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That ‘Other’ Male Cancer

October 4, 2012 By:
Elyse Glickman, Special Sections Feature
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Dr. Richard Greenberg

Prostate cancer and PSA scores have gotten a lot of airtime and print for a variety of reasons, ranging from media exposure like pharmaceutical ads to celebrity survivors of the illness. Testicular cancer may not have as much media play at the moment or as many diagnoses (8,000 new diagnoses every year, compared to 200,000 for prostate cancer), but its origins and causes merit attention.

The best news about testicular cancer is that, in comparison to prostate cancer, patients respond readily to chemotherapy and most are cured if the cancer is caught early, according to doctors interviewed. In contrast, prostate cancer patients don’t respond so readily to chemotherapy, it has been shown, and treatments are often more extensive and complex if it is not caught in its early stages.
 
Testicular cancer also hits a younger demographic, men ages 18 to 35.
According to Cancer.org, Caucasian American men are about five times more likely to get testicular cancer than are African-American men, and three times more likely than Asian-American and Native American males.

Dr. Richard Greenberg, chief of urologic oncology at Fox Chase Medical Center, and Dr. Robert Somer, co-director of the genitourinary cancer center at Cooper University Hospital, both point out that while the incidence of testicular cancer is significantly smaller than prostate cancer (6 per 100,000, compared to prostate cancer, which is 1 in 6 men), they both advise that education about its existence and preventive measures should start early.

“Boys should be taught” about testicular cancer “in health class when they are in middle school, and be taught testicular self-examinations, just as young girls should be taught to do breast self-examinations,” says Greenberg.

“If they feel an abnormality or have any question at all, examination by a physician or an ultrasound test could be a next step.”
“The best advice a physician can give to a young patient is to get to know his body, given that the highest risk occurs in the teenage years through the early 30s,” says Somer matter-of-factly.

“Although there are no definitive screening tools or guidelines, I do recommend young men have a testicular cancer examination at least once a year by a healthcare professional, and periodically do self-exams in the shower to check that there are no masses developing in either testicle.

“A good rule to follow, as with any cancer, is that the earlier it is caught, it tends to be easier to treat.”

Though testicular cancer is not a hereditary illness, and the circumstances for predisposition are few, the doctors do point out one possible determinant is when an infant’s testicles do not descend normally from his abdomen into the scrotum. While this is correctable by a pediatric urologist during childhood, Greenberg notes that it does give rise to some predisposition to the rare seminoma, a slow-growing form of testicular cancer that is usually confined to the testes, but can spread to the lymph nodes.
 
Nonseminoma, meanwhile, is the more common type of testicular cancer, which tends to grow more quickly than seminomas. Greenberg points out there are four strains, based on different cell types (choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor).

Greenberg further explains that 90 percent of the tumors will often present as a painless mass or an increase in size of the testicle. Because the condition is often painless, it is not perceived as being significant or not clinically a problem. However, nothing should be counted out.

“Everything is curable when caught early, especially in this day and age,” says  Greenberg.  “While tumor removal can be done as an outpatient, I recommend staying overnight at a hospital for a little more TLC.  

“In most procedures, the testicle is removed, with the spermatic chord cut to prevent spread. Subsequent treatment can be minimal, and in some cases removal of testicle alone may be curative. However, learning more about the histology and subtype of your tumor with your doctor will affect treatment and post-treatment management of the health situation and recovery time.”
Though some young men may be worried about their ability to start families later in life, the doctors note that sperm banking is an option, with patients putting away a semen sample before treatment begins.  However, this option is expensive, and in many cases the remaining testicle will often function normally a few years after treatment.

Somer adds that young men should never forget that a healthy lifestyle will decrease risk of any cancer, and an increasing amount of data across the country supports that.

“We know what to do out of common sense, but it is difficult to adhere to a routine that includes 30 to 40 minutes of exercise at least three to four days a week; moderate alcohol consumption, if at all; choosing foods with complex carbohydrates over simple carbs; and maintaining a healthy diet,” he advises.

“However, conscientious adhering to these guidelines will not only alleviate cardio-vascular risks, but risks for many cancers as well.”

Bryan Anmuth, a therapeutic recreation specialist who worked at the American Cancer Society as a patient advocate, literally speaks from experience when helping patients address their concerns and fears. Now a 12-year survivor of testicular cancer, the 32-year-old notes the worst things he suffered prior to the diagnosis were short bouts of flu.
 
Though he took an unusual growth in a sensitive area for granted, he later realized that a sharp abdominal pain that came out of nowhere needed attention.

“The beginning in many ways is the most difficult period of this experience because it was one of those times where everything seemed to be happening at once and in less than a week,” recalls Anmuth.

“I went from taking an ultra-sound to a blood test to visits to a urologist.  I did not understand at first that I would have to have the testicle removed, which was the worst part for me.  After that was over, I went to three doctors and picked the oncologist I trusted most who was also close to me so my family could come with me.”

From there, Anmuth went through a prescribed round of chemotherapy. Although he experienced a lot of “indescribable pain,” it went away after the first session. From there, he experienced quantifiable improvement  with every session.

“I did whatever the doctor told me to do, I believed my doctor had a great plan for dealing with the situation,” Anmuth continues.

“There were a lot of needles, gloves and masks, along with a chemical put into you that you have to get out of your system as fast as it goes into you. By the third round, it was a lot easier to deal with and I knew what to expect.”

He adds that the doctors “prepare you for the worst, but other than nausea and losing some of my hair, I had no side effects other than that. As horrible an experience as it was, I am certainly better for it in all areas of my life.”

Another event that helped Anmuth cope was an opportunity to meet with Philadelphia Phillies outfielder John Kruk, who also went through testicular cancer. Anmuth’s father arranged for Kruk to call him directly.
That call “helped a lot and really drove my confidence,” says  Anmuth.
Anmuth himself freely offers advice and encouragement to other young men to proceed through the illness with courage. “I was young and scared, but what sticks with me about the whole experience is that I caught it early and it did not have a chance to spread,” he says.

“It is easy to check yourself in the shower, and if you find anything abnormal, absolutely have it checked out.”

This article originally appeared in a special "Fighting Cancer" section of the Exponent.

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