Word on Health

Word on Male Cancers

In this weeks, 'Word On Health' we highlighted just how poor British men are at both recognising male cancers and checking for signs and symptoms. The support information below is courtesy of NHS Choices and the male cancer charity Orchid. (Click on the highlighted links for further information from each oganisation) Orchid also have a helpline - 0808 802 0010

How  Common Is Testicular Cancer? Testicular cancer is the most common form of cancer in young men, mostly between the ages of 20 and 35, although it can develop in boys as young as 15. Incidence has almost doubled in the last twenty years, with about 2,000 cases a year in the UK.

So What Can You Do To Reduce The Risk Of Developing Testicular Cancer ? Scientists are still investigating the causes of testicular cancer and do not know of any treatments that could prevent it. The most important thing is to check your testicles regularly to detect any changes in their shape or size. The most significant risk factor is undescended testis at birth with 10% of patients having a history of this condition. Testicular cancer can have a strong genetic component, with brothers, fathers or sons of testicular cancer patients having up to a 10-fold increased risk of developing the disease.

How Is Testicular Cancer Diagnosed? Testicular cancer can be diagnosed through regular self-checking of the normal size and shape of your testicles. When these have altered in some way, it is important to consult with your doctor. Please note that most lumps are benign (non-cancerous) and no operation is necessary.

How Is Testicular Cancer Treated? Testicular cancer can be treated by surgery, by radiotherapy or by chemotherapy. In some cases these treatments are combined. The most straightforward and safest way of dealing with a cancerous lump is to remove the testicle.

Can a Man Diagnosed With Testicular Cancer Make A Full Recovery? 99% of testicular cancers can be cured if caught at an early stage. Even when the tumour spreads, the cure rate is around 95%. Treatment may be very intensive, but most patients cured will have no long-term side effects from treatment. A small proportion of patients will become infertile after chemotherapy treatment. Other side effects of treatment are uncommon but may include damage to the nerve endings, hearing and poor circulation. There may be a slightly increased risk of developing other cancers. The risks of these problems are lessened if the cancer is treated early.

Will The Operation Affect My Sex Drive & Will I Still Be Able To Father Children?O nce you have recovered from the immediate effects of the operation (it can be sore for a few days afterwards) you should be able to have sex as normal. In most circumstances, one testicle is sufficient to produce sperm to father children. If additional treatment is required following surgery, your fertility can be affected and you will always be offered sperm banking before this treatment commences. Being diagnosed with cancer can be stressful and this can affect the level of performance for some men. If this is the case, please consult with your doctor.

How Will It Look, After The Operation? Following the surgery you may not look very different to how you were before the operation especially if you have a prosthetic testicle inserted. You will have a small scar in your groin, although the scrotal area itself will be little changed.

Will I Lose My Masculinity? This is a common worry for men with testicular cancer. Masculinity is due to the testosterone hormone that is produced by the testicles. In the majority of men one testicle can produce enough testosterone to support your masculinity. Occasionally if the remaining testicle has been damaged, your doctor can recommend replacement testosterone therapy to maintain this aspect of your life.

How Do I Carry Out A Self-Examination? We recommend this is done after a warm shower or bath when the scrotal skin relaxes. Support the scrotum in the palm of your hand and become familiar with the size and weight of each testicle. Examine each testicle by rolling it between your fingers and thumb. Gently feel for lumps, swellings, or changes in firmness. Remember each testicle has an epididymis at the top which carries sperm to the penis. Don't panic if you feel this - it's normal.

Prostate Cancer

How Common Is It? 95% of all prostate cancer patients are aged between 45 and 80. About 30,000 men in the UK are diagnosed with prostate cancer each year. It has become the most common cancer in men overtaking lung cancer. With PSA testing on the increase and an ageing population, incidence is predicted to rise ahead of breast cancer over the next decade.

What Causes Prostate Cancer & Is There Anything I Can Do To Reduce The Risk Of Developing It?  Little is known about the genes and molecular mechanism of prostate cancer. Men with a brother or father with prostate cancer have a 3-5 fold increased risk. It has few symptoms in its early stages. When symptoms occur they may include difficulties in urinating or pain and/or stiffness in the lower back and hips. However these symptoms are more commonly caused by other conditions, such as benign (non-cancerous) enlargement of the prostate or arthritis. If you have concerns, you should consult with your doctor.

How Is Prostate Cancer Diagnosed? Early diagnosis of prostate cancer is important for successful treatment. Diagnosis methods include the PSA Blood Test, which tests the level of 'Prostate Specific Antigen' in the blood; digital rectal examinations to feel the size of the prostate gland and biopsies which take tiny samples of tissue from the prostate. The PSA test is not specific for cancer and 'raised' levels can occur due to benign enlargement or inflammation of the prostate gland. Microscopic examination of the biopsy is required to confirm the presence of cancer.

How Is Prostate Cancer Treated? Some prostate cancers grow so slowly that no treatment is needed. Instead, an active surveillance policy is employed to monitor the condition. When more active treatment is required surgery, radiotherapy, hormone therapy or a combination of these treatments are used. Surgery, the removal of the prostate gland, is known as a 'prostatectomy' and is commonly used in the US. Both radiotherapy and prostatectomy are used in the UK.

Will Any Treatment Affect My Sex Drive And Will I Still Be Able To Father Children?Different treatments for prostate cancer can cause impotence, reduced ejaculation, a lowered sex drive, urinary incontinence, bowel problems, hot flushes and sweats and tiredness. Surgery, radiotherapy and hormone therapy all have different side effects which need to be considered in any decisions about treatment. Treatment for prostate cancer is likely to cause infertility. This should be discussed with your doctor before you start treatment.

