Medical Minute with Dr. Lee – Testicular Cancer

April is Testicular Cancer Awareness Month and is observed annually to encourage men to get tested for testicular cancer.   Compared to other cancers, testicular cancer is rare, ranking 24th in 2021.  It occurs in about 1:250 men during their lifetime.  It is estimated that there will be 9,910 new cases of testicular cancer diagnosed in 2022, and 460 deaths in the U.S.  The rate of testicular cancer occurrence has been increasing for several decades.  Experts do not know why this has occurred but more recently, the rate of increase has slowed. 

The 1971 movie Brian’s Song was the story of Chicago Bear halfback Brian Piccolo told by his friend and teammate Gale Sayers (still the youngest inductee to the Pro Football Hall of fame).  It is a poignant story of Brian Piccolo’s life before and after his diagnosis of testicular cancer, he died at age 26. This illustrates that testicular cancer is a cancer of young men and is one of the most diagnosed cancers in young adult men.  The average age at time of diagnosis for testicular cancer is 33.  Other famous people with testicular cancer include Lance Armstrong, NBA star Nene, Live PD host Dan Abrams, Olympian Scott Hamilton, and NFL kicker Josh Bidwell.

Seventy-five percent of cases of testicular cancers occur between the ages of 20 and 40 years of age, 5% occur in children and teens and only 8% occur in ages greater than 55.  The rate of survival in testicular cancer is favorable, with 95% of men diagnosed surviving at least 5 years after the diagnosis.  As with most cancers, the survival rate is highest for those diagnosed with early-stage cancer.  For stage 1, cancer that has not spread beyond the testicles, the survival rate is 99%, but only 68% of men are diagnosed at this stage.  Therefore, screening is very important.

Risk factors include undescended testes (testicles fail to move down from the abdomen into the scrotum at birth), family history of testicular cancer, personal history of testicular cancer, and HIV infection.  It is more common in white men than African- and Asian-American men. 

Signs and symptoms of testicular cancer include lumps or swelling in the testicle, breast growth or soreness, and early puberty.  There are several non-cancerous conditions that can cause these, but if present, a doctor should be seen right away.  Some men with testicular cancer have no symptoms at all and testicular cancer is found during testing for other conditions.  Symptoms of advanced testicular cancer include low back pain, shortness of breath, chest pain, cough, abdominal pain, headaches, or confusion. 

Most of the time a lump on the testicle is the first symptom of testicular cancer; alternatively, one testicle may be swollen larger than the other.  Early detection of testicular cancer is possible with self-examination and, as stated earlier, is associated with better survival.  Testicular self-exam is performed by examining each testicle separately between your thumb and fingers, rolling gently.  It is normal for one testicle to be slightly larger than the other or hang lower than the other, but this should not change from exam to exam.  There is also a small, coiled tube on the middle to upper outside part of the testicle called the epididymis that may feel like a small bump.  This is normal.  Regular examination of your testicles will allow you to detect subtle, new changes and any differences from normal.  There is debate regarding the frequency of testicular self-exam, but those at higher risk should be performing these monthly.  If you find any hard lumps or nodules, or any change in the size, shape, or consistency of the testicle you should see your doctor. 

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