Testicular Cancer – A Fit Young Man’s Experience

It was the last thing he expected. He was young – 25 – he ate well, went to the gym. So, his left testicle had changed texture a little. But he had no major lumps, and fit and healthy young men like him didn’t get cancer anyway, did they?

A dangerous cancer myth This is one of the dangerous myths Andrew is now determined to set right. When he first had his testicle checked out by a doctor in February, the GP suspected it was a minor condition. He gave Andrew the option of getting an ultrasound, or leaving it for a "couple of months" and keeping an eye on it. Andrew chose the wait-and-see approach – "But it’s difficult to assess change – you can feel it but you think nothing has changed. I didn’t want to bother about it, because it wasn’t a big deal. (I thought) nothing will happen to me, I’m healthy. Didn’t really want to think about what it was."

Diagnosis So it wasn’t until July, when his mother learnt of the visit and prompted him to get the ultrasound, that he found out he had testicular cancer. He knew during the test that something was wrong. "It lasted for probably a good half hour. The guy spent a long time looking at the left testicle – a good ten minutes. The right, he spent probably thirty seconds. I thought something was going on when I asked him and he was a bit cagey, told me I had to go to the doctor. What alarmed me was he told me to go that night.

"I told him I didn’t have a doctor – I’m healthy. So he told me to go back to the doctor who referred me. But I didn’t bother that evening, I went to the gym. It was only really later that night when it dawned on me that it was something bad. I went to bed about 10, 10.30 and I thought to myself, ‘It’s probably cancer’. I didn’t have a very good sleep."

He was "further alarmed" when he arrived at work the next morning to hear his doctor had been trying to contact him there. "When I called him at 9.00, he said to come down at 10."

Treatment Yes, it was cancer. He would have to have the left testicle removed. Very good prognosis – one of the "best" cancers to get. He would make him an appointment with an oncologist, and arrange some tests. Would know more then.

Within the week, he had the operation. He saw the oncologist the next day -"he was really personable, reassuring and made me feel informed." It looked like he had the type of testicular cancer with the highest cure rates. More tests, more appointments, and he discovered the cancer had spread to a lymph gland. But the recovery rate still hovered around 90-95 per cent. A three-week course of radiation would hopefully kill the spread.

Prognosis Christchurch hospital oncologist Bridget Robinson says testicular cancer is "usually curable". The few men who do not survive have a more aggressive variant, which is not helped by early detection. In most cases, however, the earlier the cancer is found, the less extensive the treatment is likely to be. Recovery chances fall if the cancer is left unchecked to spread to other vital organs. Dr Robinson advises men to show any swelling or change to a doctor, even if one testicle seems to grow smaller.

Andrew’s positive outlook Andrew is feeling positive as he nears the end of his five-week wait for radiation treatment. "I look at it as another challenge – not one I’d take by choice. But I will be able to take something out of it." He even "has a laugh" over the situation. "If you take a humorous approach, people are less likely to pity you (and you) don’t want pity. It’s curable, the statistics are on my side."

Statistics The New Zealand Cancer Registry recorded 138 new cases of testicular cancer in 1997, the latest year for which figures are available. In 1995 that figure was 115. About 9 per cent of men with testicular cancer die. Christchurch hospital oncologist Chris Atkinson says this cancer is the most common type of cancer among men aged 15 -24, and probably the second leading type in the 25-44 age bracket excluding leukaemias and lymphomas.

Most young men unaware of the problem and the risks Even though Andrew is in the highest-risk age-group, he had known very little about this cancer and its symptoms before July. A documentary on television earlier this year looked at testicular cancer, but failed to prod him into action. "Even on the documentary, they said it would be a big lump and that the swelling would be definite."

He believes a lack of awareness is common. "A lot of people I have spoken to in my age group don’t examine in any way. The awareness of how to perform a self-examination is non-existent, as is awareness of cancer itself."

Dr Atkinson agrees. “Most young men do not examine their testicles and have no idea that they do have a small but significant risk of developing testes cancer. Certainly any young man with pain or a lump in the testicle should immediately seek the advice of his general practitioner. The majority of men who have a lump in the testicle in this age group will actually have cancer.”

Andrew believes health promotions need to ‘instil fear’ for men to act early. “Men take the bravado approach, and if there are no statistics to frighten them, they take the ‘she’ll be right mate’ approach and carry on.”

Andrew keen to spread the message Andrew is considering taking his message to secondary schools. "Awareness should be targeted with a strong focus on the younger, the 16-year-olds. I doubt very much that 16-year-olds are self-examining. Awareness in schools would be a really good start."

Public health nurse and health promotion co-ordinator for school health services Rhonda Mikoz says every school has access to a public health nurse, but differ in the degree to which they make use of the service. Teachers can also borrow resource kits from Crown Public Health community health information centre.

Present education strategies Centre health promoter Neil Hellewell says priorities in the Government’s health strategy partly dictate the resources for different health issues. The centre has fact sheets on testicular cancer, including the Cancer Society of New Zealand’s ‘Keeping Your Eye on the Ball’ pamphlet.

Cancer Society health promotion and information manager Martin Witt says the society has no specific testicular cancer campaign, but is happy to arrange talks on the cancer for groups on request. Its main promotions focus on smoking, ‘sun-smart’ behaviour and physical activity and nutrition.

More awareness needed Andrew believes more needs to be done to raise awareness. "I left it for five months and it spread to my lymph gland. People need to be made aware of it because it’s dangerous, and to catch it at an early stage before it spreads."

Advice from the National Cancer Institute The National Cancer Institute website (www.cancernet.nci.nih.govt) says men should see a doctor if they notice any of the following symptoms: not all lumps are cancerous.

• A painless lump or swelling in either testicle
• any enlargement of a testicle or change in the way it feels
• a feeling of heaviness in the scrotum
• a dull ache in the lower abdomen or the groin (the area where the thigh meets the abdomen)
• a sudden collection of fluid in the scrotum
• pain or discomfort in a testicle or in the scrotum