‘Movember’ is the time when men grow their moustaches to raise awareness on men’s health issues. Jennifer Grech writes about a recent study published in the British Journal of General Practice.
Contrary to traditional teaching, painful testicular enlargement is a strong predictor of testicular cancer, a general practice study has shown.
The research, published recently in the British Journal of General Practice, found that a lump or swelling was the biggest risk factor for the disease.
The study looked at the symptoms of testicular cancer reported in general practice surgeries.
Researchers from the University of Exeter Medical School compared electronic patient records of 1,398 men who had testicular cancer with 4,956 matched controls to determine which symptoms were associated with a higher risk for the disease.
Diagnosing the disease early often means shorter treatment times and fewer complications, and may also help improve fertility.
The European Association of Urology guidelines say there are no high-level evidence studies proving the advantages of screening programmes, but it has been demonstrated that stage and prognosis are directly related to early diagnosis.
In the presence of clinical risk factors, and especially in patients with a family history of testis cancer, family members and the patient should be informed about the importance of physical self-examination, it points out.
“I think that men in general are not in the habit of examining themselves,” says consultant urologist Stephen Mattocks, a visiting senior lecturer at the University of Malta’s Faculty of Medicine and Surgery.
Diagnosing testicular cancer early may also help improve fertility
“I would advise that at least once every two to three months during a warm shower, men should examine and feel their testes in order to become familiar with their shape and size. The separate structure behind the testis is called the epididymis and is normal,” he continues to explain.
These structures are best felt when the scrotal skin is relaxed, hence during a warm shower or bath.
“Once an individual is used to the general shape of the testes, a new lump or change in size becomes more obvious,” he says.
If this is noticed, then a visit to the GP is mandatory. In most cases there is nothing wrong, but an ultrasound will quickly confirm the nature of any new swelling or lump.
The UK’s National Institute for Health and Care Excellence’s guidance on testicular cancer recommends urgent specialist referral of men with non-painful enlargement or a change in shape or texture of the testis. It says that a direct access ultrasound should be considered for men with persistent or unexplained other testicular symptoms. The study authors say that their findings suggest that recurrent testicular pain, unresolved epididymo-orchitis (inflammation of the epididymis and testes) or hydrocele (swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle) should come under this recommendation.
This new research indicates a promising breakthrough in understanding the biggest risk factors for testicular cancer. It also shows the incidence of testicular cancer in the period 2008-2016 – which peaks around the ages 20 to 40. Five-year survival from testicular cancer is 87.4 per cent, slightly below European average of 88.6 per cent.
Adolescents and young adults:
Symptoms may also include one or more of the following:
▪ A lump in one testis which may or may not be painful.
▪ Sharp pain or a dull ache in the lower scrotum.
▪ A feeling often described as ‘heaviness’ in the scrotum.
▪ Breast enlargement.
▪ Low back pain tumour spread to the lymph nodes along the back.
It is not very common for testicular cancer to spread to other organs, apart from the lungs. However, if it has, the following symptoms may be present:
▪ Shortness of breath, cough or coughing up blood from metastatic spread to the lungs.
▪ A lump in the neck due to metastases to the lymph nodes.
The incidence of prostate cancer peaked around the ages 65 to 79 from 2005 to 2012. It is the commonest cancer in men (followed by lung and colorectum). Five-year survival from prostate cancer is 84.9 per cent (Eurocare 5 for period 2000 to 2007) above the European average (83.4 per cent).
Men aged 50 or above should be encouraged to seek medical advice on this condition if they have any of these symptoms: Problems with passing urine – micturition hesitancy, dysuria (painful micturition), frequency in passing urine especially at night, blood in urine or semen.
A PSA test – used to screen for prostate cancer – can be elevated in other conditions such as benign enlargement of the prostate, inflammation of the prostate (prostatitis) and urinary infections. It can be useful to detect or follow up patients with this type of cancer.