, it strikes at the beginning of life of a boy (0 to 10 years) and during the prime of a man (15 to 40 years old). The last age group belong to those in their twilight times (over 60 years).
Almost always, men discover a lump or swelling of the testicle or feel a general heaviness or dull ache in the scrotum or groin. “Testicular cancer usually develops in one testicle, but also can develop in both,” says the Mayo Clinic.
Most of those men who feel those symptoms usually don’t see a doctor. If ever they consult a doctor “it is already in the advanced stage,” said Dr. Jera Dean Travilla, chief resident at the Department of Urology at Southern Philippine Medical Center (SPMC) in Davao City.
From 2017 to 2022, the SPMC recorded about 40 patients with testicular cancer. Less than 10 percent of this figure sought medical help.
Studies done in the United States found that men who notice symptoms of testicular cancer wait an average of five months before checking in with their doctors. If not checked immediately, the tumor can spread to other parts of the body during that time, making it more difficult to treat.
“Testicular cancer is curable,” says the US-based Cleveland Clinic. “While a cancer diagnosis is always serious, the good news about testicular cancer is that it is treated successfully in 95% of cases. If treated early, the cure rate rises to 98%.”
If not discovered and treated early, testicular cancer can be fatal.
Among those who died of it, according to the website ranker.com, were English journalist and broadcaster Frederick Richard Dimbleby, Swedish racing driver Gunna Nilsson, US professional football player Louis Brian Piccolo, American football center Daniel Anthony Turk, Argentine soccer goalkeeper Gustavo Danie Eberto, American singer-songwriter Josh Clayton-Felt, British musician Pete King, and Canadian hockey player James Arthur Christopher Koleff.
“Still, early detection makes a big difference in your prognosis,” the Cleveland Clinic says. “The earlier you see your doctor and receive a diagnosis, the greater your chances of being cancer-free.”
According to the journal Annals of Oncology, life expectancy still decreases with time after diagnosis. “Life expectancy of men diagnosed with testicular cancer at age 30 years is estimated as 45.2 years, 2 years less than cancer-free men of the same age,” the journal said.
Cancer Research of the United Kingdom assures that survival for testicular cancer is very high. “Nearly all men survive their disease,” it says, adding that survival depends on many factors, including the age and health of the person.
“No one can tell you exactly how long you’ll live,” Cancer Research UK points out. “It depends on your individual condition, type of cancer, treatment and level of fitness.”
The testicles (also called the testes; a single testicle is called a testis) are part of the male reproductive system. These two organs are each normally somewhat smaller than a golf ball in adult males and are contained within a sac of skin called the scrotum. The scrotum hangs beneath the base of the penis; usually the left testis hangs slightly lower than the right one.
According to The Merck Manual of Medical Information, the testes have two functions: producing sperm (the male cells needed to fertilize a female egg cell to start a pregnancy) and testosterone (the primary male sex hormone).
Among those who are at high risk of developing testicular cancer men with father or brother who had testicular cancer; men with a history of testes that don’t drop before birth (also known as undescended testes); and abnormal cells in the testicle, most often found during an infertility test.
Testicular cancer may not be preventable but it can be discovered early through testicular self-examination (TSE). “Examine your testicles once a month, after a warm bath or shower,” the Philippine Cancer Society (PCS) suggests. “The heat from the water relaxes your scrotum, making it easier for you to check for anything unusual.”
“See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks,” the PCS says. “Make an appointment with your doctor even if a lump in your testicle isn’t painful. Only a small percentage of testicular cancers are painful from the outset.”
The tests doctors use to diagnose testicular cancer may include: a physical exam (which can reveal any testicular abnormalities like lumps or swelling), an ultrasound (examine the internal structure of the testicles), and blood tests called tumor marker tests (which may show elevated levels of substances related to testicular cancer).
Jaime Herndon, in a healthline.com’s feature, says testicular cancer can spread (metastasize) to other parts of the body, including the lungs, lymph nodes, liver, and brain. The two most common types of testicular cancer are seminoma tumors and non-seminoma tumors.
Seminoma tumors tend to develop more slowly than the other type. “Seminoma tumors are usually found only in the testicles and are less likely to spread to other parts of the body,” says Herndon.
Non-seminoma tumors are more aggressive and more likely to spread relative to seminoma cancers. “Non-seminoma tumors tend to spread lymphatically, which means they can spread to the lymph nodes,” Herndon says.
There are several ways to treat testicular cancer. “The initial treatment for testicular cancer is surgical removal of the entire affected testis (radical orchiectomy). The other testis is not removed, so the man retains adequate levels of male hormones and remains fertile. Infertility sometimes occurs with testicular cancer but may subside after treatment,” says the Merck manual.
With certain types of cancers, lymph nodes in the abdomen are also removed (retroperitoneal lymph node dissection) because the cancer often spreads there first. Radiation therapy may also help, especially for a seminoma.
“A combination of surgery and chemotherapy often cures testicular cancer that has spread,” says the Merck manual. “Blood levels of alpha-fetoprotein and human chorionic gonadotropin that were elevated at diagnosis decline after successful treatment.”
If levels rise after treatment, the cancer may have recurred. “After surgery and any other necessary treatments are completed,” the Merck manual says, “a surgeon can replace the removed testis with an artificial one.”
According to Cancer Research UK, once the two testicles are removed, the level of testosterone in the blood falls quickly. This will affect the sex life of men and their ability to have children. To maintain a man’s sex drive and be able to get an erection, he needs testosterone replacement therapy.
However, if only one testicle is removed, the man can still produce testosterone and sperm. It means he can still get an erection and father children.
Unknowingly, testicular cancer can come back after removal. It’s called a late relapse if the cancer comes back more than two years after treatment. However, experts say it doesn’t happen very often. Statistics showed only around 2 or 3 out of 100 people with testicular cancer have a late relapse. – ###
