'My testicle was the size of a lemon'

When Nathan Abrams was told that the swelling in his groin was cancer, he began a diary charting his illness, the gruelling treatment - and his fears

Tuesday 11 January 2005 01:00 GMT

Testicular cancer is one of those things that I thought would never happen to me. For years my mum asked me whether I checked myself regularly. I replied, only somewhat jokingly, that I checked the shaft part very frequently. But then my girlfriend started telling me that one of my testicles was bigger than the other. My response was that they only look that way because one hangs lower than the other so that they don't bash together when you walk.

Testicular cancer is one of those things that I thought would never happen to me. For years my mum asked me whether I checked myself regularly. I replied, only somewhat jokingly, that I checked the shaft part very frequently. But then my girlfriend started telling me that one of my testicles was bigger than the other. My response was that they only look that way because one hangs lower than the other so that they don't bash together when you walk.

4 November 2003

While cycling, I notice that things aren't hanging quite right. I put this down to my baggy clothing. But when I take a bath, I notice that my left testicle has swollen to the size of a lemon (as compared with the walnut shape of the other one) and is harder, too. I know something is wrong. I get out of the bath and ring my GP. Half an hour later, I have my pants down in front him and he refers me, as a matter of urgency, to the Royal Free Hospital in Hampstead, north London, for further tests.

14 November

After some questions and prodding, the consultant urologist ascertains that I have a testicular swelling/tumour, but of what kind he won't say. He sends me for an ultrasound scan and arranges for me to have a series of blood tests and an X-ray on the following Monday.

17 November

I arrive at the hospital at 10am. For the first time, I am told that I have cancer; until now, no one has used the dreaded C-word. It all comes so fast that I don't have time to think about it. However, as Lance Armstrong put it in his autobiography, "Anyone who has heard the words, 'You have cancer', has thought, 'Oh, my God, I'm going to die'." But I am distracted by the blood tests I have to have, one of which is for HIV. For two hours I worry that the result could be positive (if only a few of all testicular lumps are cancer, perhaps there's a small chance I have Aids, too).

As the minutes tick by, I get increasingly nervous about the results of my HIV test. The cancer is at the back of my mind. Finally, at 4.30pm, the counsellor tells me that my test was negative. Despite the relief, I'm exhausted and emotionally drained. I am scheduled for surgery to remove the tumour. The operation and its risks (the dreaded erectile dysfunction and impotence) are explained to me.

18 November

In the morning, before surgery, I "bank" sperm in case anything goes wrong and I want to father kids in the future. In the afternoon, I'm admitted to hospital. It's all a bit of a whirlwind.

19 November

I am taken down for surgery. Although I feel nervous, I'm also relieved that the wait is over. In the pre-op area, the surgeon comes in to say hello and asks if the testicle has been marked. I assure him that it is so huge that he couldn't miss it if he tried. "That," he replies, "is why we're so worried." He draws a large purple arrow on my leg, indicating the testicle to be removed.

The procedure, known as a "radical orchidectomy", requires my left groin area to be shaved, an incision made, and the whole testis and tumour removed. The spermatic cord is cauterised by a diathermy as the surgeon cuts so that, hopefully, no cancer cells are transported in the blood to elsewhere in my body. I wake up about two hours later, woozy and sore and wearing a "scrotal support". Inside is a bandage where my testicle was, and a strip over the incision. I feel fine but am scared to look at what has been changed.

20 November

I once thought that expressions of sympathy were formulaic and meaningless. Cancer made me realise that such expressions are very important to those listening. Words, any words, really do help. Their absence is hurtful. Unfortunately, it is at times like these that one finds out who one's friends are. I feel hurt by those friends, colleagues, acquaintances who have had nothing to say about my illness. I learn that a large part of being alive is the feeling of being loved and of loving.

