Monthly self-exams necessary for men, too

By BRUCE A. EPSTEIN

© St. Petersburg Times,
published June 14, 2001

At age 25, Lance Armstrong was one of the world's best cyclists. He proved it by winning the World Championships, the Tour Du Pont and multiple Tour de France stages.

Armstrong seemed invincible, and he had a bright future. Entering the peak of his career, he felt "bulletproof." But he wasn't. Suffering with a severe pain in his groin, Armstrong went to see a doctor who diagnosed the problem: the cycling champion had testicular cancer, and it had spread to his lungs and stomach.

Figure skater Scott Hamilton rose to the top with technical wizardry, athleticism, enthusiasm and a natural flair to entertain. He used it to become a world and Olympic champion. But that zeal for life was severely tested when, at the age of 29 during the Stars on Ice tour, a doctor confirmed that the source of the lingering ache in Hamilton's stomach was testicular cancer.

An all-American football player at Wake Forest University in Winston-Salem, N.C., Brian Piccolo was a tougher-than-nails, gutsy running back who faced opponents who towered over him. After graduation, he signed as a free agent with the Chicago Bears and became close friends with all-pro running back Gayle Sayers.

Piccolo seemed so durable and sturdy that he was the player called on to get the first down. At the age of 26, he was diagnosed with testicular cancer, and his story was later told in the movie Brian's Song.

Who gets it?

Cancer of the testicles -- the egg-shaped male sex glands located in a pouch of skin called the scrotum -- usually occurs in men between the ages of 15 and 35, although it can strike any male at any time. In 2000, an estimated 7,600 cases of testicular cancer were diagnosed in the United States, and nearly 400 men with this cancer died.

Disturbingly, the incidence of testicular cancer around the world has almost doubled in the past 30 to 40 years. For unknown reasons, the disease is about four times more common in white men than in black men. Children born with an undescended testicle have an increased risk of getting testicular cancer, regardless of whether corrective surgery is performed. (Parents should see that their infant boys are checked at birth for undescended testicles.)

Other risk factors include a family history of testicular cancer, having an identical twin with testicular cancer and a past injury to the scrotum.

The symptoms

The earliest symptoms of testicular cancer are pain, swelling or hardness in the testis. Testicular cancer can also cause a number of other symptoms. Here are warning signs that men should watch for:

A lump in either testicle; the lump typically is pea-sized, but sometimes it might be as big as a marble or even an egg.

Any enlargement of a testicle.

A significant shrinking of a testicle.

A feeling of heaviness in the scrotum.

A sudden collection of fluid in the scrotum.

Pain or discomfort in a testicle or in the scrotum.

Enlargement or tenderness of the breasts.

How to self-examine

Most testicular cancers are found by men themselves, by accident or when doing a testicular self-examination.

It is common knowledge that a monthly breast self-exam for women is an effective part of early breast cancer detection. For men, starting at age 15, monthly self-exams of the testicles are also an effective way of detecting testicular cancer at an early, and very curable, stage.

The self-exam for testicular cancer 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 scrotal 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. You shouldn't feel any pain when doing the exam. Don't be alarmed if one testicle seems slightly larger than the other; that's normal. The testicles are smooth, oval-shaped and rather firm.

Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. Once 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. Lumps on the epididymis are not cancerous.

If you find a lump, see your doctor right away. The abnormality may not be cancer, but if it is, it will spread if not stopped by treatment. Waiting and hoping will not fix anything.

Men who examine themselves regularly (once a month) become familiar with the way their testicles normally feel. Any changes in the way they feel from month to month should be checked by a doctor.

Treatment

Testicular cancer is treated by surgery, radiation therapy and medication. In most cases, surgery is done to remove the testicle. Sometimes it also is necessary to remove lymph nodes in the abdomen if the cancer has spread. Anti-cancer drugs are recommended when there are signs that the cancer has spread, or if the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation.

Only 15 years ago, testicular cancer was considered a difficult and dangerous kind of tumor. It cost Brian Piccolo his life at age 27. Advances in treatment, along with improved diagnosis, now mean that most men found to have testicular cancer will survive the disease. Today, the overall cure rate for testicular cancer, when detected early, is above 90 percent. Cyclist Lance Armstrong and figure skater Scott Hamilton appear to be two of the lucky ones.

Fortunately, this deadly but treatable disease can be detected early by regular self-examination.

-- Bruce A. Epstein practiced pediatrics in St. Petersburg for 26 years. He edits the Web site http://www.kidsgrowth.com.

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