Each year, millions of men under the age of 40 are diagnosed with cancer. While most of these cancer patients face excellent prospects for survival, one of the very unfortunate side effects of treatment is permanent infertility. Fortunately advances in both fertility preservation and infertility treatments are occurring at a rapid rate presenting viable options for cancer patients.

Male Fertility Preservation
Male fertility can be harmed by the surgical removal of the testicles or by chemotherapy or radiation that damages sperm quantity, quality or DNA, and can cause azoospermia. Sperm cryopreservation (freezing) is a highly effective technique to preserve male fertility. It is strongly recommended that sperm are collected prior to initiation of treatment because the quality of the sample and sperm DNA integrity may be compromised even after a single treatment session. Although planned chemotherapy may limit the number of ejaculates, intracytoplasmic sperm injection allows the successful freezing and future use of a very limited amount of sperm.

What is testicular cancer?
Testicular cancer typically develops in one or both testicles in young men. It is a highly treatable and usually curable type of cancer.
More than 90% of cancers of the testicle develop in special cells known as germ cells. These are the cells that produce sperm. There are 2 main types of germ cell tumours (GCTs) in men: seminomas and non-seminomas. These 2 types occur about equally. Seminoma and non-seminoma cells look very different when seen under a microscope.
Some cancers contain both non-seminoma and seminoma cells. These are treated as non-seminomas because they grow and spread like non-seminomas.
Testicular cancer is not common; a man’s lifetime chance of developing testicular cancer is about 1 in 270. Because treatment is so successful, the risk of dying from this cancer is very low: about 1 in 5,000.

What are the symptoms  of testicular cancer?
In most testicular cancer cases, men have a lump on a testicle or they may notice the testicle is swollen or larger. Sometimes the  lump causes pain, but most of the time it is not painful. Men with testicular cancer may mention a feeling of heaviness or aching in the lower abdomen or scrotum.
Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes imaging tests done to find the cause of infertility can uncover a small testicular cancer.
A number of non-cancerous conditions, such as testicle injury or inflammation, can produce symptoms similar to those of testicular cancer. Inflammation of the testicle, known as orchitis, can cause painful swelling. Epididymitis (inflammation of the epididymis) can also cause swelling and pain. Both of these can be caused by viral or bacterial infections. The mumps virus causes orchitis in about 1 man in 5 who contracts mumps as an adult.

What are the risk factors of testicular cancer?
Undescended testicle
One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move into the scrotum before birth. Males with cryptorchidism are several times more likely to get testicular cancer than those with normally descended testicles.
Family history
A family history of testicular cancer increases the risk. If a man has the disease, there is an increased risk that one or more of his brothers or sons will also develop it. But only about 3% of testicular cancer cases are actually found to occur in families. Most men with testicular cancer do not have a family history of the disease.
Carcinoma in situ
It isn’t clear how often carcinoma in situ (CIS) in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism.
Cancer of the other testicle
A personal history of testicular cancer is another risk factor. About 3% or 4% of men who have been cured of cancer in one testicle will eventually develop cancer in the other testicle.
Age
About 9 out of 10 testicular cancers occur in men between the ages of 20 and 54. But this cancer can affect males of any age, including infants and elderly men.
Race and ethnicity
The risk of testicular cancer among white men is about 5 times that of black men and more than 3 times that of Asian-American and American Indian men. The risk for Hispanics/Latinos falls between that of Asians and non-Hispanic/Latino whites. The reason for these differences is not known. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among men living in Africa or Asia.

How is testicular cancer diagnosed?
In most testicular cancer cases, men have a lump on a testicle or they may notice the testicle is swollen or larger. Sometimes the lump causes pain, but most of the time it is not painful. Men with testicular cancer may mention a feeling of heaviness or aching in the lower abdomen or scrotum.
In rare cases, men with germ cell cancer notice their breasts are sore or have grown. This symptom occurs because certain types of germ cell tumours secrete high levels of a hormone called human chorionic gonadotropin (HCG), which stimulates breast development. Blood tests can measure HCG levels. These tests are important in diagnosis, staging, and follow-up of some testicular cancers.

Medical history and physical exam
If you have signs or symptoms that may suggest testicular cancer, your doctor will want to take a complete medical history to check for risk factors and symptoms.
Most doctors agree that examining a man’s testicles should be part of a general physical exam The American Cancer Society (ACS) recommends a testicular exam as part of a routine cancer-related check-up.
The ACS advises men to be aware of testicular cancer and to see a doctor right away if they find a lump in a testicle. Because regular testicular self-exams have not been studied enough to show they reduce the death rate from this cancer, the ACS does not have a recommendation on regular testicular self-exams for all men. However, some doctors recommend that all men do monthly testicular self-exams after puberty.

Testicular self-exam

The best time for you to examine your testicles is during or after a bath or shower, when the skin of the scrotum is relaxed.

  • Hold the penis out of the way and examine each testicle separately.
  • Hold the testicle between your thumbs and fingers with both hands and roll it gently between the fingers.
  • Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes.

You should be aware that each normal testis has an epididymis, which can feel like a small bump on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that conduct sperm. Some men may confuse these with cancer at first. If you have any concerns, ask your doctor.

Fertility and hormone concerns with testicular cancer
Testicular cancer and its treatment can affect the levels of the male hormone testosterone. If you had one testicle removed, the other testicle usually can make enough testosterone to keep you healthy. If the other testicle has to be removed because the cancer is in both testicles or if a new cancer develops, you will need to take testosterone the rest of your life.
Testicular cancer can also affect whether you can father children (fertility). Often, those with testicular cancer have low sperm counts before surgery. In some, if one testicle is left, fertility returns after the cancer has been treated. But this doesn’t always happen, and some men need to have both testicles removed. That is why men who might wish to father children should think about banking sperm for later use before treatment starts if it is possible.

Source: American Cancer Society

What You Can Do
A diagnosis of cancer is devastating and making early parenthood decisions at such a time can be very difficult. It is however imperative to perform sperm freezing prior to any chemotherapy or radiation treatment as potential damage can lead to infertility. Cancer therapy can destroy a person’s fertility and their chances of having a family. Your risk of being infertile after cancer treatment depends on the type of treatment, your pre-treatment fertility status, and your age. Your oncologist can give you an estimate of the likelihood that your treatment will decrease your fertility.

Medfem Fertility Clinic is keeping hope alive by offering the opportunity to freeze sperm before treatment. If you are facing a medical treatment such as chemotherapy, radiation or surgery that may affect your fertility, we may be able to help you. In these circumstances, we often need to take action prior to the medical treatment. Therefore, we try to see all urgent cases within 24 hours of having received a referral from your physician.

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