A Young Person's Guide to Checking Your Balls for Cancer
Testicular cancer is one of the most common diseases affecting young men, which is why a guide to self-examination could save your life.
Illustrations by Michael Dockery
For young guys, testicular cancer comes in second only to skin cancer as the most common. The average age of diagnosis sits at around 36 years and in 2016, it's predicted 795 Australian guys will be diagnosed with the disease. The risk of developing it by the age of 85 is one in 201. Although I should point out this compares to a one in eight for women of developing breast cancer by the same age. Yes, I'll be writing a follow-up on breast cancer too.
Over 90 percent of testicular cancers are what are known as germ cell tumours. These develop from the germ cells of the testes, which are cells that eventually develop into mature sperm. The two main types of germ cell tumours are seminomas (40 percent) and non-seminomatous germ cell tumours (60 percent). Seminomas tend to affect men aged between 25 and 50 years, while the more aggressive non-seminomatous type are most often found in men in their 20s.
What to Look Out for
Sometimes men with testicular cancer don't experience any symptoms at all. When they do, the most common symptom is a painless swelling or lump. Less common symptoms include a change in the size and shape of a testis, a feeling of heaviness in the scrotum, an aching or pain in the lower abdomen/testis/scrotum. Nipples can also become enlarged and tender.
The Risk Factors
The factors that put men at risk of developing testicular cancer are unfortunately non-reversible and non-preventable: a family or personal history of testicular cancer and being born with one or both testes undescended (cryptorchidism) are the main ones. Injuring your balls, wearing tight clothes, taking hot baths, or getting injured playing sport are not associated with testicular cancer.
Diagnosis, Treatment, and Survival
Diagnosing testicular cancer normally involves both imaging and blood tests. The presence of a testicular mass can be determined via ultrasound scan, and the blood tests look for various tumour markers (including alpha-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase).
Further imaging modalities such as chest X-rays and CT scans are used to determine the stage (or spread) of the cancer, and the stage in turn determines what treatment will be needed. If the cancer is only found in the testis, then removal of testis (called an orchidectomy) is often the only treatment required. If the cancer has spread beyond the testis to lymph nodes or organs (such as the lungs, liver, or brain), then chemotherapy and/or radiotherapy may be required. Removing a single testicle does not affect fertility or male hormone production, but chemotherapy and radiotherapy can lower sperm counts temporarily or permanently.
While a man's recovery from testicular cancer depends on multiple different factors (including the cancer type, spread and the person's general health), the prognosis is generally good. Of the 795 Australian men predicted to get testicular cancer this year, it is estimated that only five will die from it. At five years after diagnosis, 98 percent of men with this disease will still be alive.
To Screen or Not to Screen
Unlike breast and cervical cancer for women, there is no formal routine screening program for testicular cancer. There is however a push from many organisations such as Movember and Andrology Australia for men to perform regular self-examinations. Accompanying this are various celebrity endorsements, media campaigns and Twitter hashtags (#FeelingNuts) that help to raise awareness and reduce stigma.
In his 2012 piece for The Conversation, urologist and uro-oncologist Mark Frydenberg stated that self-examination can help men get familiar with their balls and scrotal structures. This in turn makes them more aware when a lump or change in testicular consistency occurs.
To check your testicles for cancer use the following steps:
- Make sure your scrotum is warm and relaxed (i.e. straight after a hot shower) so that the testes hang down lower.
- Use the palm of your hand to support the scrotum. Note the size and weight of the testes. It's common for one to be larger than the other, and for one to hang lower.
- Gently roll one testis between your thumb and fingers to feel for any lumps in or on the surface of the testis. The testes should feel firm and the surface smooth.
- Use your fingers and thumb to feel along the thickening located at the back of the testis, looking in particular for any swellings in this area. This is the epididymis, a highly coiled structure that transfers sperm from the testis to the penis.
- Repeat with the second testis and epididymis.
If you want to watch a really embarrassing video on self-examination, check out this one.
However, self-examination is not without controversy, While it certainly seems like a good idea, there is very little evidence to suggest that these checks detect cancer earlier or improve outcomes. Indeed, a Cochrane Database Systematic Review from 2011 found no randomised control trials evaluating the effectiveness of screening for testicular cancer had ever been done. The evidence that does exist suggests that because of the very low incidence and very high cure rate even with advanced disease, the benefits of testicular cancer screening are small to none.
Having said that, if you have any of the symptoms described in this article, go and see your GP. Evidence suggests that the key issue with testicular cancer is not men failing to notice the symptoms, but rather failing to act on them.
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