Augusta University Health
It’s probably not something most guys talk about—or even admit to themselves—if they suddenly feel a lump or an unusual firmness in their testicles.
“We all do it,” said Dr. Zach Klaassen, a urologic oncologist at Georgia Cancer Center who admits that he finally got his blood pressure checked a couple of years ago, but should have done it five years ago. “We’re all the same; none of us want to go. We’re in denial—‘Oh, it’ll get better.’ We’re wired the same way.”
But when it comes to testicular cancer, men—especially young men ages 15 to 39, who are at highest risk for it—can’t be in denial. “Fear is fine, but don’t let it paralyze you and stop you from getting checked if there’s a problem,” said Klaassen.
Why Denial Doesn’t Work
Klaassen says a good way to check testicles is to compare them to how the soft pad at the base of your thumb feels. There shouldn’t be a lump or a hard firmness.
Sure, the testicles can sometimes swell or feel different because of infection or maybe even a cyst. But any change should be checked out. “Best case scenario: I tell you it’s nothing, go enjoy your life and keep doing self-checks,” he said.
But say you keep avoiding the problem: Testicular cancer metastasizes very easily, traveling a specific path outside the scrotum and into the abdomen, stretching up to lymph nodes, and can even reach up into the liver and lungs. For example, Klaassen recently performed a surgery for testicular cancer that required him to do an incision from the belly up to the chest to remove a 15-centimeter tumor—about half the size of a football. “You don’t want that surgery,” he said.
Taking Control of Testicular Cancer
Even though finding cancer early—before it’s left the testicle—is good, any diagnosis is never easy. “These are guys who are basically at the peak of their lives, who are hit with this diagnosis,” said Klaassen. “There’s disruption with school, work, family life—often young children as well, if not young relationships. It’s a big blow to the entire psyche; everything they know is turned upside down.”
Then there’s the stress of followup visits, checking tumor markers, getting the next set of images and coming back to the physician for the news the next day.
Those are challenges, said Klaassen, but here’s how he helps guys overcome them:
- If someone is diagnosed with testicular cancer at the Georgia Cancer Center and the cancer can be treated with surgery alone, Klaassen schedules the procedure that same day. In theory, it decreases risk of spreading, but it also keeps denial away. “It may sound dramatic, but we don’t want them disappearing,” said Klaassen.
- Other patients may need surgery and chemotherapy, and if chemo’s involved, Klaassen also talks to these guys about sperm banking since the treatment can affect fertility, at least in the short term.
- Each patient also gets a calendar of his follow-up schedule, so he knows exactly what’s going to happen in a month, six months, a year and five years down the road. For example, for someone with advanced disease, chemotherapy might last three to four months, followed by surgery, then six weeks of recovery, three to six months of surveillance for the first several years, followed then by annual checks. “There’s no guessing what’s coming up next, and they can buy into their treatment and care,” he said.
- Everyone gets Klaassen’s email address, too. “I say if you have questions, reach out to me,” he said. “If you’re worried or feel like you want to slack off on visits, email me so we can go back and forth on it.”
His nursing team and residents are the same way. “We keep tabs on how these guys are doing. We talk about side effects of chemo and surgery, their sexual lives, how it’s going to be with just one testicle—all those things that might freak a young guy out,” he said. “We have a lot of personal communication and talk about home life, family, work, school. And I have a low threshold for referral to psycho-oncology.
“I want to be a champion for these guys,” he added. “I’m not that much older than they are. I’m still in the age category that’s at risk, and I tell them that I tell my friends and everybody in this age group to do self exams. That’s the take-home message from this: If something doesn’t feel right, it may be nothing, but check it out to make sure.”
Lindsey Morris
