Dear Dr G,

I am a 30-year-old man at the peak of my career and relationship.

My girlfriend and I met at work about two years ago. We are engaged and planning to get married next year.

My girlfriend noticed a lump in my right testicle while we were being intimate.

The lump was tender at first but eventually became painless, which initially reassured me, so I left it without further worries.

Over the last two months, the lump has grown bigger, and I am increasingly worried.

I was horrified when the doctors told me the painless lump was likely cancer.

Contrary to common beliefs, the doctors said testicular cancer is more common in younger men.

In fact, I was advised to have my testicle removed as soon as possible.

With a heavy heart, I am putting Dr G on the spot to face the challenges of dealing with testicular cancer.

Why is testicular cancer more common in younger men? Am I wrong in assuming cancer risk tends to increase with age?

Can you tell me how testicular cancer is diagnosed? Is a biopsy required?

I understand the treatment of testicular cancer involves the removal of testicles and chemotherapy and radiotherapy. Does that spell the end of my sex life and dreams of parenthood? I am so worried. Can you help?

Yours truly,

Terrified Tom

TESTICULAR cancer involves malignant changes that develop in the testes and is the most common malignancy occurring almost exclusively in younger men. The two peak incidences for such cancer are at the ages of 25 and 35.

The risk tends to be highest among Caucasians in Northern European countries and the USA, and relatively uncommon in Asian and African populations. Two common types of testicular cancers are Seminoma and Non-Seminomatous Germ Cell Tumor (NSGCT). Although it is largely unknown why such cancers occur in younger men, malignant changes during the active phase of spermatogenesis are likely the reason.

The exact etiology of testicular cancer is unclear. However, it is associated with men with a history of undescended testicles and infertility. About 10% of testicular cancers occur in men with a history of an undescended testicle. The testicles develop inside the abdomen of the fetus during gestation and descend to the scrotum before birth.

In some men, the failure of the descent leaves the testicles in the abdomen or groin. The higher scrotal temperature is thought to impair spermatogenesis and induce malignant transformation of the germ cells. Genetic defects are also believed to play a role, as it is associated with men with a history of infertility and family history of testicular cancer.

Most men with testicular cancer present with a painless lump in the testicle. Although some may have a dull ache in their scrotum, most describe growing lumps without any pain or discomfort, leading to false assurance and delayed diagnosis and treatment.

Diagnosing testicular cancer is straightforward using ultrasound scans and blood investigations. Tumor markers such as Alpha Feto Protein (AFP) and Beta HCG are usually elevated during late stages of cancer. A biopsy of the testicle is not advisable as it can cause unnecessary spread of the cancer. Surgical removal of the affected testicle is mandatory to determine the type of cancer and assist further adjuvant chemo or radiotherapy.

Before surgical interventions, men are usually asked to perform semen analysis to assess the necessity for freezing. The removal of the affected testicle is described as orchidectomy. The surgery is performed through an incision in the groin instead of a scrotal approach to ensure the cancer is confined and not spread to other lymphatic systems.

Recovery from radical orchidectomy takes up to one month. The removal of one cancerous testicle tends to have no adverse impact on sexual and reproductive functions for most men, as demonstrated by athletes like Lance Armstrong.

Despite presenting with late-stage testicular cancer metastasized to the brain, Armstrong underwent surgical and adjuvant interventions, became cancer-free, and won numerous cycling tournaments. He is also reported to have fathered children without difficulties. In the spirit of Movember November, the spotlight is on men’s health and cancers affecting men.

Testicular cancer deserves attention as it affects young, sexually active men. On a positive note, this malignancy is one of the most curable cancers, with five-year survival rates of more than 95%. The survival rate for early-stage cancer is near 100%.

Lance Armstrong famously said: “Pain is temporary, quitting lasts forever!”

This inspires many facing the challenges of testicular cancer at a young age.

Dr G’s view is: “The pain of initial diagnosis is temporary, the prospect of testicular cancer cure is forever!”