Testicular cancer: What all men need to know

When Staffan Thorsell was told that he had testicular cancer, he thought his life was over. But a few facts could have spared him so much trauma

I had always thought it sad that people who have beaten a serious illness or survived an accident say that they have now started to enjoy life. Why should it take something as drastic as that to make someone start really to live? It wouldn't for me. I could sit on a beach on a July evening, watching the sun set the horizon ablaze, listen to the waves reaching across the sand and think: "Yes, I am good at this. I enjoy this. I really appreciate it."

I had always thought it sad that people who have beaten a serious illness or survived an accident say that they have now started to enjoy life. Why should it take something as drastic as that to make someone start really to live? It wouldn't for me. I could sit on a beach on a July evening, watching the sun set the horizon ablaze, listen to the waves reaching across the sand and think: "Yes, I am good at this. I enjoy this. I really appreciate it."

But then something happened. Something humbling. I got cancer in the ball. And eventually, the same beach, the same burning, red sky and the same waves became just that little more beautiful. It was not that I felt that I had not enjoyed them before. But I understood what those people meant. On 18 January 2001 I walked into a doctor's office and told him he should give me a course of penicillin, as I probably had some type of infection. Ten minutes later, he told me to go straight to the hospital for an ultrasound examination and blood tests. He had examined me, and he did not look pleased with what he had found.

I knew very little about testicular cancer. It was a matter of having seen or heard the words a few times somewhere. I thought that since I knew so little, testicular cancer must be very rare. I had gone around with my symptoms for nearly a year, but they were vague. There was a slight sensation that the left testicle was a bit heavier than it usually was, and some occasional tenderness. But I did not think I could feel a lump and the symptoms did not really bother me – physically.

I convinced myself that they would pass. I was probably like most men, grinding my teeth and hissing at the sheer thought of something wrong down there, and that anxiety was probably what kept me from going for a check-up.

It was too late in the evening for a proper examination that day, and it was not until the following morning that I found myself on a trolley in the hospital undergoing an ultrasound examination, studying the eyes of the nurse doing it and analysing every expression. I remember asking nervously if testicular cancer was common, and hearing some vague answer about how everything is relative, but that it is not that uncommon. Every year in the UK, 1,600 men are diagnosed with testicular cancer, most of them between 20 and 40 years old.

I knew before I got the results. Maybe it was the expression on the doctor's face the evening before. Maybe it was that the doctor who examined me that morning before the ultrasound had said, "There is something there that shouldn't be there, and now we have to find out what it is." Or maybe it was the way the nurse who had carried out the ultrasound had said "Good luck" as she showed me to the waiting room in which I would wait for the results. But I felt I knew already that it was not good. I still hoped. But as I sat there, in that bare waiting room, I remember swearing and drinking enormous amounts of water. It was as if I had been swept into a heavy mist of seeping panic that I could not shake off.

The doctor walked in and sat down, and I stood up. I think I felt that it would be easier to take it standing up. He said there was a tumour, and although one can never be completely certain without taking the testicle and the tumour out, it was very unlikely that it would be anything other than malignant. He said I needed the surgery right away and that he had, in fact, already scheduled it for the next day. The clinically white walls in the waiting room caved in on me. The doctor in front of me became a blur and I remember thinking I needed to get out of there, out on to the streets where life was still passing by normally. I wanted to go back to that. The tears took a little while. For the moment, I felt nauseous and could think of nothing else to do but to lie down on the hospital trolley and think: "Damn it." Damn it, damn it, damn it.

At that moment, cancer meant the end to me. It meant withering away and dying. Then, I did not know much else. I wish that I had. It could have made that moment easier. I did not know that more than nine out of 10 men are cured, and that today it is extremely rare for otherwise healthy men to die from testicular cancer. They told me this later. I was 24, fit and the prognosis was good.

