Self-examinations are clutch

Ask Dr. Jeff: X: Far from ecstatic

Street MDMA content risky and unreliable

Dear Dr. Jeff: I've heard contradictory things about the safety of Ecstasy. What's your opinion? G.P. Dear G.P.: Ecstasy ("MDMA," "3,4-Methylenedioxymethamphetamine," "X," "E," "Adam," "XTC,"or "Lover's Speed") is still the most popular of the "club drugs," and a small number of students here continue to try it at least once. MDMA has both stimulant and hallucinogenic effects. Users describe a relaxed, euphoric state, with heightened feelings of empathy, pleasure, self-understanding, and self-acceptance.

Ask Dr. Jeff: Bowling together

Dear Students: Each week, I've written about a variety of health problems and concerns. Most of what I've written has aimed to inform and advise you as individuals who are learning to make your own choices and seek your own well-being. Some have touched on our need to look out for each other and to help support each other as members of a common community. The health benefits of community building, however, far exceed one-on-one mutual support.

Ask Dr. Jeff

This piece represents the opinion of the author:

April 22, 2005

Dear Dr. Jeff: I found a lump "down there" when I took a shower yesterday. How common is testicular cancer among college students? B.K.

Dear B.K.: "Lumps down there" are fairly common and most often not dangerous. Testicular cancer is not terribly common, but it IS the most common cancer affecting men between the ages of 15 and 40. Most importantly, testicular cancer is very likely to be cured if it's discovered early and treated early.

Benign lumps can appear in a number of sites. Cysts can develop in both the outer skin of your scrotum and in cord structures, like the spermatic cord or veins. In the cord, they're called spermatoceles, in the veins, varicoceles. These cysts are soft, tend to disappear when you lie down, are almost always painless, and require treatment only if they become very large or contribute to infertility.

Fluid can also accumulate in the tissues surrounding the testicle itself (especially after trauma to the area), causing more diffuse swelling called a hydrocele.

The tubular, coiled end of the cord called the epididymis can become infected, producing swelling and a painful lump where it's attached to the testicle. This type of infection is readily treatable with antibiotics. Inguinal hernias can cause scrotal swelling. Embryonic testicles, like ovaries, develop inside the abdomen, but later descend through the inguinal canal down into the scrotum.

If you have a weakening in your abdominal wall at the top of the inguinal canal, other abdominal contents, usually the small bowel, can herniate or protrude down into the groin area, producing a bulge or lump which may extend into the scrotum. The bulge can be painful or not, but usually requires surgical correction.

Testicular cancer usually begins as a painless lump on a testicle. As it grows, it may cause a sensation of scrotal heaviness or pressure.

The main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicle. In about three percent of baby boys, one or both testicles do not descend through the inguinal canal into the scrotum. About 14 percent of cases of testicular cancer occur in men with a history of childhood cryptorchidism, even if they are later corrected surgically. Interestingly enough, about 25 percent of the testicular cancers found in men with a previously undescended testicle occur in the normal, descended testicle. Cryptorchidism, then, is neither a simple nor a direct "cause" of testicular cancer.

Other risk factors include family history and HIV infection.

Most men with testicular cancer, however, do not have any of the known risk factors.

Testicular cancer may be the most common cancer among men 15 to 40 years of age, but it is fortunately not particularly common. There are some 8,010 new cases of testicular cancer diagnosed each year in the United States, compared to, for instance, 150,000 new cases of colo-rectal cancer. And testicular cancer is one of the most curable forms of cancer. Studies show that cure rates exceed 90 percent in all stages combined. Most importantly, the five-year survival rate for stage I testicular cancer (when the tumor has not spread beyond the testicle) is 99 percent. That's why so many strongly advocate the testicular self-exam (TSE).

The best time to perform TSE is during a bath or shower, when the skin of the scrotum is relaxed and you have soapy water on hand as a lubricant. The exam is pretty straightforward?you hold a testicle between your thumbs and fingers with both hands and roll it gently between your fingers, feeling for any hard lumps or any change in the size, shape, or consistency of the testicle. Identify the normal "bump" of each epididymis, and get a sense of the normal size, shape and firmness of your testicles. That way you'll establish a baseline against which you can measure any changes.

Most experts recommend TSE every couple of months or so for those at higher risk or for those who just want to minimize their risk.

If you do notice any lumps or changes, come on in to the Health Center to be examined. We fully support that "ounce of prevention!"

Be well!

Jeff Benson, M.D.

Dudley Coe Health Center

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