Explainer: Understanding testicular cancer and why men shouldn’t feel shy to get tested early

In the recent past, when one talks about men's health, there has been an increasing focus on mental health, which has come to the fore because of the Covid-19 pandemic. Every November there is also an attempt to shed more light on men's health issues. Known as Men's Health Awareness Month globally, the observance coincides with International Men's Day which was celebrated on November 19.

Incidentally, the month of November focuses on men's health in more ways than one as worldwide movements such as ‘Movember' are also underway. It broadly focuses on raising awareness about prostate cancer, testicular cancer, mental health and suicide prevention among men.

After focussing on prostate cancer and mental health as a part of the series on men's health this month, this week throws light on testicular cancer. A type of cancer that experts say is necessary to check even though it has a low incidence in India, because early treatment will lead to complete cure of the cancer.

Mid-day Online spoke to Dr Prasad Kasbekar, consultant surgical oncologist, Masina Hospital, and Dr Santoshi Janardan Nagaonkar, director, urological oncology, Sir HN Reliance Foundation Hospital to understand more about the type of cancer affecting men. Kasbekar and Nagaonkar not only dwell on the causes and effects but also the need for men to not feel shy and instead conduct self-examinations to help detect and treat the cancer early.

What is testicular cancer?
Kasbekar: Every male has two reproductive organs located in the groin region of the body in a special sac known as the scrotum; these are your testes, from which the sperms are produced for male reproduction. Abnormal development of the cells in this area can lead to cancer, and that is what we call testicular cancer. Testicular cancers are classified into three types: the first is a seminomatous germ cell tumour type, the second is a non-seminomatous germ cell tumour type, and the third is lymphoma.

Who is prone to suffering from testicular cancer? Is it seen more in a particular age group?
Kasbekar: Seminomatous and non-seminomatous are seen in younger age groups. While seminomatous is approximately seen in the 30 to 40 years age bracket, non-seminomatous is even younger in the 20 to 30 years age bracket. Testicular lymphomas are seen more in advanced stages, and above 50 years of age.

Nagaonkar: One of the predisposing factors for developing testicular cancer is undescended testes. Male children who are born with hidden testes (one or both) which are not palpable in the scrotum at the time of birth have an increased risk of developing testes cancer. This cancer also has family predisposition, mainly kids born to father or brother who suffered with testicular cancer carry higher risk. Testicular cancer is one of the cancers with the highest cure rate, if diagnosed in an early stage. Younger men in the age range of 18-44 years often get diagnosed with this cancer.

What are the causes of testicular cancer?
Kasbekar: People who have an abnormal descent of testes, which is known as cryptorchidism, or have a history of trauma to the testes, or in general have radiation exposure to the testes, or have a known genetic disorder such as Down Syndrome, or any genetic problem, are more at risk for testicular cancer.

What are the effects of testicular cancer?
Kasbekar: Usually testicular cancer presents as a reduced or loss of sensation in the testes or as a painless lump or mass in the testes that a man may feel on simple examination. This should always be taken seriously because cancers of the testes, if treated effectively, can have a very good result and long survival.

Treatment for these cancers typically begins with the removal of the testes, which is accomplished through a high inguinal orchiectomy surgery. A biopsy of the testes directly by passing a needle is completely contradicted, as it has been shown to increase spread and discomfort due to the testes.

What are the symptoms one should look for in testicular cancer?
Kasbekar: Usually the symptoms one looks for in testicular cancer are a painless enlargement of one testicle. This is usually insidious on presentation, and during routine examination, a person finds some difference in his testes. Experiencing back pain or even abdominal pain sometimes are the other symptoms.

Nagaonkar: Like most other cancers, in early stages this cancer will cause no symptoms. One can feel an abnormal painless lump or heaviness in their scrotum. In advanced cancers, the person can experience weight loss, loss of appetite, bone pain, breathing difficulties or even swelling in the abdomen or neck regions. Standard treatment for this cancer is removal of the affected testes. In slightly advanced cases, chemotherapy or radiation therapy may have to be used.

What are the misconceptions about testicular cancer?
Nagaonkar: There are some misconceptions about testicular cancer. Even though the cancer is common in the younger population, it also affects older men. Cancer cells do not get transmitted to your sexual partner and neither is it linked to Sexually Transmitted Diseases (STD's). Also, any trivial trauma to the scrotal region will not lead to cancer. Testicular cancer will not cause infertility (low sperm count), but it has been observed that more than 50 per cent men diagnosed with testis cancer coincidentally will have poor sperm count. However, the therapeutic treatment (surgery/chemotherapy/radiation therapy) of testicular cancer could be one of the causes of male infertility. Therefore, your treating doctor will recommend doing sperm banking (preservation) before initiating any treatment.

What is the severity of testicular cancer in men?
Kasbekar: Though not as common as other cancers such as breast or mouth cancer, testicular cancer is also a cancer of which people should be aware because if treated early, people can have very good results and live long lives. Avoidance and late treatment generally lead to complications such as the spread of the disease, which later leads to a lot of stress as well as a lot of surgery, chemotherapy, radiation, and other procedures. Hence, early detection can reduce the morbidity of treatment as well as improve the patient's overall survival.

What is the frequency in which men should get themselves checked?
Kasbekar: Since early treatment of testicular cancer can have very good results, testicular self-examination is very important. Go to the doctor, get yourself checked once again, understand how you should examine your testes, and do it once every 3 to 4 months after the age of 20. That means you have to look for the size, shape, consistency, and feel when you do the examination. Look for any change in the sensations.

Why is it important to raise awareness about testicular cancer? Is it among the top cancers men should be weary of?
Nagaonkar: Due to its nature, most men don't like to talk about this cancer and they are also shy in presenting them to a doctor. Therefore, it is crucial to raise awareness about this cancer. A simple ‘Self-Examination Test (SET)' on a periodical basis can lead to an early diagnosis and complete cure of the cancer. A systematic scrotal examination to palpate individual testis to feel for any lumps is very easy and can be done while having a shower when the muscles are relaxed and one has complete privacy. In case of any doubt, one should not hesitate to seek an opinion from a urologist. The urologist will perform a simple examination and based on his/her findings, will initiate any further tests. Even the subsequent tests are simple which may include an ultrasound examination, X-ray and some blood tests.

The incidence of testicular cancer is 1 in 250 male children and cannot be ignorantly low. There have been instances where a few international sports personalities have overcome this cancer in recent years. It is imperative that we buckle ourselves up and start performing SET (Self-Examination Test) and get over with this under-publicised but completely treatable demon.

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