Testicular cysts

Q:I have had a cyst growing on my left testicle for over three years and have wondered whether surgical removal would be advisable. Can you offer me some advice? AW, London.......

A:According to our panel member Patrick Kingsley, the way forward for you very much depends on the type of cyst it is, what other symptoms you may have and your attitude to possible treatment options. A visit to a doctor seems in order as he will be able to gain some information, usually through simple palpation, about the growth.

A referral to a specialist will undoubtedly entail a more invasive form of diagnosis such as biopsy. "However," warns Dr Kingsley "if you stick a needle into the tumour and it is malignant you run the risk of spreading the cells into your blood stream, so you might want to consider a less invasive form of diagnosis such as ultrasound."

A lump on the testicle could be anything. It could be an epidermiod cyst a cyst of the scrotal skin (Am J Radiol, 1993; 160: 1047; Am J Radiol, 1989; 152: 134), or a kind of varicose vein. Equally it is easy to mistake a lump on the epididymis (the tube through which sperm travels from the testicles) for a testicular lump. These kinds of cysts or simple blockages containing some sperm (spermatoceles), become increasingly common as you get older. Around 95 per cent of them are harmless and do not require any treatment.

Obviously the main worry about a lump on the testicle is that it may be malignant. Testicular cancer is the most common cancer in men aged 15-35 and accounts for 3 per cent of all cancer deaths in this age group. The major risk factors for testicular cancer are a history of undescended testes or other urogenital problems such as hypospadias (maldevelopment of the urethra).

Other risk factors include an early age at puberty, if your mother took DES or other estrogens during pregnancy, your race (white men are six times more likely to develop testicular cancer than other males) and your height (tall men are more at risk) (Cancer Causes Control, 1995; 6(5): 398-406). There is also a link between lack of exercise and most recently there has been a theory that a tendency to testicular disorders runs in families, suggesting a genetic origin (Hum Mol Genet, 1995; 4(9): 1551-5).

Testicular cancer does not usually produce pain or discomfort. When it does there will usually be a slight enlargement of one of the testes along with a change in its consistency. There may also be a dull ache in the lower abdomen and groin, together with a sensation of dragging and heaviness.

Like breast cancer, testicular cancer is most often diagnosed through regular self examination. Testicular self examination (TSE) gets a lot less publicity than breast examination but is just as important. TSE should be performed every month during or after a warm shower or bath. The heat from the water will loosen the skin and allow for a more thorough and accurate exam.

As with any potential cancer you will need to think, and ask questions, several steps ahead. According to Dr Kingsley, "Before you have any kind of diagnosis you should ask your doctor how he is likely to treat you if the diagnosis is positive. For instance, will he remove one testicle, both testicles, refer you for radiation or chemotherapy? If none of these options are ones which you will accept, then there is no point in going ahead with the diagnostic procedure."

Most practitioners will tell you that "cure" rates are 100 per cent in testicular cancer. The thing is the "cure" is often chemotherapy or radiation therapy in conjunction with removal of one or both testes. In fact, in testicular cancer, as in all cancers the "cure" rates have not significantly increased over the decades (Sci Am, 1985; 253: 51-9).

Cancer treatment can significantly effect your fertility. You still have a good chance of fathering a child if one testicle is removed. If you are receiving radiation therapy, the remaining testicle will be shielded, but your sperm quality is likely to be reduced and you can be rendered infertile for a year or two after treatment. You will be advised not to try to start a family for at least two years after treatment.

There are less aggressive ways of tackling cancer, for instance using nutrition such as Gerson therapy as well as by doing some detective work about your own environment. For instance, investigate what toxic metals you may be ingesting through your water or cooking utensils. The instance of testicular cancer has risen with the introduction of lap top computers.

If a cyst is not causing any threat to your health or reproductive functions, you may want to leave it alone. You should have a good, positive reason for wanting to embark on an aggressive search and destroy programme which may cause more problems in the long run than it solves.