Check The Twins, Everyone Wins

One of my favorite things when teaching future doctors is helping them learn the urology physical exam.

For many students this is terrifying. It shouldn’t be. Pelvic anatomy isn’t scary and the exam shouldn’t be uncomfortable – for neither the patient nor the provider.

So I came up with some phrases to help my students loosen up. One of them is ‘check the twins, everyone wins.’

Why this phrase? For one thing it’s memorable. Second, it’s one of the best, easiest ways to identify testicular cancer before it becomes malignant.

How is testicular cancer diagnosed?

Did you know that testicular cancer is the #1 solid tumor diagnosed in men aged 15-44? Overall, 1 in 270 men will have a diagnosis of testicular cancer in their lifetime. Almost 10,000 men receive a diagnosis of testicular cancer in America every year.

These numbers are scary, and the men who are affected are young! But the good news is – most testicular cancers have over a 95% survival rate.

So, men – I’ll say it again – check the twins and everyone wins!

We diagnose testicular cancer based on physical exam, an ultrasound of the scrotum, and lab work.

What does testicular cancer feel like?

Testicular cancer feels like a firm mass in the testicle. Almost all of my testicular cancer patients have found their cancer on self-exam.

Sometimes the mass causes pain, and then they find it. Sometimes the mass causes swelling. I can also tell you that every single man that I have diagnosed with testicular cancer has found it during a self-test and has ignored it and ‘hoped it would go away.’ I have never had a patient feel a mass and call a doctor right away. They all wait! Don’t do that!

Every single man that I’ve diagnosed has found it during a self-test and ignored it. Don’t do that!

We get our high survival rates from early diagnosis and treatment. And there are many other things, not cancerous, that can be felt on self-exam. You don’t know if it’s cancer or not unless you see a medical provider.

How is testicular cancer treated?

The first step in treating testicular cancer is removing the testicle with the tumor in it. Most testicular cancers are cured with surgery alone.

Some require additional treatment such as chemotherapy, additional surgery, rarely radiation. Sperm banking is always discussed as these additional treatments can impact fertility.

If you happen to be worried about being “uneven”, rest assured that testicular implants exist. No seriously.

Your surgeon should offer you one at the time of surgery. Most of my patients decline this, and I don’t understand. Sure, it doesn’t glow in the dark or vibrate, but who wouldn’t want a fake testicle?

Think of the stories you could tell!

Are you at risk of testicular cancer?

There are not many known risk factors for testicular cancer. A personal history and a family history contribute to risk. Caucasian males are higher risk than other races, and men with a history of undescended testes as infants also have a higher risk.

Conclusion

The take home message is simple: if you feel something, say something!

For every 10 ‘testicular masses’ I see, 9 are benign, but you don’t know this until you see someone who knows how to do a physical exam and diagnose and treat testicular cancer.

So if you remember nothing else from reading this article, it’s one thing: check the twins, everyone wins!

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