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November's “Movember” campaign is underway. During this period, it is especially important to raise awareness of cancer among men. The editors of Poradnik Zdrowie portal invited doctor Omar Tayara, a urologist from the European He alth Center in Otwock, to talk about testicular cancer.
Marcelina Dzięciołowska: Doctor, who is the most exposed to testicular cancer? Is it true that it affects very young men?
Dr. Omar Tayara:It is definitely a cancer of young men. The peak incidence is in the second and third decades of life, so in their 20s and 30s they are most likely to develop this cancer.
What does this mean?
This means that it is then that we have the highest incidence peak. This is the group that should be the most careful, take care to undergo regular self-examination and self-examination.
What about men outside this age group?
Of course, it's not that this cancer does not occur in the younger or older group. It occurs, but it is much rarer. It also happens in older men, but it's not as common as in younger men.
So there is no rule. Then what should be worrying? Is this just a palpable change in the testicle or are there other symptoms that should suggest that this is the time to get tested?
In fact, any deviations in testicular self-examination should be alarming. While for a urologist it is very simple to distinguish a benign lesion, such as a testicular hydrocele from a testicular tumor, for a person who has never de alt with it, any deviation should be a signal to visit a urologist. If such a patient comes to us and it turns out that nothing bad is happening, he does not lose anything.
It may also turn out that such a reaction saved his life …
Definitely! You may find that this anxiety caused by self-examination and the suspicion that something abnormal is happening could be the beginning of a serious illness that can be treated very easily.
If recognized early.
Yes, but it's worth noting that testicular cancer is one of the most easily treated cancersin the world, also in Poland. Hardly anyone dies of testicular cancer these days, and the diagnosis of the disease at an early stage is almost 100%. curable, because medicine has advanced so much that the treatment of testicular cancer is very effective.
This is a refreshing message. Especially that many people have a misconception that if I have cancer, I will definitely die. Are there symptoms of testicular cancer that affect men's sex life?
No. Testicular cancer, like most cancers in the initial stage, is virtually asymptomatic. In November, as part of the "Movember" campaign, we take care of men's prophylaxis, we remind you that he alth is in our hands - literally and figuratively. The situation in which the patient should come to us is the observation of the enlargement of the testicle or the detection of abnormalities in its structure - these are the main signals for a visit to the doctor.
How often should the self-examination be performed?
Every man - the one in adolescence, the one in his 30s and over 60s - should perform a test of the testicles once a month.
What should a proper testicular self-examination look like?
It is best done in the shower, when the water is warm, when the skin of the scrotum and the levator testis are relaxing. In this situation, we hold the scrotum, and with the other hand, from top to bottom, we check one testicle and the other testicle for any abnormalities.
How to recognize a testicular tumor?
The nucleus itself, in its structure, is an organ that can be compared to a rubber ball - hard, but slightly elastic. The testicle tumor is a completely different lesion - it resembles a stone inserted into the testicle, something irregular and rough appears, the testicle begins to be very hard in one place, e.g. it is hard in the lower pole and soft in the upper pole. I compare it to a stone, because the tumor has its considerable hardness and very often it is clearly different from the rest of its structure.
Are there any situations where, despite the presence of a testicle tumor, it will not be possible to detect it through self-examination?
Testicular tumors may manifest themselves with non-characteristic changes. In about 10 percent. cases, or 1 in 10 men, may have inflammation which may mask testicular cancer. In such situations, however, there is pain and redness, which should also prompt the man to visit the urologist, which increases the chance of a possible detection of the lesion. Then the doctor orders an ultrasound examination, which verifies whether there are any other changes and deviations.
It is also worth mentioning the testicular hydrocele,that is, spontaneous enlargement of the nucleus over the entire surface, which seems quite benign at first glance, but under a hydrocele, where water collects, such a tumor may also be found.
Therefore, I emphasize that any deviation that worries during self-examination is worth paying attention to and going to a specialist to see if it is something serious.
I have the impression that cancer prevention among women is quite widespread, we test ourselves, we also use the help of specialists. How is it actually with men? Do they get tested, or do they come to the doctor when something is happening?
This is a very good question. I will defend this younger generation a bit, because I watch younger and younger men who come prophylactically to a urologist for an examination or an interview, asking what and how they have to do to control themselves. I would say that among young men, this prophylaxis is on an increasingly higher level, we are still far from women.
What do you think it results from?
Maybe because women are more and more reliable in taking care of their he alth and that of their men. These older men often come to us in the company of wives who took them to a urologist because something is wrong and something has started to bother them.
A conversation like ours today is aimed at making these men aware and suggesting that they test themselves and control themselves. I will shyly mention that recently many colleagues or friends have been writing to me asking what they should do to get under control.
This has not happened before?
No, so it feels like this he alth campaign is getting louder and more effective. Maybe soon we will not stand out so much from women and we will start taking care of our he alth.
I have such a feeling that men, however, less often talk about he alth or diseases. Maybe it is because they are simply afraid of getting sick? There is a common stereotype that a man has to take care of the family, put food on the table, ensure that the family has a good life, and these he alth issues are relegated to the background, postponed because there is always something more important to do. And yet the issue of he alth should be the most important, because when there is no he alth, there will be no food on the table.
Of course, I always tell my patients that if there is no he alth, there will be no work either. This is one of the excuses that the patient cannot go to the hospital, cannot undergo surgery because he has a job, and what will happen if he is dismissed, etc. Unfortunately, this is allshort haul. If we don't take care of our he alth, we won't be able to do our job. A week or a month off, due to the need to undergo diagnostics or surgery, is nothing compared to the loss of he alth and the inability to continue he althy functioning or fight the disease, which will last, say, a year.
