Why Testicular Self Exams Are Important

You are probably feeling yourself up right now as you read this article. Good. I’m glad. This is the best way to catch testicular tumors early.

I would recommend giving yourself a monthly exam, which allows you to look for any interval change in the quality of your testicle.

As for how to do the exam, I’d recommend doing it after you step out of a warm shower, which is usually when the scrotal skin is most relaxed.  It is normal for one testicle to hang lower than the other.  It is also normal for one testicle to be a little bit larger than the other.

Place your index and middle finger behind one testicle and your thumb on top. Roll the testicle between your fingers, looking for any hard spots. Normal testicle should be a bit spongy. The soft structure behind both testicles is the epididymis. Sperm is stored and matured in this structure. Hard, circular structures behind the testicle within the epididymis are usually benign cysts.  If you feel anything hard or some change from the month before, you should see a doctor–preferably a urologist.  Remember testicular cancer usually presents as a painless hard mass.  Starting at the age of 15, you should start performing monthly self exams.

Once you visit your doctor, he or she will conduct a physical exam.  You will likely also go for a testicular ultrasound to take a closer look at the tissue of your testicles.  If there is a concerning mass on exam or ultrasound, routine blood work and imaging studies may be ordered by your physician.  The blood work usually include some routine tests including a complete blood count (CBC), chemistry panel (Chem 7 or Chem 14), liver enzymes (AST, ALT, Bilirubin), and more specific “tumor markers”.  Testicular cancers often secrete excess amounts of specific enzymes that allow urologists and oncologists to stage and follow cancer.  You may hear terms like “Beta-HCG” (BHCG) and “Alpha fetoprotein” (AFP), which are two common tumor markers of testicular cancer.  Those two are very specific tests that need to be done before any surgery.  Elevated tumor markers after removal of the diseased testicle can imply that there is tumor elsewhere in the body.  You may also hear about “Lactate deyhdrogenase” (LDH) which is a more nonspecific marker of overall tumor volume that is also checked before surgery.

Depending on your clinical situation, your physician may also order additional imaging studies.  A chest x-ray is routinely performed to rule out any spread of tumor to your lungs, which Lance Armstrong had when he was diagnosed. You may also undergo a “Computerized Tomography” (CT) scan of your abdomen to look for any tumor in the lymph nodes that drain your testicles.  Due to the embryologic development of your testicles, their blood supply and lymph node drainage converges around the large vessels in your abdomen (the Aorta and the Inferior Vena cava) in an area called the retroperitoneum, which is a compartment behind your intestines.  Testicular cancer usually spreads along the lines of blood and lymph flow.  The lymph nodes of the retroperitoneum are usually the first “landing zones” of cancer cells that have spread outside the testicle.

The good news about testicular cancer, if there can ever be good news about any cancer, is that it is a highly treatable form of cancer.

One could argue that it is one of the few cancers that has a legitimate “cure.” Treatment always begins with a radical orchiectomy. Through a small incision in your groin, the affected testicle and its blood/lymph supply will be removed.  Based on the pathology of the specimen and follow up studies, you may undergo treatment with chemotherapy, radiation, and/or more extensive abdominal surgery.  More than 90 percent of men diagnosed with testicular cancer will be cured by combination therapy (orchiectomy, chemotherapy, radiation, and/or more surgery).

By the time Lance Armstrong was diagnosed with testicular cancer he had tumor in his lungs and in his brain.  He underwent successful treatment with surgery and chemotherapy and needless to say did alright for himself (he won seven straight Tour De France races–all AFTER treatment)¹.  Testicular cancer is probably the most treatable form of cancer that exists today.  The first step to treatment is diagnosis though.  The key to early diagnosis of testicular cancer is literally in your hands.  Don’t be afraid to use it!

References

¹Testicular Cancer Resource Center tcrc.acor.org
²NCCN Practice Guidelines in Oncology: Testicular Cancer