Testicular Cancer: What Young Men Need to Know About Symptoms, Self-Exams and Early Detection

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November 18, 2020


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Testicular cancer is not common — about 1 of every 250 males will develop the disease at some point during their lifetime. But the incidence rate of testicular cancer is rising about 10 percent every five years.

And it’s primarily a cancer that strikes young men between the ages of 15 and 40, with the average age at the time of diagnosis at 33, says the American Cancer Society. Testicular cancer can also go undetected in early stages because a painless lump or mass may go unnoticed.

A man’s lifetime risk of dying from this cancer is very low, even if it is detected after it has spread to other organs,  said Ahmed Eldefrawy, M.D., a urologic oncologist at Miami Cancer Institute.

“We find that the incidence of testicular cancer is increasing … if we compare the incidence rate now to about 10 or 20 years ago,” explains Dr. Eldefrawy. “We find that every five years, the incidence increases about 10 percent. What is the cause of this increase? It’s unknown. It’s most likely environmental changes that cause genetic mutations that could be resulting in higher rates of testicular cancer. That’s most likely what it is. Still, at the end of the day, testicular cancer is rare. It’s just that the incidence is increasing over time.”

The primary symptom of testicular cancer is a lump or mass in either testicle and a feeling of heaviness in the scrotum.

“Men should be aware that testicular cancer can be completely painless,” emphasizes Dr. Eldefrawy. “I’ve seen so many patients who have had it for a year or two. And I ask them why they didn’t come in earlier when they noticed they had it. And they say it was painless so it didn’t bother them. But if men feel a lump or mass, they should go see their doctor, whether it’s their primary care physician or a urologist if they have access to one.”

Here’s more from Dr. Eldefrawy on testicular cancer:

Question: What is the No. 1 symptom of testicular cancer?

Dr. Eldefrawy: “Seeing or feeling a mass that comes off the testicle, and it’s usually a lot harder in consistency than the normal feeling of a testicle. It’s worth saying that testicular cancer is painless. And if people complain of pain, it’s not really pain — it’s more of a discomfort or heaviness if the mass gets bigger. And they can grow bigger really fast over weeks and months. So, the heaviness from the size of the mass is what creates a discomfort. But, generally, it’s painless.”

Question: Any other symptoms besides a lump or mass?

Dr. Eldefrawy: “Usually, we catch it early …  and we find a small mass. But if men ignore it mainly because it’s painless, then it can spread. And this cancer is highly metastatic and spreads very quickly. So that’s when the rare symptoms can happen. Some patients may have a lung mass. Their lungs will be affected by the testicular cancer. So, they would get shortness of breath because the normal lung tissues are significantly reduced to — sometimes more than half of the lung tissues are replaced by cancer. They will get short of breath with minimal effort. Sometimes they can even cough blood. I’ve also seen a patient with a brain mass and these patients can develop seizures. And, occasionally, they have very large lymph nodes in the retroperitoneum (the area in the back of the abdomen behind the tissue that lines the abdominal wall and covers most of the organs in the abdomen) and they can develop back pain.”

Question: Are there any preventative measures that men can take against testicular cancer?

Dr. Eldefrawy: “There are preventive measures in terms of early detection, but not in terms of not getting testicular cancer. Men who are going to develop testicular cancer will develop it no matter what. What they can do is to detect it very early before it metastasizes so it can be treated early. Prevention can take the form of self-examination once a month in the shower. And that’s recommended for men between the ages of 15 and 40. That’s peak time for testicular cancer. So once a month, every man should examine their testicles. The self-exam is done with one hand over each testicle, usually with the thumb and the middle and index finger against the skin. Stretch the skin over the testicle. With the other hand, feel the testicle to see if a lump or mass or different consistency. Perform the same self-exam over the other testicle.”

Question: What is the probability of testicular cancer on both sides?

Dr. Eldefrawy: “Roughly, one out of 100 testicular cancer patients will develop cancer on both sides. The vast majority is only on one side. I only saw one patient that had on both sides at the same time. It’s rare.”

Question: What are the top risk factors for testicular cancer?

Dr. Eldefrawy: “White men tend to have more testicular cancer (than men of color). The other risk factor, in addition to a family history of testicular cancer, is being born with undescended testicles. When a boy is born with undescended testicles, we wait up to a year for the testicles to descend on their own. After one year, if it doesn’t descend, we perform a surgical procedure known as orchiopexy to move the testicle down into the scrotum. So, males born with an undescended testicle are at a higher risk of having testicular cancer in the future, even if the orchiopexy was successful.”

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