Surviving testicular cancer

AUG 31 is our proud day of Independence. Instead of spending quality time at home with the kids, I felt sad I was stuck in a long flight to Taipei for a conference. Long plane journeys are bores! It is mere claustrophobia of rigidity, complemented by an atrocity of bad food and cheap wines.

I often try my best to pretend to drift away in my own clouds behind the loose eyeshades and useless earplugs when travelling. Of course it was not easy when on the left, there was an oversized man overpowering the whole cabin with his snores and the lady on the right was drowning in her own tears absorbed by the inflight movie.

I was captivated. The lady was watching the movie The Fault in our Stars. I reached out to the stewardess and asked for the earphones. Needless to say, I wasn’t just crying. I was drenched in my own tears. I don’t remember when was the last time a grown man like me was reduced to tears by a film, but this love story of teenage cancer sufferers were truly inspiring.

I admit, I have been dreading to answer this email from Peter, as I did not have the courage to address his questions. After today, I cannot think to a more appropriate time to respond.

Dear Dr. G,

I am 24 year old. I was diagnosed with testicular cancer.

I could not believe it when the doctor told me I had cancer. I mean cancer, at 22 years old? Truthfully, I still find it difficult to accept my fate until I felt the empty left scrotal sac. Why me?

I was lucky. The doctor said the scan showed stage one disease. Despite that, I received one course of chemotherapy to reduce the risk of recurrence.

I was advised by the oncologist to keep the sperms in the sperm bank just in case the therapy wipes out my chances of fatherhood in the future.

It has been two years and I am counting on my lucky stars.

Don’t get me wrong; I appreciate every moment of life, and trust me, my life has changed. I am treating everyday, as it was my last.

On the other hand, I am also worried. After all, I had lost 50% of my manhood.

I am apprehensive in getting involved in relationships as I worry I may be compromised in the bedroom. Worst still, I worry about be struck by cancer recurrence during a relationship.

What impact will the can testicular cancer have on me? Will it affect my sexual ability? Can I even father a child naturally?

Will I ever be normal again?

Peter

As a doctor, I was disheartened to read Peter’s letter. Sometimes, it is true that our effort is focused on treating the disease instead of the person behind that pathology. In truth, we all have so much to learn from inspirational journeys many cancer sufferers had experienced in their lives.

Testicular cancer is one of the commonest cancers affecting young men aged between 18 to 45 years old, as this may be the age of maximal spermatogenesis. Apart from undescended testicles during childhood, the real etiology of this condition is largely unknown.

The treatment of testicular cancer is one of the rare success stories in medicine. The efficacy of chemotherapy had improved from 60% in 1960’s to near 100% survival in the 21st century, even in the advanced stages. This exceptional triumph is mainly due discovery of a platinum-based chemotherapy.

Although, it is daunting for Peter to face the follow-up scans with the fear of tumor recurrence. The actual chance of him developing cancer in the remaining testicle is about 5% and the risk of tumor re-emerging after adjuvant chemotherapy is less than 3%. I think the odds are with him. So, go on, start your journey of love.

It is not uncommon for testicular cancer survivors to feel “inadequate” when it comes to sexual matters. The two functions of the testicles are sperms and testosterone productions. These are more than adequately compensated by his remaining testis, despite one course of chemotherapy. The back-up frozen sperms may not be necessary, once we confirm normal semen analysis.

The erectile functions and other sexual performance are rarely affected by the orchidectomy. However, many men stills experience “emptiness” after the surgery. This may be rectified by silicon testicular prosthesis as a replacement.

The success of the testicular cancer therapy had not just changed the landscape of medicine. The stories behind many personalities fought hard to be cancer-free such as Lance Armstrong, Jimmy White and Bobby Moore also bring hope to many who are facing cancer and lessons for others to appreciate life without taking it for granted.

“There is no easy walk to freedom anywhere, and many of us will have to pass through the valley of the shadow of death again and again before we reached the mountain of our desires” once said Nelson Mandela. “For the free is not merely the cast of one’s chains, but to live in a way that respects and enhances the freedom of others”

On our 57th Independence Day celebration, let’s don’t forget the struggles of our fathers and fore-fathers and learn from those who had journeyed life even in the face of death. Lets don’t take things for granted and take them with gratitude. As JFK once said: “As we express our gratitude. We must never forget that the highest appreciation is not to utter words, but to live by them.”