Posts Tagged ‘testes cancer’

Big Ball Series: How To Examine Your Testes (And What You Need to Know About Testicular Cancer)

November 24, 2018

Andrew Siegel MD  11/24/2018

This is the concluding segment of the “Big Ball” series of entries, which provide information about maladies of the male gonads.

Image below: testes cancer occupying entire testicle (pathology: seminoma)

Seminoma_of_the_Testis_(with_ruler)_(267781611) Attribtion: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

Most testes lumps, bumps and growths are benign and not problematic. Although cancer of the testicle is rare (< 9000 cases/ year in the USA), it is the most common solid cancer in young men age 15-40, with the greatest incidence in the late 20s, striking men at the peak of life.  Notable men who are members of the testes cancer club include the following: Tour de France Champion Lance Armstrong; baseball player Scott Shoenweis; skater Scott Hamilton; MTV Host Tom Green; comedian Richard Belzer; sportswriter Robert Lipsyte; and Olympian Eric Shanteau.  The great news is that it is a highly curable cancer, especially so when picked up in its earliest stages, and also potentially curable even at advanced stages.

Testes cancer has a predilection for occurring more commonly in Caucasian men as compared to African-American or Asian men and is seen more commonly in men with undescended testes and Klinefelter’s syndrome.

In its early phase, testes cancer causes a lump, irregularity, asymmetry, enlargement, heaviness or a dull ache of the testicle. It most often does not cause pain, so the absence of pain should not dissuade you from getting evaluated if you are concerned about something that does not feel right.

 Note well: If you feel that there is a lump or bump in or on your testes that was not present previously, please see a urologist. You will never be chided for being a “hypochondriac” for getting checked out; it is truly better to be safe and cautious.

Testes cancer can also present with a sudden fluid collection around the testes, breast enlargement and/or tenderness, back pain and rarely shortness of breath, coughing up of blood or a lump in the neck.

The testicles have two functions, the manufacture of sperm (via germ cells) and the manufacture of testosterone (via Leydig cells).  Most testes cancers (about 95%) are of germ cell origin.  Germ cell cancers consist either of seminomas or non-seminomas.  Non-seminomas include embryonal cell cancers, choriocarcinomas, yolk sac tumors and teratomas. Many testes cancers are mixed germ cell tumors consisting of several of the sub-types. 5% of testes cancers are of stromal cell origin, including Leydig or Sertoli cell tumors.

If a patient complains of an abnormality of the testes, the first step is a careful physical examination, usually followed by an ultrasound of the scrotum. The ultrasound will confirm if the mass is solid versus cystic (fluid-filled) and determine its precise location and size.  If the mass is suspicious for a malignancy, blood tests—known as tumor markers—consisting of alpha-feto protein (AFP), human chorionic gonadotropin (B-HCG) and lactate dehydrogenase (LDH) are routinely obtained.

An outpatient surgical procedure is necessary to remove the diseased testicle along with the spermatic cord that contains the blood and lymphatic supply of the testicle.  This is accomplished via a relatively small groin incision.  A pathologist examines the testes microscopically and determines the precise diagnosis.  At the time of surgery, some men will elect to have a testicular prosthesis implanted, whereas others are not concerned about an empty scrotal sac on one side.   Additional staging studies—repeat tumor markers after testes removal and computerized tomogram (CT) of the abdomen and pelvis as well as a chest x-ray—are often necessary to determine if there is any spread of the cancer to remote areas of the body.

Note: Stage I is confined to the testes; stage II to the regional lymph nodes (abdominal lymph nodes); stage III is distant spread.

Depending on the final pathology report and the staging studies, additional treatments may  be required.  At times chemotherapy is the treatment of choice, the go-to cocktail of medications often a combination of bleomycin, etoposide and cisplatinum (BEP).  At other times, sampling of the abdominal lymph nodes is necessary (retroperitoneal lymph node dissection) and depending on the specific pathology, at other times, radiation therapy is necessary.  In addition to the urologist, a medical oncologist and radiation oncologist often are involved with the treatment process.

The Sean Kimerling testicular cancer foundation is an awesome resource for learning more about this disease.

How to do a testes self-exam, a simple task that can be lifesaving

Since only 5% or so of men with testes cancer are diagnosed by a physician on routine physical exam and 95% are picked up in the followup of a testes abnormality noted by a man or his partner, it makes a lot of sense to learn how to do a good self exam. 

Note: For most men, touching/manipulating/rearranging their nether parts is a natural and almost reflex activity that—supplemented with a little instruction, knowledge and direction—can be put to some practical clinical use. What follows is appropriate for the partner of the man in question.  If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.  Several times in my career as a urologist, it was the man’s partner that was astute enough to recognize a problem that prompted the patient visit that determined the diagnosis of testicular cancer. 

The goal of self-exam is to pick up an abnormality– in a very early and treatable stage–at a time when testes cancer is a localized issue that has not spread to the lymph nodes or lungs, which are common sites of metastasis.

Because sperm production requires that testes are kept cooler than core temperature, nature has conveniently designed men with testicles dangling from their mid-sections. There are no organs in the body—save female breasts—that are more external and easily accessible to examination. One of the great advantages of having one’s gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to the ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at a more advanced stage.

The testicles can be examined anywhere, but a warm shower or bath is an ideal setting as the warm water tends to relax and thin the scrotal sac and allow the testes to descend to a position that is most accessible.  Soapy skin will eliminate friction and allow the examining fingers to easily roll over the testicles.

