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How is testicular cancer screened, diagnosed and treated? What to expect after a diagnosis

By Dr Kevin Cheng, founder of Osana, a preventative healthcare service in Sydney which aims to keep you happy, healthy, and where possible, out of hospital. 

If you or someone you know has been diagnosed with testicular cancer, it can be a stressful and frightening time. As the second most common cancer in young men, with around 900 cases diagnosed in Australia each year, there are many resources available to support you. The medical profession can achieve excellent results without loss of function and the chances of cure are high with sexual function and fertility often well preserved after the loss of one testicle. It’s important to stress that survival rates are excellent, being 98% at 5 years post diagnosis.

Who is at risk of testicular cancer?

As our age increases however, so too does the rate of diagnosis. The lifetime risk by age 85 is 1 in 200, and rates of diagnosis have grown by 50% over the past 30 years. While the survival rate is high, every year there are 30-40 deaths due to this disease so anything we can do to bring this number down is absolutely worth doing.

How is testicular cancer screened for and diagnosed?

Testicular cancer is often asymptomatic, and its nature may cause embarrassment or delay seeking medical attention. But early screening is paramount, so we need to bring down any walls of embarrassment, ignorance, or stigma so that more men live longer, healthier lives. 

The most common presentation is a painless lump in the testicle. One’s testicle may feel heavy, tender or an ache, but usually a swelling just causes unevenness between both testes or a different consistency. 

Men have a higher risk of testicular cancer if they have been previously diagnosed, have a family history of the disease, are infertile, had undescended testes at birth, or have HIV infection. There is no link to testicular injury, tight clothing, or hot bathing.

The focus is on early detection by feeling for any lumps or swellings or painful areas (regular self-examination), followed by medical review, ultrasound or MRI scan, blood tests, and sometimes a biopsy (or just excision if the suspicion is high).

How is testicular cancer treated?

After you’ve been diagnosed with testicular cancer, you can expect to meet specialists who will be involved in treatment and surveillance. These include a urologist for potential removal of the affected testes and an oncologist for chemotherapy or radiotherapy. Treatment usually involves a procedure that requires a short hospital stay followed by regular cancer treatment (day visits) for a period of weeks. 

Side effects of testicular cancer treatment may include:

  • Pain and infection after surgery
  • Nausea, fatigue, diarrhoea, loss of appetite, skin irritation and temporary infertility after radiotherapy
  • Hair loss, vomiting, chills, shortness of breath, rash, mouth sores and dizziness after chemotherapy.

Afterwards, surveillance involves regular check-ups, X rays and blood tests. If you have surgery to remove a testicle, a prosthesis may be inserted. 

For most men who are diagnosed, there is full return to a normal quality of life, including normal sexual function.

How to cope and where to find support after a testicular cancer diagnosis

There are support groups for men with testicular cancer, such as the online Smart Patients Testicular Cancer Support Group or Nuts & Bolts.

Resources for patients include Living with Cancer on the Cancer Australia website, Movember, and the Cancer Support Community website.

Talking to loved ones, getting help from a GP or psychologist, and linking in with a support group are important ways to live a full and independent life despite testicular cancer.

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