Testicle cancer, treatment and teens

Dear Dr. G,

I understand Dr. G is featuring paediatric urological conditions in June.

Technically, my son is an adolescent and therefore should be considered as having a paediatric condition.

I am a father of two young men aged 18 and 16.

My older son came to me a few weeks ago, complaining of some painless swelling in his left testicle.

He was born prematurely with an undescended testicle, so I assured him that the swelling was probably related to his childhood operation.

I even told him not to fiddle with his testicles too much.

As the swelling continued to worsen, I eventually took him to the doctors.

To my horror, the doctor told us it is likely to be cancer and requires surgical removal to confirm the diagnosis.

We underwent several ultrasound scans and sought other medical opinions, all of which concluded that it was cancer.

Both my wife and I are convinced the operation is inevitable, but we would like to put Dr. G on the spot for last-ditch clarifications.

Why is testicular cancer more common in young men and adolescents?

Am I wrong in assuming cancer risk tends to increase with age?

How is testicular cancer diagnosed, and who is at risk?

I understand the treatment for testicular cancer includes castration, chemotherapy, and radiotherapy. Does this spell the end of his sex life and dreams of parenthood?

Shouldn’t a cancerous testicle be painful rather than painless?

Is testicular cancer genetic in origin, and will it affect my younger son too?

Finally, do you think I have done my son harm by delaying his diagnosis by a few weeks?

I am so worried. Can you help?

Yours truly, Painless Philip

Testicular cancer is a malignant growth that develops in the testes. It is well-recognised to occur almost exclusively in younger men, with peak incidences at the ages of 25 and 35. The risk tends to be highest among Caucasians in Northern European countries and the USA. This cancer is relatively uncommon among Asian and African men.

Although the causes of testicular cancer in youth are largely unknown, it is likely due to genetic mutations during the active phase of spermatogenesis. The exact cause of testicular cancer is unclear, but risk factors include undescended testicles and male infertility. Men born with undescended testicles expose the affected scrotum to warmer body temperature, increasing the risk of malignancy fiftyfold.

There is a small genetic risk of developing testicular cancers, but most scrotal malignancies occur spontaneously without any predisposition. Ten percent of testicular cancers occur in men with a history of undescended testicles. The testicles develop inside the abdomen of the foetus during gestation and descend to the scrotum before birth.

In some men, the failure of the testicle’s descent leaves them 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 also play a role in testicular cancer and are associated with men with a history of infertility and family history of testicular cancer.

Men with testicular cancer tend to present with a painless lump in the testicle. Occasionally, some sufferers describe a dull ache in the scrotum in the early stages. In general, most men experience growing lumps in the testicle without any pain or discomfort. Painlessness often gives false assurance to sufferers, potentially delaying diagnosis and treatment. The diagnostic process for testicular cancer is straightforward, involving definitive ultrasound scans and blood tests.

Following confirmatory investigations, surgical removal of the affected testicle is the only way to determine the type of cancer. Radical orchiectomy is both curative and diagnostic. The two common types of testicular cancers are Seminoma and Non-Seminomatous Germ Cell Tumour (NSGCT).

Further staging CT scans are often necessary to determine the true extent of the tumour, which dictates the necessity of adjuvant chemotherapy or radiotherapy. The removal of one cancerous testicle will have no adverse impact on the sexual and reproductive functions of affected men.

This is reflected by countless athletes and sporting icons diagnosed and treated for testicular cancers, such as Lance Armstrong.Despite presenting with late-stage testicular cancer that had metastasised to the brain, Armstrong underwent surgical and adjuvant interventions and famously won numerous cycling tournaments. He is also reported to have multiple sexual partners and has fathered numerous children without difficulty. Apart from the doping scandals, Armstrong is a beacon of hope for young men newly diagnosed and treated for testicular cancer.

Testicular cancer deserves the limelight as it mainly affects adolescents and young, sexually active, and productive men. On a positive note, this malignancy is arguably the most curable cancer, with five-year survival rates reaching nearly 100%. The key for early detection is regular self-examination and early medical attention.

The true lesson for young men with abnormal testicular lumps is not to be fooled into thinking that painless lumps are less likely to be lethal. When men notice lumps and tenderness in their scrotum and are terrified about seeing a doctor, Dr. G’s opinion is that without tenderness, a man should never be uninterested.

On that note, keep up with regular self-examinations, starting from adolescence