April is testicular cancer awareness month and a much-needed reminder on how cancer can equally impact younger and older patients. In the United States, testicular cancer affects 10,000 men who are typically healthy and between 18–35 years of age.
“Men will notice swelling in their testicles or they have some pain, and they’ll often seek urgent care or their primary care physician, which leads to a few more tests,” Dr. Todd Yezefski said, a medical oncologist at Seattle Cancer Care Alliance and assistant professor of medicine at the University of Washington. “They wind up at the urologist’s office and have surgery to remove the testicle.”
Testicular cancer is largely symptomatic. Dr. Umang Swami, a medical oncologist and assistant professor of medicine at the University of Utah, explains that most patients feel a dull ache or heavy sensation in the lower abdomen or scrotum; this can also be accompanied by scrotal swelling and less commonly abdominal fullness.
Dr. Daniel Lin, a professor of medicine at the University of Washington and urological surgeon, shared that some men are diagnosed during a fertility workup because testicular cancer can lead to infertility. Although most young patients typically put off seeing their doctors until their symptoms become more pressing, testicular cancer is largely treatable, even in the metastatic setting, with a cure rate greater than 95%.
“It follows a very predictable spread,” Dr. Lin explains. “It goes from testes to Point B, which is the lymph nodes in the abdomen to point C, which is the lung to point D, which encompasses bones and brain.” Metastases from testicular cancer usually spread in an orderly fashion from one organ site to another.
For localized cancer, surgery is the treatment of choice. For more advanced cases, surgery, radiation therapy, and chemotherapy may be required to ensure the best chance of cure. Medical oncologists typically use a well-established and tested chemotherapy regimen of three drugs abbreviated as “BEP” — bleomycin, etoposide, and cisplatin. However, while the chemotherapy doses and schedules are straightforward, the effects of the treatment can be severe and long-lasting.
“Heart disease at an older age, issues with lung disease, kidney problems, and infertility are common problems for 30% to 40% of patients who are treated with chemotherapy,” Dr. Yezefski shares.
Post-chemotherapy, surgeons are faced with the challenge of deciding whether to subject the patient to additional surgery to ensure that the remaining tumor does not have the potential to grow or spread. They sometimes struggle in their efforts to know with certainty if the remaining swelling represents viable cancer or a conglomerate of dead tissue. The question that Dr. Lin and other surgeons ask is, “Can we predict who to do these surgeries on because if we knew beforehand its dead non-cancerous tissue, we wouldn’t put them in through a pretty significant surgery with its own potential for adverse outcomes.”
To identify the 10% of patients who have remaining cancerous tissue post-chemotherapy and require surgery, researchers are developing a blood test that looks for biomarkers to track the recurrence of cancer post-chemotherapy. Such an approach may prove more accurate and more sensitive than current efforts which rely on radiographic imaging studies and more mundane blood tests.
There is also a greater need to promote testicular self-examinations in young men, similar to breast cancer self-exams. Oncologists agree that testicular cancer needs more awareness amongst young men through messaging in public spaces including schools and sports organizations, as well as through social media.