Alberta Cancer Foundation

The Scare Down There

Illustration by Heff O’Reilly

By the time Mike Metcalfe was diagnosed with testicular cancer at age 24, he was in extreme pain and could barely walk five feet. “At work they threatened to fire me, jokingly, if I didn’t go to emergency. I went to emergency and they took two days to diagnosis me with the most advanced form of testicular cancer,” says Metcalfe.

What the athletic Metcalfe thought was a pulled abdominal muscle turned out to be a pinhead-sized tumour on his testicle that had spread into his abdominal region. Metcalfe’s testicle was removed and he underwent aggressive treatment that included more than 500 hours of chemotherapy in seven months, a stem cell transplant and a rare procedure to remove abdominal lymph nodes, known as a retroperitoneal lymph node dissection.
Now 32, Metcalfe is cancer-free.

When Metcalfe’s brother was diagnosed with testicular cancer two years later, his testicle was removed but, unlike Metcalfe, he didn’t need difficult chemotherapy. “He said his left testicle felt a little weird” and he went to his doctor right away, says Metcalfe. “He did not have to have chemo because he was proactive.”

Testicular cancer is the most common cancer in men aged 15 to 35 and, if caught early, it can be cured with surgery alone. “It usually presents as a lump in the testicles, the patient goes for an ultrasound, it’s confirmed and then we take it out with surgery,” says Dr. Daniel Heng, a medical oncologist and co-director of the testicular cancer clinic at the Tom Baker Cancer Centre in Calgary.

“With one testicle, people can function completely normally,” says Heng. The testicles produce testosterone (and other hormones) as well as sperm. One testicle alone will still produce sperm and testosterone. Testicular cancer can, however, have an impact on fertility. Heng says even if patients don’t have chemotherapy, the chance they will be infertile is 50 per cent. (Some patients opt to bank sperm before surgery in case their fertility is negatively affected by treatment.)

In some cases, the cancer has metastasized to other organs and chemotherapy is used as a treatment. “We have noted that testicular cancer is very chemotherapy-sensitive, so, even if it has spread to other organs, chemotherapy can wipe out the testicular cancer in most situations,” says Heng. It’s the situations where chemotherapy doesn’t eradicate the cancer that Heng says need further research. “There’s a gap we need to fill in with research to find better treatment.”

Jason Baker is an advocate and fundraiser for testicular cancer research. He aims to educate young men and promote early diagnosis of this disease. Dr. Heng works closely on Baker’s fundraising initiative as his medical director. They aim to raise $1 million over the next five years.

Baker was diagnosed with testicular cancer at age 29, in fall 2008. Baker’s testicle was removed and he was cancer-free for almost a year before finding out the cancer had spread. He underwent chemotherapy while his wife was eight months pregnant with their first child. “We were a circus together. She was a pregnant little ball and I was bald and white and we definitely looked pretty alarming to people,” says Baker.

Baker’s chemotherapy was ultimately successful and today he delivers presentations about his experience to medical students, oncologists and high school students. “I didn’t think that cancer could affect somebody as young and healthy as I was,” says Baker.

Age is a consideration for testicular cancer: “If you are between the ages of 15 and 35, that’s the biggest risk factor,” says Heng. Other risk factors include having a family history of testicular cancer and having an undescended testicle (known as cryptorchidism). But it can strike any male and Heng says there’s never an age where men can stop worrying about the disease.

Testicular cancer affects a young population on a part of the body with which a young guy just doesn’t want anything going wrong. It makes an open discussion of the disease rare. “These are young people,” says Heng, “and usually young people don’t like to talk about illness, so this advocacy group is small.”

Clothed, even in a swimsuit, it would be hard to tell if a man were missing one testicle. But if the guy were naked and an observer were looking in the right spot, it would be noticeable. For patients who have had one removed, there is an option for a cosmetic prosthetic – a small, silicone filled sac can be surgically implanted to make it look like there is still a pair. It’s not for everyone.

Baker says when he found out a prosthesis was an option he “laughed and said ‘they make those?’” He estimates he spends “.001 per cent” of his time thinking about the fact he has one testicle. “For me, there are no psychological impacts associated at all with having one testicle,” he says.He plays a lot of hockey and, if he gets a questioning look in the dressing room, he takes it as an opportunity to share his story and teach the importance of checking oneself for the disease.

Through speaking out and fundraising initiatives, Baker and Metcalfe are getting men to talk about testicular cancer. While still undergoing treatment, Metcalfe’s friends and teammates started a soccer marathon in his honour. In seven years, the annual event has raised more than $350,000 toward the purchase of cancer-related diagnostic and treatment equipment.

Metcalfe, 32, is open about his story and encourages others to be proactive if they notice something amiss. “Make sure when you’re in the shower, check yourself, look for little pinhead-sized abnormalities. It doesn’t have to be huge. A lot of people think your ball grows to the size of a grapefruit and that’s how you know and that’s not the case every time.”

Metcalfe says his mindset at age 24 was to write everything off to an athletic injury and avoid the doctor at all costs. “When it came down to the symptoms of cancer, I ignored it. You feel like you’re young, you’re going to heal.”

Today Metcalfe encourages males to be proactive like his brother was, to not procrastinate, and to visit their doctor. “You never know what it’s going to be so make sure you get yourself checked.”

What’s with the cough?

Asking questions during a routine check-up can be embarrassing for guys, especially when those questions have to do with their junk. Many young men don’t know what their doctor is looking for when he holds their testicles and tells them to cough. This is actually a simple test used to check for hernias, not testicular cancer.

“When we do a testicular exam, we don’t ask patients to cough,” explains Dr. Daniel Heng of the Tom Baker Cancer Centre in Calgary. To check for testicular cancer, doctors will put on gloves and hold and feel around the testicle. They want to make sure each testicle is still smooth and there are no lumps, bumps or masses around it. If a patient notices discomfort, a lump, pain, hardness or aches in one or both of their testicles, he should consult his doctor right away.