FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SON’S TESTICULAR CANCER HAS OPTIMISTIC PROGNOSIS

Question: My 24-year-old son recently found a lump in his testicle. He had tests that showed the lump was cancer and then he had the testicle removed. His doctor is optimistic that he will be cured, but I’m still worried. Can you give me any additional information about testicular cancer?

Answer: About 8,000 cases of cancer of the testicle are diagnosed in this country each year. For unknown reasons, the incidence of testicular cancer in the United States has almost doubled since the 1930s and continues to climb. The good news is that with today’s treatment methods this cancer is often cured. I’ll give you more specifics later.

Victims of testicular cancer are most often between 20 and 35 years old -- just like your son. Since this cancer is more common when the testicle fails to descend into the scrotum, it is recommended that any boy whose testicles have not descended into the scrotum by age two have surgery to correct the problem. This will reduce his lifetime risk of developing testicular cancer.

Testicular cancer is usually found by the individual. It may appear on the testicle as a hard growth that is as small as a grain of rice, or it may first come to the person’s attention as tenderness and swelling without an obvious lump. Commonly, the testicular tenderness is first treated as an infection called epididymitis, but if it doesn’t clear up with medication as epididymitis does, then further diagnostic tests are ordered which can establish the cause as cancer.

Actually, all testicular cancer is not the same. There are two major types of cancer cells -- germ cell and non-germ cell cancers. This distinction can only be established after surgery when the tissue is studied under a microscope, but it is important because it is one of the factors that must be considered when determining the proper treatment for the cancer.

Germ cell cancers account for 95 percent of all testicular cancers. These cancers can be subdivided into two additional cell types. All of this is important in planning the best treatment. Another major treatment consideration is whether or not the cancer has spread beyond the testicle, a process which is called “metastasis” in doctor vernacular.

All testicular cancers are treated by surgical removal of the cancerous testicle. Depending on the specific cell type, additional treatment with more surgery, radiation, chemotherapy or a combination of these is used to give the best chance of a cure.

It is appropriate that your son and his doctor are optimistic. Most types of testicular cancer have about a 90 percent chance of being cured. This even includes cases where the cancer has metastasized to many other areas of the body. Some types have cure rates of 97 percent.

Another concern is about the patient’s sexuality. In some types of testicular cancer, the treatment leaves the individual fully able to have erections and to father children. These are important issues for any man, but particularly for a young man who wishes to have a family. Unfortunately this is not the case for all treatments for testicular cancer. However, it is often possible and advisable to have sperm frozen before surgery so that it is possible to father children in the future even if the cancer treatment leaves him infertile, impotent, or both.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.