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A personal story of testicular cancer
November 02, 2004Every fall, as the baseball playoffs are in process, I remember my internship in Minnesota and the Twins' first World Series Championship. You could see the big, white bubble of the Metrodome from the cancer wards at the University Hospital, and it seemed to be shaking with an electrifying energy that Seattle Mariner fans can only dream of. I sat in Dan's hospital room and watched the games. Dan was a fourth year medical student at the University of Minnesota. He would never graduate. Dan was dying from testicular cancer. This column is inspired by Dan's story.
Dan was in a urology lecture during his second year of medical school when the lecturer plowed through testicular cancer statistics. About 9000 new cases of testicular cancer will be diagnosed in the United States this year. 7,500 of them will occur in young men between the ages of 20 and 34, and though it accounts for only one percent of all cancers in men, it is their most common malignancy. Though more than 90 percent of testicular cancers are cured, it is never the less the number one cancer killer among men in their third and fourth decades.
Then the lecturer instructed the class in how to perform a doctor's testicular exam and a self-exam. Stand in front of a mirror. Check for any swelling on the scrotal skin. Examine each testicle with both hands, placing the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers. You shouldn't feel pain. Don't be alarmed if you discover one testicle seems slightly larger than the other. That's normal.
Find the epididymis, the soft tube like structure behind the testicle that collects and carries sperm. It often feels lumpy. Become familiar with it and you won't mistake it for a cancer. Cancerous lumps are usually found on the sides of the testicle but can also show up on the front. Testicular cancer starts in the testicle and free-floating lumps that are not attached to a testicle in any way are not testicular cancer. If you find a lump on your testicle, see a doctor right away. When in doubt, get it checked out. It may not be cancer. Infections, hernias, varicose veins and extra fluid in the scrotum can all cause benign lumps, but let a doctor decide that.
The urology lecturer then told the men in the class that there was a statistical probability that if they all went home and did a self-exam, one of them would have a cancerous lump. That one was Dan. In retrospect, Dan knew that the cancer had been evident for some time, but he hadn't had the lecture 6 to 12 months earlier when it might have first been discovered. When caught early, the cure rate is 95 percent. CAT scans showed that it was in his liver and lungs, the chances for a cure dropped to 70 percent.
He had a great attitude, though. Lance Armstrong is today's testimony that even patients with advanced widespread testicular cancer can be cured. But, by the time I knew Dan, he had already relapsed twice. He knew he was dying.
That night, watching ball players on TV scratch like ball players do, he asked aloud why his sisters reported that during high school they were instructed ad infinitum about self breast exams, but that he had never heard boo about testicular cancer self exams. Why, he asked, couldn't it be included in the PE teachers lecture about always wearing a jock strap? Why wasn't it part of the sex education curriculum? Dan wasn't bitter or resentful, but he was indignant that something so simple is so widely overlooked.
So this is Dan's column. If you are a man between puberty and 40, or if you have one in your life - a son, a boyfriend or a husband - if you teach or coach young men, or have a role in developing curriculum for those who do, please encourage or instruct monthly self-exams. There are a number of good web sites with detailed instructions on self-exams that can help. I don't know if regular exams would have saved Dan's life, but maybe his story will save others.
Dr. Jeffery Ward is a medical oncologist at Puget Sound Cancer Centers. He currently serves as Cancer Committee chair at Stevens Hospital and has been medical director of Hospice of Snohomish County since 1994. For more information, call (425) 775-1677 (Edmonds), 206-365-8252 (North Seattle) or go to www.pscc.cc on the Web.