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COMMENTARY:Testicular cancer commonly seen in younger men - (Univ. of New Mexico)

By Dr. Debra Beeson
April 12, 2000

(U-WIRE) ALBUQUERQUE, N.M. -- Because of denial and embarrassment, many men are reluctant to talk about testicular cancer, let alone seek evaluation and care for lumps they find. This is unfortunate, as the cure rate for this cancer is excellent, with a five-year overall survival rate of 92 percent. This article will explore some facts and myths about the disease.

     Testicular cancer is rare, with an incidence of about four in 100,000 men. It is most commonly seen in young men between the ages of 15 and 35. And it usually manifests as a painless lump or a sense of heaviness in the scrotum. It is five times as common in white men as in black men. The major predisposing factor is an undescended testicle that was not surgically corrected in early childhood. Other risk factors include previous cancer in the other testicle, a history of mumps that affected the testicles, inguinal hernia and high socioeconomic status.

     Most lumps or testicle pains are due to causes other than cancer. The most common diagnoses include testicular torsion (sudden onset of swelling and pain in the testicle due to twisting off of its blood supply), epididymitis (pain, fever, urethral discharge and burning on urination, usually from an infection), inguinal hernia (a mass in the scrotum due to a piece of intestine bulging through a tear in a muscle), hydrocoele (a fluid collection around the testicle), varicocoele (a varicose vein of the testicle) and spermatocoele (a painless cyst containing sperm).

     If the cause is not obvious from physical examination, the physician will usually order an ultrasound of the scrotum to investigate further. Suspicious masses will be removed and biopsied by a urologist.

     Treatment for testicular cancer has improved dramatically over the past decade or so. Early cancer has a cure rate of 95 percent. Even when the cancer has spread beyond the lymph nodes into other organs such as the lungs or the liver, the cure rate is still very high, about 70 percent. A patient's age and overall health are important in determining treatment options. Generally, surgery to remove the testicle can be combined with radiation therapy or chemotherapy or both. Many men worry that losing one testicle will make them impotent. This is not true. For cosmetic reasons, many men will have an artificial implant placed in the scrotum. Radiation and chemotherapy can interfere with sperm production and many men store sperm in a frozen "bank" before treatment as a precaution.

     Although cure rates are good even with advanced disease, obviously earlier is better. The question always comes up as to whether young men and/or their physicians should routinely screen for testicular cancer. It turns out that it is such a rare disease with such a high cure rate that screening for testicular cancer is not very worthwhile. Prevention of AIDS, hepatitis, substance abuse, injuries and violence are all much higher up on the list because they are more common and the consequences more grave. If 100,000 men age 15-35 were screened with a 100 percent sensitive test, at most 10 cancers would be detected. Due to the high cure rate, at least nine of these would be expected to be cured even if the screening program did not exist

     What should you do? If you are at high risk because of being born with an undescended testicle, it is wise to check yourself for lumps monthly. If you are not at high risk and discover a painless lump, it's best to get it checked if it persists for more than two weeks. If you have sudden pain and swelling, get it checked immediately. If you have pain in the testicle and a discharge from the penis or burning on urination, refrain from sex and have it checked within a day or so.

     Remember -- most testicular lumps are not cancer, and testicular cancer is easy to cure, so you needn't fear seeing a doctor for evaluation.

(C) 1999 Daily Lobo via U-WIRE