Testicular Cancer

A Personal Narrative

On the night before the first day of his third year of college, a student woke up at four-thirty in the morning with a persistent, terrible pain in his lower abdomen. Thinking it would pass, he tried to go back to sleep, but the pain kept him awake until it was time to get out of bed and get ready for class. The pain, he noticed, became worse when he stood up, but he knew he had to make it to his first day of class. He changed his mind when he felt a small, hard lump on one of his testicles while washing in the shower.

Later that day the student went to the emergency room, where the doctors told him that he most likely had testicular cancer. This was a hard thing for the student and everyone who knew him to hear. Cancer was something very few of his friends and family had experienced, and even though the doctors said that they had detected the disease very early and that the survival rate was 95% for testicular cancer patients, they were all very nervous.

About a month later, the student underwent a surgical procedure during which the affected testicle was removed. He seemed to hardly let the disease or the operation negatively affect his outlook on life. In fact, he seemed confident and cheerful, despite the fact that he could barely walk for nearly two weeks. Even though he could not go to class regularly, he was still able to manage all his classes that quarter and earn good grades.

Despite the student's remarkable ability to deal with the disease, having testicular cancer was the scariest experience of his life. Even though the mortality rate for testicular cancer patients is quite low, dealing with testicular cancer is a difficult and frightening experience. Young and middle-aged men need to be aware that they are always at some risk, and should examine themselves regularly and be proactive with their health. 

Overview

Testicular cancer is a type of cancer that occurs in the tissues of the male testicle. Although this type of cancer is not very common (about 9,000 men are diagnosed with it every year in the USA), it is still the most common cancer for men between 29 and 35 years of age.¹ Most cases of testicular cancer occur in younger and middle-aged men between the ages of 20 and 39. Based on worldwide data, white men in industrialized nations are most likely to develop testicular cancer and (with the one exception of New Zealand Maoris) black men in any nation are the least likely. The likelihood of testicular cancer for other races falls somewhere in between the two.²

There are two types of testicular cancer:

  1. Seminomas, which are tumors that grow slowly and are sensitive to radiation therapy.
  2. Nonseminomas, which are tumors that grow more quickly and are more difficult to treat.³

Risk Factors

Certain factors increase a man's chances of developing testicular cancer. The following are risk factors associated with testicular cancer:

  • Having an undescended testicle: Normally, the male testes descend into the scrotum during puberty, but sometimes one does not. Men with undescended testes are at greater risk for testicular cancer. The risk is equally high even if the man has surgery to descend the testicle.
  • Previous testicular cancer: Men who have had cancer in one testicle are more likely to develop it in the other testicle, even after the affected testicle is surgically removed.
  • Family history: Men are more likely to develop testicular cancer if their male biological relatives, such as fathers, brothers, or uncles, have had the disease.

These factors alone do not predict testicular cancer. Only a doctor can determine whether or not cancer is present in the body.³

Symptoms

Men with testicular cancer may notice any number of the following symptoms:

  • A painless lump in one of the testicles.
  • Swelling or enlargement of the testicles.
  • Pain or discomfort in the testicles or scrotum.
  • A mild, persistent ache in the lower abdomen, back, or groin.
  • A sudden collection of fluid in the scrotum.

Men who have these symptoms could have a condition other than testicular cancer; however, one must see a doctor for a reliable diagnosis.

Doctors can diagnose testicular cancer through the use of a blood test, an ultrasound, or a biopsy. In almost every biopsy for testicular cancer, the surgeon removes the entire testicle through an incision in the groin. Contrary to popular belief, doctors do not remove the testicle by cutting open the scrotum. Such an operation could cause the cancer to spread to other organs.3

Treatment

Fortunately, 95% of men who have testicular cancer survive. However, the survival rate drops to 75% if treatment does not begin soon after the onset of the disease. Like most other cancers, testicular cancer spreads to other organs if left unchecked. Thus, it is important to detect and treat the disease as early as possible. Doctors may treat testicular cancer with any of the following three methods, or with some combination of them:

  • Surgery: The surgical removal of the entire affected testicle. The doctor generally does this during the diagnosis process. Removing a testicle does not decrease a man's physiological sexual ability, though the stress of having cancer might produce libido-inhibiting stress. Men only need one testicle in order to be fertile and produce a normal amount of male hormones. Removing one testicle does not cause impotence (the loss of the ability to have an erection). Some men choose to have a gel-filled prosthesis implanted in the scrotum to replace the missing testicle, but the majority of men feel no need for a replacement. 
  • Radiation therapy: The use of radiation to kill cancerous cells. Doctors often do this to eliminate any cancer that remains in the body after surgery.
  • Chemotherapy: The use of anti-cancer drugs to kill cancerous cells. Like with radiation therapy, doctors will sometimes combine this method with surgery to eliminate all remaining cancer cells. Most of these drugs come in the form of injections.

