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If a man finds an abnormal swelling in their testicle it is advisable to see their GP for further advice or examination. If a GP is unsure of the exact cause of the testicular swelling they will usually recommend an ultrasound scan of the scrotum and make a referral to a urologist for assessment. The ultrasound scan and referral will usually be made on an urgent basis meaning that men will be seen by a urologist possibly within a few days and no more than a few weeks. It does not necessarily mean that testicular cancer is present.
Once a man has had an ultrasound scan they will be reviewed by a urologist who will be able to interpret the results. If there is any doubt as to the diagnosis a further more detailed ultrasound scan may be requested.
Sometimes if there is a strong suspicion that testicular cancer is present but no definitive proof, a decision may be made to surgically remove the affected testicle. This decision will not be taken lightly but will be made in a mans best interest. No one will want to wait around and see what happens.
Surgery to remove the testicle (orchidectomy) will usually be the only time that a definite cancer diagnosis can be verified or ruled out.
If testicular cancer is identified or suspected, a urologist will want some further tests performed to see if there has been any potential spread of the cancer to other parts of the body. These tests may include some or all of the following:
Some testicular cancers produce chemicals, which are released into the bloodstream. The three main chemicals, called tumour markers, are alpha-fetoprotein (AFP), beta human chorionic gonadotrophin (BHCG) and Lactase dehydrogenase (LDH). They are sometimes found to be abnormal in the presence of particular types of testicular cancer. For instance AFP can be raised in the presence of a particular type of testicular cancer called non seminoma. They can also be used to measure the effect of treatment and may be repeated after orchidectomy (see below) at 48-96 hours if they were abnormal before the operation. Blood tests to measure kidney and liver function will also usually be requested.
Occasionally if the specific blood tests for testicular cancer are very raised or abnormal or there is obvious evidence that testicular cancer is present or has spread to other areas in the body, a referral may be made to an oncologist to see if chemotherapy should be given prior to any surgery. This is called neo-adjuvant treatment.
This can identify any cancer which may have already spread to the lungs.
Yes believe it or not this is sometimes used to detect testicular cancer. A pregnancy test works by identifying BHCG.
Computerised Tomography (CT)
A CT scan is performed to check for any signs that the cancer has spread to the lungs or to the lymph glands in the abdomen. The CT scan takes a series of x-rays, which are fed into a computer to build up a three-dimensional picture of the inside the body. The scan takes from 10 to 30 minutes. A drink or injection of a dye that allows particular areas to be seen more clearly will be given. For a few minutes, this may cause a sensation of feeling hot all over. If someone is allergic to iodine or has asthma it may cause a more serious reaction to the injection, so it is important to let the doctor know beforehand. Men should be able to go home as soon as the scan is over. The scan is painless, but it will mean lying still for 10-20 minutes. Any scans that may be needed will be requested on a very urgent basis and will usually be performed within a few weeks of request.
Positron Emission Tomography (PET)
A Positron Emission Tomography scan (PET scan) PET scan can be used to find whether testicular cancer has spread beyond the testes, or to examine any lumps that remain after treatment to see whether they are scar tissue, or whether cancer cells are still present. They are not always necessary, but men can discuss with their doctor whether one would be useful.
A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in the arm. A scan is then taken. Areas of cancer are usually more active than surrounding tissue and show up on the scan. It is not usually used on a routine basis but may be performed after initial treatment.
Orchidectomy is the removal of a testicle and is usually performed very quickly after a suspected diagnosis of testicular cancer. It is a simple procedure which may take about half an hour or so to perform and will usually be performed as a day case procedure under general anesthetic. During this surgery a small incision is made into the groin region on the affected side and the testicle is removed from above. The scrotum will not be cut. Prior to surgery the doctor may ask a man if he wishes to have a prosthetic (artificial) testicle in place of the removed testicle. However some men may develop minor problems in the long term (see below). Men may also be offered the possibility of sperm storage before surgery (see information sheet on sperm banking).
Falsely or not?
A doctor may discuss the insertion of a false (prosthetic) ball to take the place of the old one. These are silicone implants that can be inflated with salt water. They come in various sizes and can make men feel whole again. They can give a very good cosmetic result and be of great psychological value but some men may experience problems with them at a later date. Some of these possible problems include:
· Scar tissue can form around the implant inside the scrotum. This can sometimes cause a thick fibrous growth of tissue to form which may in turn cause discomfort or give rise to worry that a second cancer has appeared.
· Rupture of the implant can rarely occur due to vigorous activities such as contact sport, cycling or physical contact including sex.
· Sometimes the implant may move out of its original position.
· Surgery can cause small spots of calcium in the testicle to appear usually some years following surgery. Although they are harmless they can sometimes be confused with the type of calcium deposits (microlithiasis), seen in testicular cancer.
If a man is unsure of whether they want an implant or not, the procedure can always be carried out at a later date.
For more information on the insertion of a prosthetic testicle the British Association of Urology Surgeons (BAUS) have produced some guidelines.
Once a diagnosis of testicular cancer is suspected things will begin to move very fast for men, surgery will be booked and scans arranged usually within a two-week period. Plan ahead. Try and involve all the family. Let them know what is happening so that they can help with any arrangements that need to be made while treatment is taking place (childcare, work etc.).
While being treated and afterwards, men will need to take some time off work. Keep any correspondence/ letters and contact details of the health professionals or procedures that are performed as proof of treatment in case an employer wants evidence. It may also be a good idea to talk to the human resources department and inform them of the current situation and the fact that some time off of work will need to be taken. Think about working from home if possible. Although the hospital where a man has been treated can issue a sick certificate to cover hospital stay they will not provide a long term sick certificate. This will have to obtained from a G.P.
Men who are self employed and have to stop working due to their illness should be entitled to incapacity benefit providing they have been paying National Insurance contributions previously. They may also be entitled to other benefits or rebates if they are going to be out of action for some time.
· There will be a small dressing covering the incision site on the groin. This can usually be removed at about 24 hours after the operation. The stitches (sutures) in the wound will be dissolvable but can take up to 3-months to fully dissolve.
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