The news that GAA footballer Ronan McGarrity had testicular cancer has once again focused attention on a disease which men very often try to ignore, but one for which there is often a very good outcome. David Labanyireports
A short time ago, a man in his 40s walked into an appointment with a hospital consultant with a testicle "swollen to the size of a football".
The patient was examined by consultant urologist Thomas Lynch at Tallaght Hospital and diagnosed with testicular cancer. Following chemotherapy to reduce the swelling, the testicle was removed during surgery.
"The swelling had just got bigger and bigger until he was absolutely petrified," says Lynch, who adds that some men "stick their heads in the sand and do nothing" when it comes to health concerns.
"They are walking around worried sick. We call them the 'worried well', because in the vast majority of cases these lumps are not cancers and I can reassure them after a couple of minutes. However, there is also a 95 per cent cure rate when we catch it early."
Happily, following treatment and surgery, this patient is "now doing very well", according to Lynch.
Testicular cancer is relatively rare, accounting for 2 per cent of male cancers. The high success rate of treatments for it also make it unique. Famously, American cyclist Lance Armstrong recovered from advanced testes cancer before going on to win the Tour de France a record seven times.
This cancer came to the fore in Ireland recently after Mayo footballer Ronan McGarrity temporarily withdrew from his county's senior team to receive treatment for it.
Roughly 120 men are diagnosed with this cancer in Ireland each year. However, unlike other cancers, it mainly affects young men, typically those between their late teens and 40s. It is the commonest cancer in this age group.
Identifying a small hard lump on a testicle or swelling in the scrotum is the most common way to identify testicular cancer. There are two types of testicular cancer: seminomas and non-seminomas.
Seminomas are relatively slow growing and are found mainly in the testicles. This cancer is generally found in males of 30-40 years of age and accounts for about one-third of all testicular cancers. Non-seminomas are more common in younger men, aged between their late teens and 30s.
A man's treatment will vary depending on the type of testicular cancer he has but in almost all cases it will involve an operation to remove one of the testicles.
"Depending on test results, they may then need further treatment. About half of all patients will require either radiotherapy or chemotherapy, or sometimes both," says Lynch.
Medical oncologist at St James's Hospital, Dublin, John Kennedy says chemotherapy is required for roughly one in three patients where the cancer has spread to a patient's abdomen or has recurred.
Chemotherapy is "not a walk in the park", says Kennedy. "It is fairly intensive, running over nine to 12 weeks and is a full-time project. Patients will often experience tiredness, kidney problems and infections."
After chemotherapy about half of men will be infertile. "As a result, we offer sperm banking to all patients before they undergo treatment," says Kennedy.
Prof John Armstrong is a radiation oncologist at St Luke's and St Vincent's University Hospitals in Dublin and says roughly 30 per cent of men with testicular cancer will need radiotherapy. "We use radiation to the glands in the abdomen to sterilise bad cells that might be undetectable to a Cat scan. We know that in 15 per cent of patients where the cancer appears confined to the testicle, there are actually bad cells there that are undetectable on the scan, so we radiate preventatively."
While radiation has a high success rate with testicular cancers, Armstrong says new technology being introduced in Irish hospitals will reduce the amount of radiation going to healthy parts of the body.
"These are young men, so you want to avoid giving radiation to parts of the body that don't need it," says Armstrong, who is also chairman of the Irish Cancer Society.
Relapses after testicular cancer are relatively rare and the risk reduces as time passes.
While recovery depends on the severity of the cancer, many men return to their work and leisure activities within months of completing treatment. For most, there will be no long-term impact on fitness levels.
After treatment, patients are regularly followed, something Kennedy admits can be a challenge: "These are young, very busy men and some of them don't like coming back every month."
There are two clear risk factors for testicular cancer. The first is if a man had an undescended testes as a child. The testicles should usually move from the abdomen to the scrotum by the time a child is one year old and if they did not, the man is at an increased risk.
The second risk is a family history of this type of cancer. A man with a brother, father or uncle diagnosed with testicular cancer is also at a higher risk.
"There is clearly a family history with testes cancer and there is a lot of research interest in trying to find out why that is," says Kennedy.
Cancer Facts
Number of cases:Approximately 120 per annum.
Treatment success rate:Over 95 per cent; higher if caught early.
Treatment locations:Surgery and chemotherapy are available in most teaching hospitals. Radiation is restricted to hospitals with radiotherapy units.
Risk factors:An undescended testes as a child or a family history of this cancer.
Risk groups:Men aged 15-40.
Symptoms:Usually a lump or swelling of the testicle.
Response to symptoms:Discuss with your GP.
Long-term implications:Should not affect a man's sex life or chances of becoming a dad, albeit with aid of sperm banking.
Detection:Self-examination after bath or shower. Examine the shape and smoothness of testicles.
Contact details:For more information: visit www.cancer.ie
The Irish Cancer Society operates a National Cancer Helpline: Freefone 1800 200 700 (weekdays 9am-5pm, Tuesdays until 9pm).