Testicular Cancer: Treatment and Survival (cont.)

Side Effects

Any kind of cancer treatment can cause undesirable side effects. But not all patients react the same way or to the same degree. One of the main concerns of young men is how treatment might affect their sexual or reproductive capabilities.

Removing one testicle does not impair fertility or sexual function. The remaining testicle can produce sperm and hormones adequate for reproduction. Removal of the retroperitoneal lymph nodes usually does not affect the ability to have erections or orgasms. It can, however, disrupt the nerve pathways that control ejaculation, causing infertility.

Modern "nerve-sparing" surgical techniques have increased the odds of retaining fertility. Many surgeons are abandoning a "total scorched-earth policy where you take out every single lymph node," Malkowicz says.

"We now can limit the amount of dissection necessary to get a good therapeutic cure, but not overdissect to disrupt every bit of nerves," he says, adding that "ejaculation can be preserved" in as many as 80 percent of cases.

Testicular cancer patient Knies points to his twin sons as proof that though his reproductive capacity was temporarily lost, it was restored.

Chemotherapy can cause increased risk of infection, nausea or vomiting, and hair loss. Not all patients experience these. Some drugs may cause infertility, but studies have shown that many men recover fertility two to three years after therapy ends. Radiation patients may experience fatigue or lowered blood counts. Infertility may also occur, but this usually is temporary.

Doctors emphasize that even though the cure rate is very high for all types and stages of testicular cancer, many of the drastic measures taken to cure later-stage disease can be avoided if the tumor is caught early enough. The best way to do this is through regular self-examination, a message that Knies says might be difficult to convey to the prime risk group.

"You have a real sense when you're in your late teens and early 20s of invincibility," he says. "The last thing you're thinking then is that something can stop you. But as I know, it can."

"I never examined myself."

How to Examine the Testicles

Pennsylvania resident Glenn Knies, 34, says he wasn't consciously looking for possible cancer 11 years ago. He calls it "pure luck" that he noticed an abnormality in the shower and sought medical attention.

Now a survivor of testicular cancer, Knies strongly urges men to examine their testicles regularly.

Medical professionals say men can greatly increase their chances of finding testicular tumors by testicular self-examination, or TSE. Locating a tumor this way can boost the odds of early intervention and total cure.

"Diagnosis of testicular cancer usually starts with self-discovery," says S. Bruce Malkowicz, co-director of urologic oncology at the University of Pennsylvania Medical Center. He advises men of all ages to do TSEs, not just those in the prime risk group of ages 15 to 34.

[diagram of testicular self-examination] TSE is best performed after a warm bath or shower. Heat relaxes the scrotum, making it easier to spot anything abnormal. The National Cancer Institute recommends following these steps every month:

  • Stand in front of a mirror. Check for any swelling on the scrotum skin.
  • Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers. Don't be alarmed if one testicle seems slightly larger than the other. That's normal.
  • Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. If you are familiar with this structure, you won't mistake it for a suspicious lump. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front.
  • If you find a lump, see a doctor right away. The abnormality may not be cancer, but if it is, the chances are great it can spread if not stopped by treatment. Only a physician can make a positive diagnosis.
Knies says fear shouldn't keep men from doing the TSE. "And men need not feel self-conscious about touching themselves there. It only takes a few seconds for them to tell if everything's fine. If they find something, they shouldn't be afraid to say something. Wishing it away isn't going to make it go away."

Source: U.S. Food and Drug Administration (www.fda.gov) John Henkel is a staff writer for FDA Consumer

Last Editorial Review: 8/29/2005