The exam is best performed with the thumb in front and the remaining fingers behind the testicles.  The four fingers immobilize and support the testicle and the thumb does the important work in examining the front, sides, top and bottom of the testicle; then the thumb immobilizes the front while the four fingers examine the back of the testes.  When examining the back surface of the testicle, the index and middle fingers will do most of the work. The motion is a gentle rolling one, feeling the size, shape, and contour and checking for the presence of lumps and bumps.

Compare the two testes in terms of size, shape and consistency.  Generally, the testicles feel firm, similar to the consistency of hard-boiled eggs, although this can vary between individuals and even in an individual.  Lumps can vary in size from a kernel of rice to a large mass many times the size of the normal testes.  The epididymis is a comet-shaped structure located above and behind the testes that is responsible for sperm storage and maturation.  It has a head, a body and tail, and it is worthwhile running your fingers over this structure as well.

This exam should be done regularly—perhaps every couple of weeks or so—such that you get to know your (or your partner’s) anatomy to the extent that you will be attuned to a subtle change.  Once you get in the habit of doing this on a regular basis, it will become second nature and virtually a subconscious activity that only takes a few moments.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

4910841630_d096720d0d_o (1)

(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made, https://www.flickr.com/photos/burgtender/4910841630)

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes

 

Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.

Bleeding

Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Testes Exam

December 8, 2012

Testes Exam

 

Andrew Siegel, M.D.   Blog # 85

Question: For genital health issues, women have gynecologists, but who do men have for their genital health issues?

 Answer: Urologists

 

The next five blogs will be dedicated to men’s health issues.  Today’s blog will cover examination of the testicles and the next three will cover penile issues—fracture of the penis, priapism, and Peyronie’s disease—and the final will be on testicular torsion.

 

Examining one’s testicles is a simple task that can be lifesaving.  For most men, touching/manipulating/rearranging their nether parts is a natural and almost reflex activity that—supplemented with a little instruction, knowledge and direction—can be put to some very good clinical use.  What follows will also be appropriate for the partner of the man in question.  Several times in my career as a urologist, it has been the man’s partner that was astute enough to recognize a problem that prompted the patient visit in which a diagnosis of testicular cancer was made.

Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20’s, striking men at the peak of life.  Lance Armstrong, Scott Hamilton, Eric Shanteau, Tom Green, John Kruk, Brian Piccolo, Richard Belzer, and Bernard Goetz are all members of the testicular cancer club.

The great news is that it is a very treatable cancer, especially so when picked up in its earliest stages, when it is commonly curable.  One of the great advantages of having one’s gonads positioned in such an accessible locale (as opposed to the ovaries) is that examination and early cancer diagnosis is a cinch (once again, as opposed to the ovarian cancer, which most often presents at an advanced stage).

The goal of self or partner-exam is to pick up an abnormality in a very early—and treatable—stage, at a time when testes cancer is a localized issue that has not spread to the lymph nodes or lung, which are common sites of metastasis in advanced testicular cancer.

In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle.  It most often does not cause pain, so the absence of pain is not a feature that should dissuade you from getting an abnormality looked into.  If you feel something that was not present previously, please see a urologist—I promise that you will never be chided for being a “hypochondriac” for getting something checked out.  It is truly better to be safe and cautious.

The testicles can be examined anywhere, but a warm shower or bath is an ideal setting as the warm water tends to relax and thin the scrotal sac and allow the testes to descend to a position that is most accessible.  Soapy skin will eliminate friction and allow the examining fingers to easily roll over the testicles.

The exam is best performed with the thumb in front and the remaining fingers behind the testicles.  The four fingers immobilize and support the testicle and the thumb does the important work in examining the front, sides, top and bottom of the testicle; then the thumb immobilizes the front while the four fingers examine the back of the testes.  When examining the back surface of the testicle, the index and middle fingers will do most of the work. The motion is a gentle rolling one, feeling the size, shape, and contour and checking for the presence of lumps and bumps.

Compare the two testes in terms of size, shape and consistency.  Generally, the testicle feels firm, similar to the consistency of a hard-boiled egg, although it can vary between individuals and even in an individual.  Lumps can vary in size from a kernel of rice to a large mass many times the size of the normal testes.  It is important to know that not every testes abnormality is a cancer; in fact, most are benign.  The epididymis is a comet-shaped structure located above and behind the testes that is responsible for sperm storage and maturation.  It has a head, a body and tail, and it is worthwhile running your fingers over this structure as well.

 

This exam should be done regularly—perhaps every couple of weeks or so—such that you get to know your (or your partner’s) anatomy to the extent that you will be attuned to a subtle change.  Once you get in the habit of doing this on a regular basis, it will become second nature and virtually a subconscious activity that only takes a few moments.

And to every wife, girlfriend, partner…if your man is a stoic kind of guy who is not likely to examine himself here is what to do—at a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom line: Have the “cajones” to check your or your partner’s cajones.  Because sperm production requires that the testicles are kept cooler than core temperature, nature has conveniently designed man with his testicles gift wrapped in a satchel dangling from his mid-section. There is no organ in the body—save the breasts—that are more external and easily accessible.  Take advantage of that accessibility to do regular exams—it just might be lifesaving.

For more info:

http://www.seankimerling.org/

 

 Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

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