Doctors might also chose to remove the lymph nodes surrounding the groin area so that the cancer cannot spread to them. With any of these operations, there is a slight chance that the patient will lose the ability to ejaculate, leaving him only capable of “dry” orgasms, thus rendering him infertile. Therefore, men with testicular cancer who want to have children may want to ask their doctors about sperm banking.3

Self-Examination

Although testicular cancer is neither as common nor as deadly as many other cancers that occur in men (such as prostate cancer) it is important for men to be aware of its symptoms and risk factors so that they can detect the disease in its earliest stages. Because testicular cancer is the most common form of cancer in young men, some choose to regularly perform testicular self-examinations. This examination can easily be performed after a bath or shower. To do the examination, first face a mirror and hold the penis away from the testicles so you can see them more easily. Then, one after the other, hold each testicle between your thumb and index finger and roll gently so that you can feel if there are any lumps or enlargements in the testes. If you feel any symptoms or have any concerns, see a doctor as soon as possible.1

Testicular Cancer and Masculinity

For some men, having a disease that threatens their reproductive organs makes them feel as if they have been robbed of part of their masculinity. They may feel that, along with losing one or both of their testicles, they are losing part of their “manhood.” This feeling may also stem from the fact that surgical treatments for testicular cancer sometimes render men infertile. Yet, in the long run, most testicular cancer survivors feel that their sense of masculinity is the same as it was before they had the disease, and some even think that their masculinity has increased because of the cancer.

It is common for men who undergo surgery or chemotherapy for testicular cancer to feel a loss of masculinity immediately following treatment. This is because, immediately following such medical treatment, men cannot maintain erections as easily as they did before, if at all. However, as cancer-surviving men regain their normal levels of sexual functioning, their feelings of manliness may return to their original levels. One man described his experience:

“At the beginning, when I first lost my testicle, I thought, Oh my God, I'm only half a man now. But that really went away quickly. Once I had been through my surgery and stuff like that, and after I was feeling better, we went back to, to know, making love. It was easy. I did not feel stifled.”4

Many survivors even feel an elevated sense of manliness after dealing with the disease. Men often think of their condition as a "fight" in which they must bravely and confidently assert themselves against a life-threatening force. One man described his battle with cancer as a “defiance against castration.”4

Masculinity is not even a major concern for some survivors. One man in a study of cancer survivors told an interviewer that he had chosen to have a prosthesis implanted in his scrotum to replace the lost testicle, but not for reasons concerning masculinity. The man, who was single and in his twenties, chose to have the prosthesis implanted because he wanted to look normal to the women with whom he had sex, and so that he could tell women about his fight with cancer at a time of his own choosing. For him, the decision was less about masculinity and more about personal freedom.

Thus, although testicular cancer can negatively affect men physically, mentally, and emotionally, it need not rob them of their sense of masculinity. Whether they think of their experience with the disease as a test of their manhood, or they deal with the issue of masculinity in different ways, survivors of testicular cancer do not need to feel that they are “less than whole” as men.

 

References

1 .Hyde, J.S., & DeLameter, J.D. (2006). Understanding Human Sexuality (9th ed). New York: McGraw-Hill.

2. "Testicular Cancer Incidence Statistics." Cancer Research UK. Cancer Research UK, 30 Apr. 2014. Web. 19 May 2014.

3. "Testicular Cancer Home Page." National Cancer Institute. National Cancer Institute, Web. 19 May 2014.

4. Gordon, D.F. (1995). Testicular cancer and masculinity. Men's Health and Illness: Gender, Power, and the Body. Thousand Oaks: Sage.

 

Last Updated 26 June 2014.

 

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