I am discharged after less than 48 hours, feeling sore and tender. I'm still wearing the bandage and jockstrap, but when I look underneath, I'm impressed with the shaving job they've done. I still manage to cut my chin, so I'm glad they did it. I'm curious to know whether the equipment still works, but it takes me two days to perform a full manual test. Gladly, everything is A-OK.

8 December

I learn that I had a "classic seminoma" at stage 1, ie, it was confined to the testis and hadn't spread, and that it is non-aggressive and very responsive to treatment, with a 98 per cent rate of effectiveness. I am advised to take it easy and only engage in sexual activity according to what I can manage. My test results give me the all-clear, and I leave with a big grin on my face.

16 January 2004

I am given a choice of post-surgery treatment: prophylactic "dog-leg" radiotherapy to wipe out any possible remaining cancer cells; or "active surveillance" - monthly check-ups and X-rays and blood tests, and a CT scan every three months. Because of the size of my tumour (75mm x 45mm x 32mm), they estimate my chance of a relapse as 30-40 per cent (about 10 per cent higher than in normal-size cases). I opt for active surveillance.

19 March

After two months of active surveillance, I receive bad news. My CT scan showed an enlarged lymph node, which means I need chemotherapy. I feel really scared. I've never really been ill before. Chemo is so aggressive that I can't get a handle on how they're going to break me down just to destroy one tiny cancerous growth. I feel fit, well and healthy. In fact, I am probably in the best shape of my life.

23 March

The oncologist calls to offer me radiotherapy instead of chemo. I feel that I've been given an 11th-hour reprieve, as radiotherapy is localised and targeted, whereas chemo is systemic.

24 March

I return to the fertility clinic for the first of several visits, banking more sperm as a precautionary measure. In case you're wondering, I function just as well on one testicle as most of you do on two. Besides, we men are designed, like planes, to function on just one engine. The only real difference is aesthetics and, to be honest, I don't look very different from before. Yes, I have a bit of excess skin, but it's hardly noticeable, and the other one has dropped into the middle, to occupy the recently vacated space. Apparently, although I can't tell, it has increased in size to compensate for the loss. I feel more streamlined - it makes sitting on the bike easier, especially now that I've got rid of the tumescent testis - and I feel like the dead weight has been excised to my benefit.

2 April

I am prepped for radiotherapy. Three dots are permanently tattooed in a line on the skin on either side of my waist and below my belly button so that they can line up the X-rays, which will be beamed to the area of my abdomen known as the para-aortic region and containing the lymph nodes either side of my spine. Vital organs and my healthy testis are protected by an alloy mould fitted to the X-ray machine.

19 April

Three and a half weeks of daily radiotherapy begins. It involves being positioned very precisely on a bench by three radiographers who talk numbers as if putting up some shelves. Radiotherapy affects everyone differently, but my side-effects include dehydration, diarrhoea/loose bowel motions, stomach cramps, wind, tiredness, weight loss, boredom, skin irritation, dryness, soreness, itchiness and hair loss on the affected area. The main one, however, is nausea. Although I'm given anti-nausea pills, these aren't entirely effective because such a large area of my bowels and intestines were zapped, and I puke twice on my first day of treatment.

The damn disease is also determined to feminise me. First, I lose a testicle. Then it kills my sperm (temporarily, I hope). Next, I exhibit all the symptoms of having a period, as well as enlarged breasts. My daily cocktail of pills does the trick eventually, though, and, cancer aside, I am almost approaching a normal (male) human being again towards the end of it.

January 2005

One year on, my treatment is considered to be "definitive", and I'm now deemed "unremarkable". This means that I am cancer-free. I still have to be checked regularly for the next 10 years, but the gap between appointments widens as the years progress.

Did cancer change me? Looking back, those around me were more shocked by the whole experience than I was. Among my friends, I was the "healthy" one, who ate properly, exercised regularly, and never got ill. Don't get me wrong, I was very scared during the week or two of uncertainty. But now, with the cancer behind me, it is strange how something that was once so scary is just a part of my past.

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