Testicular Cancer

THIS week, we address a reader’s celebration of “independence” from the dark days of testicular cancer, and yet cautiously guiding him to move forward in the days ahead.

Dear Dr G,

I am 28 years old and I remember the day I was diagnosed with testicular cancer.

Two years ago, I had a painless lump in my testicle and did not think much about it.

Initially, I actually thought I hurt myself from too much “self-indulgence” (you know what I mean).

After three months of anxiety, I eventually built up the courage to see a doctor.

Besides, the bulge in my groin was getting so big that I couldn’t hide it anymore.

The doctor told me I had cancer and the scan showed the cancer had spread to the lymph nodes in my body.

I had my sperms banked, testicle removed and this was followed by chemotherapy.

Incidentally, my girlfriend also left me after two cycles of treatment.

On the first year since my diagnosis, the doctors found more cancers in my lungs and advised me to have more chemo.

Since then, I have been slowly getting back on track to recovery.

I had a check up for two years following the diagnosis, and the doctors told me that I am cured! Is that possible? Is cancer really curable?

I have not had sex for the last two years during treatment, and I have started cautiously dating.

I don’t want to tell the woman I am dating that I had cancer as I don’t want to scare her off. What should I do?

Also, what am I going to do with all those sperms I previously banked?

M

The lifetime risk of men diagnosed with testicular cancer is 0.5% or one in 200.

Contrary to common belief that cancer only affects men with advancing age, testicular cancer is the most common cancer in males aged 20 to 40 years.

Globally, the incidence of testicular cancer is on the rise, affecting 8,000 men in the United States and 2,000 men in the United Kingdom annually.

Although testicular cancer resulted in 8,300 deaths in 2013, this cancer has one of the highest cure rates of all cancers with an average five-year survival of more than 95%.

In a recent report, the survival in the UK had even soared to 96% compared to 68% in the 1970s.

Experts believe the medical success is due to the advancement of the platinum-based chemotherapy and early detection that saves lives.

According to the latest studies, stage I cancer that remains organ confined has a five-year survival of 99%, while cancers which spread to the lymph nodes still stand a chance of 96% survival with further treatment.

Although the distant metastasis cancer has less survival advantage (74%), the role of chemotherapy is still paramount in saving lives.

Oxford English Dictionary defines the word “cure” as “elimination or the removal of a disease and resulted in the independence of an unhealthy condition”.

In medical literature, the word cure is rarely mentioned as this may be subjected to different interpretations.

Hence, the “disease-free survival” following a five or 10-year interval is a better reflection of “cure”.

Technically, there is always that risk of re-emergence of the cancer, as we are dealing with living cells, which often have some degree of unpredictability.

Besides, for someone who is affected by testicular cancer, the risk of cancer affecting the other testicle is well documented at 5%.

To most, this might not be a significant risk but for men with solitary testes, the fear of losing the remaining “crown jewel” may be a nightmare, keeping them awake at night.

The key functions of testicles are hormonal and reproduction.

With the advent of modern medicine, both these functions can be preserved by the technology of sperm freezing and testosterone replacement.

The longest interval of sperm freezing for the fertilisation of a completely healthy baby was above two decades.

Therefore, there is always no real hurry to thaw those poor frozen gametes.

French philosopher and writer, Voltaire once said: “Injustice in the end produces independence.”

The “injustice” of testicular cancer has undoubtedly generated fear and lost of hope, however, with vigilant treatment and determination, the “independence” from the illness is often a matter of time.