Not the end of the line

Dear Dr G,

I am a 25-year-old-man who never imagined I could get cancer.

I was diagnosed with testicular cancer in November last year and would like to relate my experience.

Two years ago, I noticed a lump in one of my testicles. However, it was painless and I did not think much about it.

After six months, its size increased considerably – to the point that the bulge in my groin area was too big to hide.

I then went to see a doctor, who told me I had cancer and scans showed it had spread to my lymph nodes and lungs.

I was advised to have my testicle removed and to have chemotherapy treatment.

It was terrifying for me and I delayed for one month before I decided to go for the operation.

The operation itself was uneventful and it was confirmed I had stage four cancer and had to undergo chemotherapy.

I also stored some sperm in the event I want children in the future.

After a year, doctors found cancer in my lungs and advised me to have more chemotherapy.

Since then, I have been on the slow road to recovery.

Two years following the initial diagnosis, doctors told me that I was cured of cancer!

I would like to know, however, is stage four cancer indeed curable?

I have not had sex for the last two years and I have started dating.

I don’t want to tell her I have/had cancer as it might scare her off. But it will soon be obvious that I am a bit “lopsided”.

However I would like to know if my sex life ever be normal? Will I still be fertile?

Barry

For testicular cancer, germ cell tumours are the most common type of malignancy. Such tumours are also divided into seminomas and non-seminomatous germ cell tumours.

The risk of being diagnosed with testicular cancer is 0.5% or one in two hundred.

Contrary to common belief that cancer only affects men of 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. The reasons for the increase in its prevalence is unknown.

The most common risk factor for testicular cancer is an undescended testicle but most individuals suffering from testicular cancer have no such association.

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 recent reports, the survival rate in the United Kingdom had even soared to 96% compared to 68% in the 1970s. Experts believe this is due to the advancement of platinum-based chemotherapy and early detection.

According to the latest studies, stage one cancer that remains organ-confined has a five-year survival of 99%, while the cancers with lymph node involvement have a 96% chance with further treatment. Although distant metastasis cancer has less survival advantage (74%), the role of chemotherapy is still paramount to save lives. Hence, the key for complete cure of testicular cancer is early intervention.

The reason for late presentation of testicular cancer is mainly embarrassment, taboo and fear of losing the testicle. The key functions of testicles are hormonal and for reproduction. With the advent of modern medicine, both these functions can be preserved by sperm freezing and testosterone replacement. The longest interval of sperm freezing for the fertilisation of a completely healthy baby is more than 20 years!

The former road racing cyclist, Lance Armstrong, is an example of success in treating testicular cancer. At the age of 25, Armstrong was diagnosed with potentially fatal metastatic testicular cancer to the brain. The cancer was advanced embryonal carcinoma that required multiple operations to remove the testicle and tumours in the brain. Armstrong also underwent numerous chemotherapy sessions after the surgeries.

Within two years, Armstrong engaged in serious training for racing and won his seventh consecutive Tour de France titles (later stripped of all titles after he was found guilty of using performance-enhancing drugs). He was married in the same year and had three children using stored sperm. He had two further relationships and naturally fathered two more children in his second marriage.

While the Oxford Dictionary defines the word “cure” as “elimination or the removal of a disease and resulting in the independence of an unhealthy condition”, the word is rarely mentioned in medical literature, as this is subject to different interpretations.

Hence, the “disease-free survival” following a five- or ten-year interval is a better reflection of “cure”. Technically, there is always that risk of cancer re-emergence as we are dealing with living cells which often have some degree of unpredictability.

Additionally, for someone affected by testicular cancer, the probability the other testicle will be affected is 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 keep them awake at night.

For this testicular cancer survivor, vigilance, treatment and determination saw him through the worst of times. Hopefully, recent successes in testicular cancer treatment which does not affect performance between the sheets will encourage more men to come forward should there be suspicion of testicular cancer.