By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TESTICULAR CANCER TYPICALLY STRIKES YOUNG MEN -- FROM 15 TO 40

Question: I just saw in the paper that one of my favorite sports figures may have testicular cancer. He is a young guy, 22, and is in great shape. I thought only old people who didn’t take care of themselves got cancer. Can you tell me more about what might be going on here?

Answer: While many cancers are much more common in people over 50, there are also certain types of cancer that primarily affect babies, children and young adults. Testicular cancer is typically found in young men between the ages of 15 and 40, with the early 20s being the most frequently affected age group. There are about 8,000 new cases every year in the U.S. Overall in this country, testicular cancer accounts for about 1 percent of all male cancers and about 390 deaths annually.

As with many cancers, there are often no symptoms except for a painless lump. In fact, a painless testicular lump is the most common finding that brings a patient with testicular cancer into his doctor’s office. Most often this lump is discovered by the man during a regular self testicular exam or during his regular shower routine. However, at other times the first symptoms that a man may notice are pain in the testicle or scrotum, enlargement of a testicle, or a sudden collection of fluid in the scrotum for no apparent reason. Sometimes, though, the only symptom may be a general feeling of heaviness and discomfort in the low back, abdomen or groin.

Some people are at higher risk for testicular cancer than others. White males of Scandinavian descent have the highest overall incidence of testicular cancer. A family history of testicular cancer or a personal history of testicular cancer increases a man’s risk. Men with an undescended testicle or men with a history of congenital problems in the genitourinary system are also at increased risk for the development of this disease.

If your physician finds a testicular mass, he or she will probably first recommend an ultrasound and some blood tests. The ultrasound can determine if the mass is a fluid–filled cyst or a solid tumor. It can also help your physician gauge the size of the mass. The blood tests can check for “tumor markers” -- elements in the blood that are higher when cancer is present. Depending on the results of the ultrasound and blood tests, the doctor may recommend a biopsy.

Generally when a testicular biopsy is called for, this means the suspicion of cancer is quite high. For this reason, the entire testicle is often surgically removed. Not only does this help prevent the spread of the disease to the other testicle, it makes a second surgery unnecessary if the lump is found to be cancerous.

Great strides have been made in recent decades in the treatment of testicular cancer. About 95 percent of men with this disease are now cured of it. Sometimes surgical removal of the diseased testicle is all that is needed. In other cases, depending on the type of cancer and its stage at diagnosis, chemotherapy and/or radiation may also be helpful. With one type of testicular cancer, a second surgery to remove lymph nodes is often helpful. As with all cancers, though, early detection not only improves your chances of a cure but also usually results in an easier course of treatment.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.