Do your balls hang low? ....... testicular cancer that is

Testicular cancer is often a young man’s disease ......... as we age and life expectancy increases we have to watch our health so here is something to consider. Originally published on the Jamaica Observer

MEN have notoriously bad health-seeking behaviour. They take very little interest in health matters because, I am told, there are more important things to worry about. With many non-communicable diseases remaining symptomless until advanced stages, it is important that we educate our men and boys to take responsibility for their own health.

There are, of course, some illnesses which strike fear in the hearts of men. In young men especially, any disease which affects the organs of reproduction, are often thought of as being worse than death. I have in fact been told this on many occasions by men who would rather die than receive bad news about their genitals.

TESTICULAR CANCER

Testicular cancer is one affliction that is especially feared, not only because of the organ it affects, but also because it can affect young men. Testicular cancer is rare, accounting for only one per cent of all malignancies in men. It is 4.5 times more common in white men than black men. In white men, it is the most common cancer in men aged 20-34 years. Patients with cryptorchidism (undescended testicles) are 2.5 to eight times more likely to develop testicular cancer.

SYMPTOMS

Symptoms of testicular cancer include, but are not limited to:

• A painless lump in any testicle;

• Pain or discomfort in the testicle or scrotum;

• Enlargement of a testicle or any change in the way it feels;

• Heavy feeling in the scrotum;

• Dull ache in the lower back, abdomen or groin;

• A sudden collection of fluid in the scrotum called a hydrocele.

Any man who experiences any of the symptoms outlined will be referred by his physician to a radiologist for a scrotal ultrasound.

The radiologist will examine the testicle using a high-frequency ultrasound probe. There is absolutely no pain. Gel is placed on the scrotal sac and the ultrasound probe uses sound waves to examine the anatomy of the testicles.

Skin and different membranes cover each testicle. The testicle is divided into 250-400 lobules by fibrous septa. Each lobule contains one to three seminiferous tubules. Each tubule supports two different types of cells that produce the sperm and testosterone. The sperm is transported out of the testis via a system of tubules and eventually ends up in the ejaculate.

There are a multitude of diseases of different parts of the testicles which can be imaged with ultrasound. For the purposes of this article, we will focus on testicular cancer.

Ninety to 95 per cent of testicular tumours are derived from germ cells. These tumours are divided into seminomatous and non-seminomatous groups. Seminomas are the most common type of testicular tumour and account for 50 per cent of all germ cell tumours. They occur most often in men in their 40s and almost never in infants.

The tumours are often confined to the testicle by one of its membranes called the tunica albuginea. The tumour can spread in the blood or lymphatics to the lymph nodes, brain or lungs, and in fact this is found in 25 per cent of men at the time of diagnosis. Many of these patients therefore undergo further radiological tests such as chest X-ray, abdominal ultrasound or computerised tomography (CT) scan to stage the disease. Fortunately, this type of cancer responds well to chemotherapy and radiotherapy.

Non-seminomatous tumours occur most often in men in their thirties. There are different types of this broad group of tumours. One type known as endodermal sinus tumour or infantile embryonal carcinoma occurs most often in children younger than five years old.

Other types of malignant testicular tumour include those of gonadal stromal origin, lymphoma, leukemia and metastasis. Metastasis to the testes is rare; however, the most common primary sources are prostate tumours, lung tumours, malignant melanoma, colon tumours, and kidney tumours.

TREATMENT

Depending on the type and stage of the cancer, treatment options for testicular cancer include:

• Surgery;

• Radiation therapy;

• Chemotherapy; and

• High-dose chemotherapy and stem cell transplant.

TAKE-HOME MESSAGE

The take-home message is similar to the message in all my previous articles: People should take responsibility for their own health and pay attention to any unusual changes in their body.

Men should examine their bodies routinely, just as women are advised to routinely check themselves. Go to your doctor if you find something different and have it investigated. Don’t be afraid to come to the radiologist as the earlier we find disease, the greater the likelihood it can be cured.

Dr Duane Chambers is a consultant radiologist and founding partner of Imaging and Intervention Associates located at shops 58 and 59 Kingston Mall, 8 Ocean Boulevard. He may be contacted through the office numbers 618-4346 or 967-7748.