Cancer of the testes is not one of the more widely discussed cancers. It is however, the cancer that most frequently affects young males in our community aged 15 to 35 years-old. While testicular cancer can grow quite rapidly, it is also a cancer that if diagnosed early, is often found to be curable. The five-year survival rate for this cancer, if detected and treated early, is now 95 percent. The month of April has been designated as Testicular Cancer Awareness and Prevention Month. The awareness color for testicular cancer is orchid - a bright, rich purple tint.
This cancer develops in the testicles, a part of the male reproductive system. More than 95 percent of Testicular cancers are germ cell tumors. As with all cancers, early detection and correct diagnosis is critical for ensuring the most effective and appropriate treatment.

Signs and symptoms of testicular cancer
One of the first signs is often swelling in the affected testis. Symptoms may also include one or more of the following:
o A lump in one testis which may or may not be painful.
o Sharp pain or dull ache in the lower abdomen or scrotum.
o A feeling of "heaviness" in the scrotum.
o Breast enlargement (gynaecomastia).
o Low back pain (lumbago), especially if the tumor has spread to the lymph nodes along the back. If undetected and untreated, it is not uncommon for testicular cancer to spread to other organs, including the lungs. Should this happen, the following symptoms may also be present:
o Shortness of breath (dyspnoea), cough or coughing up blood (haemoptysis) caused by metastatic spread of the cancer to the lungs.
o A lump in the neck, as a result of the spreading of the cancer to the lymph nodes.

Making the diagnosis
There are a number of ways to diagnose testicular cancer, however, the main method is through careful examination of the lump or mass inside the affected testicle. If a young adult or adolescent male has a simple enlarged testicle, which may or may not be painful, his doctor would have reason to suspect that he had developed testicular cancer.
A scrotal ultrasound would determine the exact size and location of the lump or tumor. CT scans would be useful in assessing the extent of the disease and whether it was localized or had spread to other organs (metastasized).
Blood tests are also useful in the diagnosis of testicular cancer. Certain proteins are specific to testicular cancer, and if found in the patient's blood, would confirm the presence of the disease.
It must be noted however that there are other conditions that could present with symptoms similar to that of testicular cancer, these conditions include: Epididymitis, which is an inflammation of the epididymis (the curved structure in which the sperm matures and is stored); Epididymo-orchitis, which is inflammation and swelling of the epididymis and testicles; Haematocele, swelling of the membrane covering the testicles; and Varicocele, enlargement of the veins in the scrotum.

Testicular cancer treatment
Since testicular cancer, like all cancers, can spread to other cells and organs in the body, patients are recommended to have adjuvant treatment - that is, a combination of chemotherapy and/or radiotherapy - following surgical removal of the cancerous testicle, orchiectomy. In certain cases, where the cancer is detected early, patients may be offered a regimen of careful screening, by means of frequent CT scans and blood tests, following their orchiectomy, instead of adjuvant treatment (surgery as well as chemotherapy and/or radiotherapy).
Surgery: As only one testis is generally needed to maintain fertility, hormone production and other normal male functions, the cancerous testis is almost always removed completely (to prevent the spread of pre-cancerous cells to neighboring sites, including the remaining testis), in a procedure called "inguinal orchiectomy" or "radical orchiectomy".
Chemotherapy: As an adjuvant treatment, two doses, typically delivered three weeks apart, or occasionally a single dose is proving to be very successful. Chemotherapy is also the standard mode of treatment when the cancer has spread to other parts of the body.
Radiation therapy: This is used both as adjuvant (preventative) therapy in the case of stage 1 disease, to minimize the chances that small, non-detectable tumors may exist and spread to neighboring structures by means of the (inguinal and para-aortic) lymph nodes. Radiation therapy is generally never used as the primary therapy in the treatment of testicular cancer.
While the treatment success depends, to a significant degree, on how advanced the disease is, the average survival rate after five years is around 95 percent. However, with respect to stage 1 cancer cases, if monitored properly, they essentially have a 100 percent survival rate. This is the primary reason why prompt action, when testicular cancer is a possibility, is so very important.
The prognosis for a male with testicular cancer is very good. It is relatively easy to detect, diagnose and effectively treat. As with most cancers, early detection is key.

oFor more information on any cancer related topic, telephone the Cancer Society of The Bahamas at 323-441 or 323-4482; you may also email us at cancersocietybahamas.com; or log on to our website at www.cancersocietybahamas.org.

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