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Here's a question for men: Other than the annual digital rectal examination for prostate cancer by your doctor, which we assume you have been diligently doing, when was the last time you’ve really examined things down there? And, yes, by that, we mean your testicles.
Like women, who should be
performing monthly breast self-examinations for breast lumps, men should also
be conducting monthly self-examinations for lumps in the testicles, according
to Dr Chong Weiliang, an associate consultant with Tan Tock Seng Hospital’s
Department of Urology.
This is particularly important if
you have a high risk of testicular cancer, he said.
“During this self-check, each
testis should be examined for unusual lumps. If any is present, medical
attention should be sought and appropriate tests ordered,” he explained.
(Art: Testicular Cancer Awareness Foundation)
Although testicular cancer
represents a small percentage (1 per cent to 2 per cent) of all cancers in men
worldwide, the incidence rate has steadily increased over the past few decades
in Singapore.
According to the Singapore Cancer
Registry Annual Report, the number of cases has risen from 92 from 1998 to
2002, to 202 cases from 2013 to 2017.
“Thankfully, the absolute number
remains relatively low and, if diagnosed early, can be treated successfully in
the majority of cases,” said Dr Chong.
If this has brought on more
questions, for instance, are you at risk if you’ve injured your groin area
before or if you’re an avid cyclist, here are some answers from Dr Chong:
SCENARIOS TESTICULAR CANCER RISKS
“I found a painless lump in my
scrotum.” The lump may arise
from the testis, cord structures or the skin, and they all carry varying levels
of cancer risks and management options. So seek medical attention as soon as
you can.
“I was hit or kicked in my
scrotum before while playing sports/doing martial arts.” There is no change in the risk of developing testicular
cancer.
“I cycle long distances every
weekend.” Same as the above.
“I was born with only one
testicle.”
The important question to ask is,
what happened to the missing testis. Here a few possibilities:
If the missing testicle was never
formed, or was undescended and subsequently removed. There isn’t a risk of
testicular cancer on this side of the scrotum.
If the missing testicle was not
corrected and/or its fate is unclear. Medical attention should be sought. It
would often involve the removal of the undescended testis.
If the missing testicle was
undescended and corrected.
Before puberty: The risk of
testicular cancer is still present although it is lower than if it was not
corrected.
After puberty: The risk of
testicular cancer is high. Close monitoring of the testis is advised.
(Photo: iStock/Manuel-F-O)
WHAT ARE THE SIGNS OF TESTICULAR
CANCER?
Testicular cancer can sometimes
go unnoticed as it could be present as a painless, pea-sized lump in one of the
testicles – and they can grow much bigger, according to Cancer.net. In some
cases, there may be swelling, pain, discomfort, numbness or a feeling of
heaviness in the affected testicle.
What may also happen is one
testicle may become firmer than the other, and at times, cause the affected
side to grow or shrink, noted the website.
There may be symptoms not related
to the scrotum at all. These include a dull ache in the lower abdomen or groin.
For some young or middle-aged patients, developing a blood clot may be the
first sign of testicular cancer. Signs of such clots could be the swelling of
one or both legs, or shortness of breath.
In later-stage testicular cancer,
there may even be lower back pain, shortness of breath, chest pain, and bloody
phlegm, according to Cancer.net.
(Photo: iStock/Korrawin)
WHO IS AT RISK OF DEVELOPING
TESTICULAR CANCER?
In case you think only elderly
men who can’t control their bladder well are at risk, you’d be wrong. According
to Dr Chong, testicular cancer patients often fall in the age range of 20s to
40s.
A family history of testicular
cancer is another risk factor. Having a father who suffers from it increases
your risk by four times; and by eight times if you have a brother who has the
cancer.
Using a combination of physical
examination as well as an ultrasound scan, according to Dr Chong. “The physical
examination would commonly reveal a hard testicular lump, while the ultrasound
scan would often show a mass arising from within the testis.”
If malignant, the scan would also
pick up an increased blood flow to the lump and “possible invasion into the
surrounding tissues, such as the spermatic cord or the scrotum”.
Blood tests for tumour markers,
including alpha-fetoprotein, B human chorionic gonadotropin and lactate
dehydrogenase, may also be ordered to determine the cancer type, said Dr Chong.
(Photo: iStock/Korrawin)
HOW IS THE CANCER TREATED?
Before any treatment is
performed, sperm banking is advocated, said Dr Chong, as both surgery and
chemotherapy can affect the patient’s fertility.
Then, the whole diseased testis
and its cord will be removed through an inguinal incision, explained Dr Chong.
“If picked up early enough, this is sufficient to render the patient
disease-free and would only require regular surveillance scans and blood tumour
markers.”
However, he explained, if the
cancer is deemed high risk or if the disease has spread from the testis into
the lymphatic system or beyond, chemotherapy would be required.
Should the cancer persist
post-chemotherapy, further surgery may be used to clear up the lymph nodes in
the abdomen. “This surgery, known as a retroperitoneal lymph node dissection,
is a major undertaking, and expert hands will be required to perform such a
complex surgery,” said Dr Chong.
WHAT IS TESTICULAR CANCER’S LINK
TO HAVING HAD AN UNDESCENDED TESTICLE AS AN INFANT?
“It isn’t entirely clear why a
previously undescended testis can increase the risk of testicular cancer,” said
Dr Chong, although there are some hypotheses.
During pregnancy, the testes
actually develop within the foetus’ abdomen, just below the level of the
kidneys, he explained. “As the testes mature, they progressively move downwards
to take their place in each hemi-scrotum.” This descent happens by the 26th to
28th weeks of the pregnancy, well before birth.
An undescended testis is an
indication that its cells are “abnormal to begin with”, said Dr Chong.
Moreover, its undescended position after birth could further expose the testis
to an environment that induces cancerous mutations.
The latter is the reason why
surgical correction is needed for an undescended testis by about 18 months,
said Dr Chong. “It is to reduce the chance of future malignancy and preserve
fertility.” However, this intervention does not nullify the baby’s risk of
testicular cancer. Monthly self-examinations later in life are still required
for the early detection of the cancer.
Just how common are undescended
testicles in babies? “Globally, the incidence of an undescended testis in a
full-term baby ranges from 1 per cent to 3 per cent, while a premature baby may
have an incidence of up to 30 per cent,” said Dr Chong.
HOW DO YOU TELL IF A BABY HAS AN
UNDESCENDED TESTICLE?
“Often, it appears as an absent,
under-developed hemi-scrotum, possibly with a testis felt in the groin on the
same side,” said Dr Chong. “Rarely do you have both testes being undescended.”
If the condition is not picked up
during infanthood or childhood, the patient may notice an absent hemi-scrotum
during adulthood, he said.
Source: CNA/bk