The surgery revealed that I had one of two types of testicular cancer, seminoma. The other type is non-seminoma. Mine was the less aggressive of the two, but both types can spread to the lymph nodes and, in a few cases, to other organs as well, such as the liver and lungs. In the Seventies, young men all over the world died of testicular cancer. Today, treatment is mostly successful, even when the cancer has reached advanced stages. My cancer had not spread.

A day after the surgery I was ready to forget about it all. The now-faded scar on my lower abdomen was then still sore and bleeding, but I wanted to put the experience behind me. Then my doctor contacted me. In the first of many meetings I was told that the risk of relapse was about 15 per cent, so I would need regular check-ups for the next 10 years – every three months over the first two years, then gradually less regularly. Anxiety hit me like a fist in my face. Was I going to live three months at a time? Would I have to keep wondering if the next check-up would show that the cancer had returned and that I would need radiotherapy or chemotherapy? If so, how well would I respond to treatment?

That anxiety kept jabbing its fist at me for the first few months, and occasionally got a good hook in that would knock me to the floor. During those moments it was hard to get back up. I remember spending a whole month sleeping, eating and drinking on the same couch. Eventually I could not remember when I had last taken a shower or been outside and, with some persuasion, I finally realised that I might need to get some help to get back up. I was referred to a therapist at the hospital, and I think it did some good. But during those difficult periods I did not think of anything other than death and illness. There were times I tried to deny what had happened. At other periods I ate enormous amounts of vegetables, constantly went for walks and worked out to try to avoid illness in the future. I had had something in my body that would have killed me, had I not dealt with it. That knowledge bothered me.

But it is remarkable how you adjust when you have to. It is no fun to sit in a waiting room in a cancer ward surrounded by leaflets with titles such as "Accepting death in life". I do not enjoy being hooked up to scanning devices and X-ray machines. But those moments are quick and quite far apart. I know that in the unlikely event of a relapse, the treatment will work. And I am not frightened of this any more. I am a little anxious sometimes, but not frightened.

Since this happened, male friends have come to me looking worried. Usually they have some sensation, they feel this or that, and wonder if it is what I felt. Sometimes they look to me for reassurance that everything is fine. I cannot give that. My symptoms were vague. All I can say is, examine yourself – regularly. And if you feel anything unusual or are worried, go for a proper examination. It is completely painless. You have nothing to lose. Unfortunately, with cancer you may stand to lose a lot if you let too much time pass.

As for appreciating what's around you – in my native Sweden, most believe that we enjoy summer so much because our winters are so long and dark. Dark moments make me more passionate about the things I enjoy. Maybe the darker the moment, the more appreciative I will be about the next time I sit under that summer's evening sky and listen to those waves. It may sound hollow, banal even, but I enjoy being alive. And I find it difficult. I find it an effort. That balance is what I find makes life beautiful. I have trouble seeing how I could be passionate about living if everything flowed by in the same mode all the time. Then again, that may all change.

What to look for

How to examine yourself: choose a certain time each month so that it becomes a routine. Soak your hands in soapy water when you perform the examination. This makes it easier to feel small irregularities. Examine each testicle carefully between your thumb and your index finger. Check all around for anything odd. Also examine your epididymis, which is located on top of the testicle and feels softer.

See a doctor if: you feel a lump on the testicle or epididymis; the testicle feels tender or is larger than normal.

Signs to watch for: the most common symptom of testicular cancer is that the testicle feels heavier, has become larger, is swollen, or feels harder than usual. Pain is far from common, even if the testicle is swollen. But tenderness or ache can be first signs. Seek medical attention if a testicle is swollen – even a harmless infection needs to be treated quickly. In some cases, backache is the first symptom. This could indicate that the cancer has spread.

Facts: the cause of testicular cancer is not fully known. If in childhood the testicle did not descend properly into the scrotum, the risk of testicular cancer later in life is higher. Early detection is vital. Testicular cancer is highly curable. Almost all men who have had testicular cancer will be able to have children.