Are you at risk of testicular cancer? A doctor explains the red flags to look out for
It represents a small percentage of all cancers in men worldwide but the incidence rate has steadily increased over the past few decades in Singapore. What should you be looking out for? Read on to find out.
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.
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:
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.
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.
HOW IS TESTICULAR CANCER DIAGNOSED?
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.
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.