Undescended testicles may raise cancer risk

SINGAPORE — When 23-year-old undergraduate Peter Tan (not his real name) first noticed that one side of his scrotum had become “surprisingly larger” than the other side, a cancer diagnosis was the furthest from his mind.

Mr Tan, who was serving National Service then, was in the prime of his life. The fitness buff worked out regularly, and did not smoke or drink alcohol.

“I thought I might have strained a muscle. What was especially worrying was that there was no pain,” said Mr Tan.

His worry was not unfounded. A week before his 21st birthday, Mr Tan was diagnosed with Stage 1 cancer in his left testicle. Located inside the scrotum, testicles produce male sex hormones and sperm.

Soon after the diagnosis, he underwent surgery to remove his left testicle. He also underwent chemotherapy that left him with hair loss, skin rashes and gastric problems.

Testicular cancer makes up 1 to 2 per cent of all cancers in men, said Dr Wong Seng Weng, medical director of The Cancer Centre, a Singapore Medical Group clinic. The National Cancer Centre Singapore (NCCS) sees about 30 cases each year.

MORE COMMON IN YOUNG MEN

Although testicular cancer is not as common as the other male reproductive cancers such as penile and prostate cancer, Dr Sim Hong Gee, a urologist at Gleneagles Hospital Singapore, pointed out that it “stands out among the three male cancers as it affects mainly younger men in their prime”.

Most patients are diagnosed between the ages of 18 and 44, he said.

Dr Sim said that the youngest patient he has seen was only 17 years old at the time of diagnosis.

“The diagnosis invariably comes as a rude shock, as cancer and death are issues furthest from their minds at this age. Apart from cure of the disease and survival, a potential fertility problem leads to much anxiety as many patients have not completed their family planning at such an early age,” said Dr Wong.

It is not known exactly why some younger men develop this cancer.

Dr Toh Chee Keong, senior consultant medical oncologist at the NCCS, said one known risk factor for testicular cancer is an undescended testicle.

Men with this condition, whereby one or both testicles do not descend into the scrotum at birth and remain in the abdomen, have a three to four times higher risk of developing testicular cancer.

Undescended testicles can be corrected with surgery, ideally during childhood, and this will lower the risk of the cancer, said Dr Toh.

Also at higher risk are men with a family history (for instance, a brother or father who has the cancer) as well as those who are born with abnormal testicle development.

MUSCLE-BUILDING SUPPLEMENTS LINK?

A case-control study published in the British Journal of Cancer in March this year has also linked muscle-building supplements to testicular cancer.

The authors found that the risk of developing testicular cancer may increase by up to 65 per cent in men who use muscle-building supplements (MBS), which contain creatine or androstenedione.

The risk increased even more among men who used these supplements before the age of 25, used two types or more, or used them for at least three years.

However, Dr Toh from the NCCS said the study did not definitely determine the case but merely suggested it. More studies need to be done to confirm a clear link between MBS and testicular cancer.

Still, Dr Toh said, it is important for young men to be aware of the possible risks of taking these supplements.

Coincidentally, five months before he was diagnosed with cancer, Mr Tan downed muscle-building protein shakes that he bought online in a bid to bulk up.

He would drink the shakes after each workout session.

Dr Wong said: “The study shows that the use of pharmacological interventions, including health supplements to gain better health, might have hidden risks that we are not aware of.”

While dietary supplements are popular among fitness buffs, Dr Sim added that their benefits are not proven and risks not well studied.

“These products are also not subjected to the same manufacturing standards and justification by clinical trials as prescription medications are by US Food and Drug Administration or Health Sciences Authority in Singapore,” said Dr Sim.

HIGHLY-TREATABLE DISEASE

Fortunately for many patients, testicular cancer is among the most treatable of cancers.

One of the reasons is that most patients are diagnosed early as the testes is an external organ, said Dr Toh. This makes it easier for patients to detect any symptoms of testicular enlargement, lumps and pain.

Mr Tan said: “I was very lucky that the cancer was in a location where it could be felt easily. I believe that saved my life.”

Added Dr Toh: “The earlier the cancer is detected, the higher chance of a cure.”

The disease is also extremely responsive to chemotherapy, said Dr Wong and Dr Sim. Dr Sim said more than 90 per cent of testicular cancers can be cured with chemotherapy and/or surgery to remove the affected testicle.

However, the downside is that treatment may affect fertility.

While the other normal testicle should still be able to produce sufficient sperm needed for conception, Dr Sim said chemotherapy or radiotherapy — especially in more advanced cases — can potentially affect fertility.

For that reason, the experts said patients who are not done with their family planning are usually advised to consider using a sperm bank before starting these cancer treatments.

Mr Tan, who was single at the time of diagnosis, said: “While I felt hopeful about treating and surviving my early-stage cancer, the possibility that the treatment might affect fertility was a huge scare. Luckily, the chemo didn’t affect my fertility but as a backup plan, I’ve banked my sperm.”

Two years after completing his cancer treatment, Mr Tan is studying in university. He has been given the all-clear by his doctor.

He is now dating someone but is reluctant to tell his girlfriend about his cancer scare.

Other than his close friends and family, he has not told anyone about his brush with death.

“I’m not comfortable sharing that I had testicular cancer as there is a stigma attached to it. For me, nothing has changed but from other people’s perspective, would they see me as a lesser man?

“But eventually, I’d have to tell my wife-to-be because cancer is hereditary and my children may potentially get it too,” said Mr Tan.