Tenderness in the sac is the saving grace

Dear Dr. G,

I am a 30 year-old man, and I am currently at the peak of my career and relationship – but something is happening in one of my testicles, and it terrifies me.

My fiancée noticed a lump in my right testicle when she was fondling my testes about two months ago.

The lump was initially tender to the touch, but it has become bigger and more uncomfortable since then. Additionally, my fiancée told me testicular cancer occurs more commonly in younger men and has been urging me to see a doctor.

With a heavy heart, I am putting Dr. G on the spot about the risk of testicular cancer, and would like to ask why it is more common in younger men and if it tends to increase with age?

Also, am I wrong in assuming that the risk of cancer tends to increase with age? Can you tell me how testicular cancer is diagnosed? And who is at risk?

I am scared to see the doctors because I worry about what they will do to me; I understand that testicular cancer is treated through castration, chemotherapy and radiotherapy, so does that spell the end of my sex life and dreams of parenthood?

I am so worried.

Yours truly,
Tender Terrified Tim

Testicular cancer is defined as the malignant changes that develop in the testes. Indeed, this is the most common malignancy occurring almost exclusively in younger men.

The two peaks for the incidence of such cancer are at the age of 25 and 35, and the risk tends to be highest amongst Caucasians in Northern European countries and in the United States while it is relatively uncommon in Asian and African populations.

Having said this, there are generally two common types of testicular cancers, which are Seminoma and the Non-Seminomatous Germ Cell Tumor (NSGCT).

Although it is largely unknown why such cancers occur in younger men, malignant changes during the active phase of spermatogenesis is likely to be the reason. The exact etiology of testicular cancer is also unclear. However, such malignancy tends to be associated with men with a history of undescended testicles and infertility.

About 10% of testicular cancers occur in men with a history of an undescended testicle. The testicles develop inside the abdomen of the fetus during gestation and descend to the scrotum before birth. In some men, the failure of the descent renders the testicles remaining in the abdomen or stuck in the groin.

The higher scrotal temperature is thought to impair spermatogenesis and induce malignant transformation of the germ cells. Genetic defects are also believed to play a role in testicular cancer, as it is also associated with men with history of infertility and a family history of testicular cancer.

Having said that, most men with testicular cancer presented with a painless lump in the testicle and although some men may have a dull ache in their scrotum, most men describe growing lumps in the testicle without any pain or discomfort. This may give a false assurance to some men and delay diagnosis and treatment.

When it comes to a diagnosis, the process is rather straightforward, as it is done using both ultrasound scans and blood investigations. The surgical removal of the affected testicle is usually necessary to determine the type of cancer, assisting further follow-on chemotherapy or radiotherapy.

Also, contrary to what is commonly believed, the castration of both testicles is not necessary, as only the orchidectomy of the affected testicle is required.

The removal of one cancerous testicle tends to have no adverse impact on sexual and reproductive functions of most men. This is clearly demonstrated by countless athletes and sporting icons, famously Lance Armstrong.

Despite presenting with late stage testicular cancer metastasized to the brain, Armstrong underwent surgical and adjuvant interventions which render him cancer-free and won countless cycling tournaments. He is also reported to have multiple sexual partners and fathered numerous children with no difficulties.

In the spirit of Movember November, the spotlight is focused on men’s health and cancers affecting men. Testicular cancer is definitely deserving of the limelight, as it affects mainly young sexually active and productive men.

On the positive notes, this malignancy is arguably one of the most curable cancers with five-year survival rates of more than 95%. This translates to 95 out of 100 men diagnosed with such cancer will live at least 5 years after the diagnosis. The survival rate for early-stage-cancer is near 100%.

Finally, when it comes to early detection, the key is undoubtedly regular “self-fondling” and early medical attention. The saving grace is that most lumps in the sac are benign in nature especially when they come with some pain or tenderness.

The famous actress and singer Marlene Dietrich once said that “without tenderness, a man is uninteresting”.

Therefore, when a man notices a tender lump in his scrotum and is putting Dr G on the spot for his opinion because he’s terrified to see a doctor – my view is that “the tenderness is the saving grace” as without tenderness, a man with a lump in the sac is in need of serious attention! On that note, keep up with the regular self-fondling!