One testes is bigger than the other. Do I have testicular cancer?

first of all, it is normal for one testes to be slightly bigger and hang lower than the other. Usually it's the right testes that is bigger. Talk to your doctor if the size difference is too much or if you feel a lump in one of your testes.

A brief background on testicular cancer would help.

Testicular cancer, the most successfully treated cancer in men

Introduction

Of all the cancers men can have, testicular cancer is the one which can be treated most easily and completely provided it is diagnosed early. With a simple regime of chemotherapy and sometimes radiotherapy, this group of cancers can be cured 96% to 100% of times. Not just that but survivors of these cancers then can expect to have full reproductive functions including sex and fertility ! The interesting irony is that until we discovered the right treatment with methotrexate (anti folic acid drug) this was the fastest growing and most fatal cancer. In some ways it is a source of hope for all cancer specialists that if we strike lucky and find a specific cure, even seemingly deadly cancers can be cured. Hopefully that may apply to all the cancers in the future.

Relative incidence of cancers in men

The most common cancer in men is that of lungs mainly caused by cigarette smoking - a direct correlation. This is true over most of the world. In India cancer of the mouth is the most common and that is directly related to chewing of tobacco and gutka. Prostate cancer, and cancer of a gut are the other common cancers. Testicular cancer is called a “germ cell” type cancer and it arises from the primitive cells that are needed to make sperms. They also typically occur in young men, between 16 and 30-35 years of age.

Catch them young

The most common presentation of this cancer is irregular growth on the testis. Since it is initially painless, if undetected, the cancer can grow very fast and grow beyond where it can be cured off easily and completely. So regular manual palpation of the testes in a systematic manner is important.

Tumor markers

Testicular tumors were the first ones to be studied for tumor – markers. These are typically hormones (hCG, Alfa –feto proteins, LDH) which get eliminated because of the sense of these tumors are well differentiated cells and actively produce these hormones. These means that blood tests for the tumor markers can be an easy corroborative evidence. USG of the testis can also be of great help.

To B(iopsy) or not to B(iopsy), that is the question

Doing a biopsy becomes a little complicated because simple needle biopsy (like you can do for a breast lump) can cause seeding of the cancer cells. For that reason we need biopsy only when we are almost 100% sure that we are dealing with a cancer. The biopsy is then called "excision biopsy" and the whole affected testis is removed. This obviously means that on the very rare occasion doctor gets it wrong, a man has lost the testis for no reason. But then on almost all occasions the physical examinations, ultrasound scans and tumor markers make the biopsy almost as a matter of formality.

Treatment

This tumor is sensitive to radiotherapy as well as chemotherapy but we choose the latter because it can then preserve the function of the testis of making hormones and making sperms. The tumor cells are fast growing cells and they need large amounts of folic acid. This fact has been used to choose methotrexate which acts by stopping folic acid reaching the tumour cells. Treatment over several weeks and months causes shrinkage of the tumor and it’s eventual cure. There are other drugs too which too preserve the fertility of the patient.

On the rare occasion we may need to give radiation whilst shielding the other testis. Radiation also helps in managing the lymph nodes in the pelvis which can sometimes get affected early in the disease process.

Summary

All in all testicular tumor is something that we should look out for proactively. At the age of 16 or 18 young adolescence should be explained the importance and taught the skill to examine their own testis.

We run a programme wherein we teach breast examination and testicular examination to the young couple and encourage them to remind each other and check themselves every month. We suggest they may do it for each other and mix business with pleasure !