A cancer men would rather not consider
By Meg Hagerty
In the late summer of 2007, Matthew Foster, then 25, felt pain like he had been kicked in the right testicle.
"It was really sore every single day," Foster said.
Then the pain went away.
A week later in the shower, he felt something abnormal in the same spot.
Foster was worried and told two friends, who urged him to see a doctor. He waited two weeks but then went to the Whitehall Health Center.
He was referred to Dr. Vincent Cooper, a Glens Falls urologist, for an ultrasound, and was diagnosed with cancer. Shortly afterward, he had his right testicle removed in a procedure called an orchiectomy.
Following the surgery, doctors found cancer in lymph nodes on his back. An inverted "v"-shaped scar remains on his torso.
"I'm working on a baseball diamond," Foster joked. "And I really don't want to finish it up."
He had follow-up chemotherapy, which ended a little more than a year ago.
At this point, Foster is cancer-free.
According to the National Cancer Institute, in 2008 there were 8,090 new cases of testicular cancer in the United States and 380 deaths, accounting for 1 percent of all male cancers.
Cooper said the testicular patients he sees are most commonly between 20 and 40, but older men develop it, too. He cautioned, however, teenagers also get it.
"Testicular cancer is a very fast-moving cancer. The nice thing about it is it's probably the most curable type of solid cancer, but it can also spread fairly quickly. When we find the lump, we usually like to move in within a couple weeks to get it taken care of," he said.
Cooper said he thinks testicular cancer should be talked about in school. Men need to be familiar with their anatomy and educated about what is normal and abnormal, he said. He recommends once-a-month self exams in the shower.
"You may get concerned about different lumps that you feel and be rushing to the doctor. A simple five-minute talk to kids about what they're looking for, how often they should do an exam would be extremely helpful," he said.
The subject, Cooper acknowledged, can be embarrassing for men, especially teenagers.
Foster said he took a pragmatic approach.
"You've got to weigh the difference of 'Do I want anybody to know and start poking around down there?' or 'Is it going to make me sick to the point where they can't fix it?' "
Men will usually seek medical attention because they feels a nodule inside the testicle, at times with pressure or discomfort.
Cancer of the testes can metastasize to the lymph nodes in the back. It also can spread to the brain or lungs, Cooper said.
The usual first step in diagnosis is an ultrasound.
"The key distinction is, is this thing they're feeling inside the testicle itself? There's a lot of bumps and lumps around the scrotum that are not dangerous," Cooper said.
If a lump is found within the testicle, there is concern for cancer. A CAT scan is done of the chest, pelvis and abdomen to determine if the tumor has metastasized.
Treatment can involve a radical orchiectomy, or removal of the testicle, depending on how aggressive the cancer is. A slower-moving cancer can be treated with radiation.
Side effects to radiation can show up years later, however, so doctors want to be careful about exposing young men to the treatment if it's not needed.
The cancer itself, and the treatments, can affect fertility. Doctors usually recommend to younger patients that they bank some sperm before the surgery.
"Even though they may have another good testicle left, sometimes just going through the trauma of the operation can decrease sperm production for a period of time of the other testicle," Cooper said.
The risks of recurrence are "fairly low" after treatment, but a lot depends on the size of the initial tumor, according to Cooper. Even if the cancer reappears, with treatment, the cure rate is high.
"(Men) may be in a little bit of a denial because if they go and (doctors) find cancer, then they're going to have to lose their testicle. Men do fine with one testicle -- it provides testosterone and sperm," Cooper said. "Usually, visually even with one testicle it looks fine. However, (for) people who may be self-conscious, we have testicular prostheses."
The prosthesis is made of silicone and feels like a testicle, he said.
Foster has been back to work at International Paper Company in Ticonderoga for almost a year.
He said the experience has made him open to experiencing more in his life, while before he might have held back.
"I thought two weeks (of waiting) wasn't a lot, but it had enough time to travel from where it originated up into my abdomen, and they removed a four-and-a-half-inch tumor. You don't have to be 20-anything. You could be 15. Who knows?" he said.
