Testicular cancer

The first time I came across ‘traditional surgeons’ was an encounter with a testicular cancer patient. I was very familiar with traditional healers and their ability to use non-invasive herbal compounds for ailments but not their advanced colleagues who actually perform surgeries in what has now become unconventional environments for us. There was so much misinformation in this case that I think it’s appropriate to share with you my readers so that you are aware of myths.

It was a slow morning in the emergency department during my internship year. I was quite frustrated because this usually meant there would be an influx just before the afternoon round with the consultant and it would seem to him as if we did not know what we were doing when in fact we were quite a good committed team from senior registrar to us the measly junior doctors. The consultant wasn’t the type who yelled. He just gave you a disappointed look, which left you doubting the call you answered when entering the profession. I particularly didn’t like letting him down because he took time to teach us the ropes thoroughly before letting us fly when we were new to the surgical rotation.

 So when a young man in his early twenties was brought to the admission ward I quickly jumped up to take his history and examine him barely letting the nurses finish their formalities of patient hand over.

His main complaint was a chronic cough that had gotten worse progressively and he was now producing blood stained mucus. He had no fever. No tuberculosis contact. He had never smoked. And indeed when the nurse handed me the file where she had recorded his vitals his body temperature was not too high, though I noted it wasn’t in that normal range that I could dismiss it.

Initially I struggled to obtain a thorough history, as he was not convinced I was actually the doctor on duty. However, with well-seasoned persistence we got to an understanding of our roles in the room and he started giving me more information. He mentioned the problem began when he started dating a certain lady. He truly regrets this as he had been warned not to get into a relationship with her, but her charms won him over. Within a month of sexual relations he developed a lump in his left testicle. He obviously ended the relationship as he believed her charms to keep him faithful may cost him his manhood. He was then advised to visit one of his uncles in the outskirts of the city, who addressed these testicular lumps on a regular basis. The young man did and a ‘traditional’ surgeon cut out his lump.

As he spoke I removed the chest X-ray films from the envelope and examined them. The reason for his blood coloured sputum was clear. He had what we call ‘canon’ ball lesions on the films, which is cancer that has spread to lungs.

By the time I finished examining him I was hundred percent sure he had testicular cancer but I had to wait for the consultant to make the call. The traditional surgeon had done the first management step, which is to remove the lump but unfortunately with a wrong technique as he cut through the skin. Appropriate surgery performed is called inguinal orchiectomy – the testes are removed through an incision in the groin. This prevents the cancer from spreading. Additionally inguinal node dissection confirms the presence or absence of disease guiding further interventions. A CT scan is also done to rule out spread in the chest, abdomen and pelvis. Generally testicular cancer is a very responsive disease to chemotherapy and outcomes are good if proper management is followed.

If you have been following the order of how we manage cancer as I describe in the features, you are probably asking then how is a biopsy done before surgery. Well testicular cancer produces serum markers that we can use to diagnose and monitor the disease called alpha feta protein and beta HcG. Beta HcG is a marker we find elevated in women during pregnancy but in the case of cancer it is present in men. 

There are certain risk factors that increase the probability of testicular cancer. These include undescended testicle, having an abnormal development of the testicles, a personal and family history of testicular cancer.

Presentation can vary with some men complaining of a painless lump or swelling, change in how the testicle feels, a dull ache in the lower abdomen or the groin. This brings me to the next point about men knowing their testicles as women know their breasts to fight cancer.

Every man should know how their normal feels like so that when there is something wrong they can seek medical attention at the right time.

The steps are firstly to look and inspect. It advisable to check them after a bath or shower, as the muscles in the scrotum are more relaxed. Next would be to hold your scrotum in your hands and feel the size and weight of each testicle. After that you gently feel each testicle by rolling it between the thumb and finger. Lastly would be to repeat the steps on a regular basis. Self-examination saves lives!

To conclude, the young man was referred for chemotherapy. He was lucky the cancer clinic had just opened its doors to the public officially and he had a fantastic response as is expected.

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