Exactly. What does the procedure usually look like and how long does it take for the patient to recover?
If a testicular tumor is diagnosed at an early stage, the patient goes home the next day after the surgery to remove the testicle from the inguinal canal. It is a minimally invasive procedure that takes about one hour. Nothing serious happens, the patient may return to work after a week or two, if it is not manual work. If it is in the early stages, it is very possible that it will not require further treatment, but only observation.
Are the patients fully fit after the procedure?
Usually yes, but if we neglect the matter, ignore the disturbing symptoms, and despite the surgical treatment, the patient will probably require chemotherapy or other forms of treatment at a later stage. It may then turn out that she will not be able to return to her activities and, as you said, she may not be able to help her family. These stereotypes are terrible and they do not only apply to oncology, but also to men in the whole field of he alth - including mental he alth, because this is also a very important topic this month.
Why? Men do not use therapists' help?
It turns out that men report depression to a doctor much less frequently. According to research, it looks tragic. They rarely come to therapy and do not fight their fears, as the statistics clearly show that suicide occurs three times more often in men than in women.
What about oncology?
When it comes to oncology and what we deal with as urologists, we can definitely see that a man can come to a urologist when he is already extremely debilitated, when the disease is already very advanced, which begins to bother so that it is not able to function normally.
Do women often bring men to the urologist's office?
Yes, they take their husbands, fathers, partners to a urologist because they see that something is wrong, but prophylaxis is still limping. Unfortunately, I have to scold these older men, because this older generation believes that a man is indestructible, that he cannot be sick, he cannot be sad, he cannot have bad days. This group of men isvery lost, unable to come to terms with the disease, what's more - often does not want to come to terms with it.
We are talking about cases of men who cannot turn to help. But even if there are such people, we know that access to mental he alth specialists is currently much more difficult.
The topic of accessing a psycho-oncologist or psychotherapist and starting psychotherapy, e.g. in the fight against cancer, is a difficult and long topic, because many men simply do not want to take advantage of such therapy. Even if we find a fairly large group of people who want to undergo therapy, we will not always find access to it. Let's face it, in our he alth care system, which is already barely spinning, access to a psychotherapist under the National He alth Fund is virtually nonexistent, and this availability is very limited.
Do you have such a therapist at ECZ?
Yes, a psycho-oncologist cooperates with us, but within the scope of the National He alth Fund's capabilities, we are not able to provide access to it for all cancer patients. Hence, patients often use private visits.
Why is specialist support so important in the treatment of neoplastic disease?
Therapy with a psycho-oncologist or psychotherapist in the event of a neoplastic disease should begin just before starting treatment. The patient must be prepared for a fight that the body must win, the patient must be mentally strong, understand what he has to face, he must learn how to endure all these situations, we must prepare the psyche for the fact that the patient will fear for his life, that he will be scared and worried about what will happen next. Due to this difficult access, deadlines are distant. Therefore, private consultation is often helpful.
A man who is depressed who is terrified has a much more difficult situation because his body does not have the strength to fight back. Also, the chances of success of the therapy are much lower than in the situation when the patient tries to bear it all.
This is very important because chronic stress is terribly harmful to the body.
How does stress affect the body and the healing process itself?
If we're stressed, we don't eat. If we do not eat, the body does not have the strength to fight. The immune system is responsible for fighting cancer. Chronic stress weakens this system, chronic stress will reduce immunity, malnutrition will reduce the power to fight the disease, and all of this will have consequences. The patient, who works on himself, has taken up the fight against the disease, talks, and often includes his relatives from his surroundings.Insulation is an important issue. Men tend to close themselves off about the disease, and often don't want to talk about it, even with their family.
They hide in their shell and pretend there's no problem?
They build armor, and keeping emotions inside is extremely dangerous. Emotions like crying and anger should go out. Conversation is salutary and is definitely a better solution than any drug, because it can greatly strengthen and, above all, give strength to fight. It is much easier to fight cancer when you have companions with you - someone who is your support.
The prognosis for testicular cancer is very good. Just keep your finger on the pulse. If that doesn't convince the men, they still have us - women.
I would not like to use stereotypes, but a large crowd of men are automotive fans - so even if the car is operational, it drives, you should regularly check it and change the oil. We also have our course, even if nothing happens, let's go to the doctor, let's do this review once a year. Remember that most diseases do not give signals in the early stages of development.
A fair comparison. I hope that it will appeal to this group of male patients, which will have a positive impact on the frequency of preventive visits. Thank you for the interview.
Expert
bow. med. Omar Tayara, FEBU Specialist urologist, Member of the Polish and European Association of Urology In 2013, he began specializing in the Department of Urology and Urology Oncology in Międzylesie Specialist Hospital in Warsaw. From 2022, he was associated with the II Clinic of Urology at the CMKP at the European He alth Center in Otwock. He completed numerous internships in the field of urooncology, among others at the Urology Clinic of the Jagiellonian University, Pomeranian Medical University in Szczecin and training at the IRCAD center in Strasbourg. His main field of interest is diagnostics and treatment of patients with suspected kidney, prostate and bladder cancer. In addition, she deals with pharmacological and surgical treatment of disorders such as benign prostatic hyperplasia (BPH) and kidney stones. Outside of work, he is interested in sports: cycling and running.