Hearing a doctor say, "I'm sorry to tell you this, but you have cancer," can be terrifying for patients and their loved ones.
The anxiety is amplified when the disease involves delicate, private parts of the body. Yet, we shouldn't live in fear or surrender to embarrassment. Talking about these types of cancer is the first step in gaining information. And as everyone knows, knowledge is power.
One reason for the silence surrounding testicular cancer is its rarity.
"It comprises about 1% of all tumors in men," said Lee A. Hugar, MD, MSCR, with Lexington Urology. "There are only about 10,000 cases in the U.S. a year. Okay. So, if you think about a population with 150 million men, it's not that many."
"But if it happens to you, it's going to be scary," Dr. Hugar added.
While the jolt of a positive diagnosis is indeed frightening, Dr. Hugar said most patients have every reason to be optimistic.
"The good news with testicular cancer is that the survival rates are excellent with early treatment," he said. "There is about 90% survivability."
The first step begins with self-examination - i.e., men checking their bodies similar to how women check theirs for signs of breast cancer.
"That's why Testicular Cancer Awareness Month is so important," Dr. Hugar explained. "It brings the issue to the forefront where maybe those people who wouldn't normally think to do a self-testicular exam might say, 'You know, I should look into that. I should keep tabs on that a little more closely.'"
Anatomy works to their advantage, too, he noted.
"A man's testicles are in a very accessible location for screening," he said. "So, it's really easy to do. You can do it in your free time in the shower and just learn what the contour of the testicle feels like, what's normal, and then if you notice a change, specifically a new lump or mass, that's when you'd want to be seen right away by your primary care provider. Or make an appointment with a urologist."
Which males are at most significant risk for the disease? Unlike other cancers, this one targets men at the front end of their lives.
"It's generally a disease of young men, late teens to early forties," Dr. Hugar stated. "Half of all men diagnosed are between the ages of 20 and 34, and another 25% are between 35 and 44. So the average is around 33 years old. You can think of it as a disease of men in their thirties, plus or minus a decade. That's probably the most important time to screen. Certainly, teenagers and older men can be diagnosed with testicular cancer as well. It's just not quite as common."
And what happens once a man is diagnosed with testicular cancer?
"If there is a mass, you talk the patient through the next step, which is surgery to remove the testicle, and you get that scheduled as soon as you can," he said. "It's certainly scary, and you can understandably recognize they're worried. But they've usually internalized the necessity of surgery by the time they see me."
And while few medical procedures are ever painless, this one is surprisingly easy to navigate.
"The patient is going to be sore for a couple of days," Dr. Hugar explained. "But the scrotum is a very forgiving structure. You can ice it. So long term, you don't see it. I have patients who take anti-inflammatories and ice, and generally, they can get by without any opioids, which is preferable."
Given the biological task of the organ we're talking about - and the fact most testicular cancer patients are young - what about the ability to have children after surgery? Not to worry, Dr. Hugar advised.
"I'm asked that a lot," he said. "And the good news is whether you have one testicle or two, fertility rates and hormonal function, meaning how much testosterone your body makes, are the same. So, generally, the other testicle will make up for any lost endocrine or testosterone-producing function. Also, there are millions upon millions of sperm. So, one testicle can certainly do the job."
Once the surgery is over, there is obviously a physical difference in the patient's appearance. But Dr. Hugar says that can be easily addressed.
"After the surgery, some men have a cosmetic body image change because they go from having two testicles to one," he said. "I let patients know that a prosthesis placement, which is kind of similar to a breast implant, is an option. It's a little silicone egg-shaped device placed in the scrotum after the testicle comes out to restore that symmetry to the appearance. Patients will have an inguinal incision in the same location as if they were to have an open hernia repair."
Recovery time is short, too.
"Usually about two weeks," Dr. Hugar estimated. "No heavy lifting, no strenuous exercise. After that, they can generally return to doing what they'd like."
As with other types of cancers, patients are regularly screened for five years to guard against recurrence. As is also the case with all illnesses, a lifestyle based on a healthy diet and plenty of exercise prevents the disease.
But Dr. Hugar stressed that should a patient become one of the rare cases diagnosed with testicular cancer, they don't have to go through it alone.
"I recognize what they're feeling," he said. "It's a very stressful time and there's a lot of uncertainty. But I'm going to help them through it. At Lexington Medical Center, we've got nurse navigators who help patients get through the flow of seeing different physicians and cancer doctors coordinating their follow-up. And they're a huge help and resource for patients. So, I often tell them, 'You've got a big team looking out for you.'"
Lee A. Hugar, MD, MSCR, Lexington Urology
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