MEN'S HEALTH MATTERS:An undescended testicle can lead to a higher risk of cancer, writes THOMAS LYNCH
Q I am 27 years of age. When I was 18 I realised that I had only one testicle in my scrotum and could feel the other one in my groin. I never did anything about it as I was too embarrassed to tell anyone. Can you explain why my testicle has not come down into my scrotum? I am getting married soon and I read on the internet that I should have it removed because of the risk of cancer. Is this true? Will this make me infertile or am I infertile now?
ABefore birth, the testicles normally develop in the belly of the fetus and then move down (descend) into the scrotum before birth. In about 3 per cent of boys, the testicles are not in the scrotum at birth. Sometimes the testicle stays inside the belly and in other cases, the testicle starts to come down, but gets stuck in the groin. Of the 3 per cent of testicles that are not in the scrotum at birth the majority will descend on their own in the child's first year.
Young boys with undescended testicles generally undergo surgery to bring the testicle into the scrotum (orchidopexy) by the age of one year so as to protect the potential fertility of this testicle. Leaving the testicle undescended longer than this damages that testicle’s ability to produce an adequate number of sperm in the future. If the other testicle is normal then it should not be affected in any way and most men with a solitary testicle will have normal fertility. If you are particularly worried about fertility, your doctor can arrange for you to have a semen analysis performed. This is performed in a laboratory and will give you an indication of the number and quality of the sperm produced. It will not tell you for definite whether or not you can father a child as other factors play a part also.
It is unlikely that bringing a testicle into the scrotum decreases the risk of testicular cancer, which is four to 10 times greater in an undescended testicle compared with normally descended testicles.
Placing the testicle in the scrotum when you are a child allows for easier periodic examination when you are an adolescent and older so that if a tumour should develop, it can be detected early. Most testicular cancers occur in the 15-40 year age group. The overall risk of testicular cancer even in men with an undescended testicle is relatively small (three per 1,000). Despite this relatively low risk of developing cancer it is generally recommended to remove the testicle in pubescent or older males. If it is in a position in which it can be easily palpated, there is an argument for doing nothing. It is possible to have a false (prosthetic) testicle placed in the scrotum at the time of removal and you should ask your surgeon about this.
Q I went to see my doctor recently with a lump in my neck and was told that it was a lump in my thyroid gland. He has referred me to an ear, nose and throat surgeon and I am terrified that this might be a cancer. What else could it be?
AMost thyroid swellings are benign (non-cancerous). Even in the unlikely event that your thyroid swelling turns out to be malignant it is likely to be an eminently curable papillary or follicular cancer, with a cure rate in the region of 95 per cent.
The thyroid gland produces thyroid hormone, which plays an important role in regulating the body’s metabolism, ie how quickly the body burns energy, makes proteins, and how sensitive the body should be to other hormones. If you do not have enough thyroid hormone, you may feel mentally and physically sluggish. Other symptoms include slow heart rate, constipation and cold intolerance. Too much thyroid hormone causes anxiety, heat intolerance, sweating, palpitations, muscle weakness and weight loss in spite of increased appetite.
Swellings of the thyroid gland are very common and do not usually alter the amount of thyroid hormone in your blood stream. Typically they cause no symptoms other than a visible or palpable lump in the neck.
Gross enlargements can compress the airway with reduced exercise tolerance. A thyroid swelling may be a uniform enlargement of the whole gland or it may consist of single or multiple nodules; most are entirely harmless.
Your specialist will probably arrange an ultrasound. If this confirms that you have a single nodule then a needle biopsy of this will be taken as an outpatient. Most of these biopsies indicate a benign non-cancerous process. If the needle biopsy finds suspicious or frankly cancerous cells, your surgeon will recommend partial or total thyroidectomy.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Mr John Kinsella, consultant ear nose and throat and head and neck surgeon, St James’s Hospital
If you have a men’s health question, please e-mail healthsupplement@irishtimes.com