Is The Chance Of Developing Prostate Cancer Influenced By Dietary Or Environmental Factors? Eating a diet high in animal fat and low in fresh fruit, vegetables and fish and being exposed to cadmium (a heavy metal) or 'radiation' have been identified as possible risk factors which may be associated with prostate cancer. However research is still continuing in this area. Some preliminary research suggests that Lycopene (the compound that gives the tomato its appealing red colour), selenium and vitamin E in the diet could play a preventative role in the development of prostate cancer.

Is It Necessary For All Men Over A Certain Age To Be Screened? The PSA test (Prostate Specific Antigen) can be used to screen for early prostate cancer. A raised result does not necessarily mean you have cancer, a positive biopsy is needed to confirm cancer which will occur in about one man out of every five. If prostate cancer is diagnosed, it is not necessarily life threatening and curative treatment many not be required - as most men diagnosed with early prostate cancer following a positive PSA test would be expected to have slowly growing cancer which should not cause any problems during their natural lifespan.

Penile Cancer 

Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis.In the UK, around 550 men are diagnosed with cancer of the penis each year. It most commonly affects men over 60 years of age.

Over the last 30 years, the number of penile cancer cases has increased by more than 20%, possibly due to changes in sexual practices.

However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition.

Signs & Symptoms You should be aware of any abnormalities or signs of penile cancer, including:

  • a growth or sore on the penis that doesn't heal within four weeks 
  • bleeding from the penis or from under the foreskin
  • a foul smelling discharge
  • thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis)
  • a change in the colour of the skin of the penis or foreskin
  • a rash on the penis

If you experience these symptoms, it's important that they're checked by your GP as soon as possible. It's unlikely they'll be caused by cancer of the penis, but they need to be investigated. Any delay in diagnosing penile cancer could reduce the chances of successful treatment.

Types Of Penile Cancer The penis is made up of many different types of tissue. The type of penile cancer you have will depend on the type of cell the cancer developed from.

The most common types of penile cancer include:

  • squamous cell penile cancer – which accounts for more than 90% of cases and starts in the cells that cover the surface of the penis
  • carcinoma in situ (CIS) – a particular type of squamous cell cancer where only the cells in the skin of the penis are affected and it hasn't spread any deeper
  • adenocarcinoma – cancer that starts in the glandular cells of the penis that produce sweat
  • melanoma of the penis – where the cancer develops in the skin cells that give the skin its colour

The Cancer Research UK website  and Orchid's site has more information about the different types of penile cancer.

What causes penile cancer? The cause of penile cancer isn't known, but certain risk factors can increase your chances of getting it.

Men who carry the human papilloma virus (HPV) have an increased risk of developing penile cancer, which is the virus that causes genital warts.

Studies have found that almost 5 out of 10 men (47%) with penile cancer also have an HPV infection.

Age is also a risk factor for cancer of the penis. The condition rarely affects men under 40 years of age, and most commonly occurs in men aged over 60.

Smoking is the most significant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases your risk of getting the condition.  

Conditions that affect the penis, such as phimosis, which makes the foreskin difficult to retract, increase your chances of developing infections such as balanitis.

Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system.

The Cancer Research UK website and Orchid's site has more information about the risks and causes of penile cancer.

Diagnosing Penile Cancer Your GP will ask you about any symptoms you have and when they occur. They'll also examine your penis for signs of penile cancer.

If your GP suspects penile cancer, they may refer you to a specialist – usually a urologist (a doctor who specialises in conditions that affect the urinary system and genitals).

The specialist will ask about your symptoms and check your medical history. They may also check for any physical signs of penile cancer.

A blood test may be carried out to check your general health and the number of blood cells.

To confirm a diagnosis of penile cancer, you may need to have a biopsy. A small tissue sample will be removed so it can be examined under a microscope for cancerous cells.

Treatment For Penile Cancer will depend on the size of the affected area and the rate at which the cancer has spread.

For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment will usually involve either using a chemotherapy cream or having laser surgery to remove the affected area of skin. You will usually have a skin graft after surgery.

The main treatments for penile cancer that isn't at a very early stage are:

 

  • surgery
  • radiotherapy
  • chemotherapy

 

Surgery will involve removing the cancerous cells and possibly some of the surrounding tissue.

In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis.

However, with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible.

As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread.

The test that's used, known as a sentinel node biopsy, is widely available in the UK. In some cases, the lymph glands may need to be surgically removed.

As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis.

The Cancer Research UK website and the Orchid website has more information about staging penile cancer and the types of treatment for cancer of the penis.

You can also download a booklet called Penile cancer: everything you need to know from the Orchid website . They also have a helpline you can call - 0808 802 0010.

Prevention It isn't always possible to prevent penile cancer, but you can reduce your chances of getting it.

One of the main ways you can reduce your chances of developing penile cancer is to give up smoking (if you smoke).

It's also important to maintain good penis hygiene to prevent the bacterial and viral infections that can increase the risk of penile cancer.

This is easier if you were circumcised as a child, but there are steps you can take if you haven't been circumcised. Simple penis hygiene can include:

  • using condoms to help reduce the possibility of catching HPV
  • regularly washing your penis with warm water, including under the foreskin

There's little evidence to suggest that being circumcised as an adult will reduce your chances of developing penile cancer. However, if you have sores that don't heal, or if it's becoming increasingly difficult to clean under your foreskin, seek advice from your GP about the possibility of circumcision.

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All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.