Know Your Balls Check Them Out Carolyn Salzano Public Health Practioner June 2008

1. Know Your Balls Check Them Out Carolyn Salzano Public Health Practioner June 2008

2. Introduction Testicular cancer is the most common form of cancer in males aged from 15 - 45. It is affecting more young men each year Testicular cancer causes around 70 deaths in the UK each year. Justyfying why this is important Why nowJustyfying why this is important Why now

3. Aims of the Session Structure and function of testes What is cancer? Possible causes of cancer Testicular cancer statistics Risk factors What to look for Testicular awareness Ask group other names for testiclesAsk group other names for testicles

4. Nutty facts: number one When a man in Ancient Rome was required to give an oath, he would cup his testicles with his hand as he spoke. It's from this that we get the words testify, testimonial and testament. Information that I found while researching testicular cancer Not suggesting this is something that you do when you speak to the head teacher next time your in trouble!!Information that I found while researching testicular cancer Not suggesting this is something that you do when you speak to the head teacher next time your in trouble!!

5. Structure and Function of the Testes The testicles are two small oval shaped organs which hang below the penis in a pouch of skin called the 'scrotum' which produce sperm They provide the main source of testosterone, the male sex hormone, which is responsible for male sexual characteristics. If we are talking about testicles them a recap on the structure and function Testosterone is the main cause of male qualities such as: Deep voice Beard growth Muscle development Ability to have an erection Sex drive (libido)If we are talking about testicles them a recap on the structure and function Testosterone is the main cause of male qualities such as: Deep voice Beard growth Muscle development Ability to have an erection Sex drive (libido)

6. Nutty facts: number two According to records kept during World War II detailing the health of conscripted men, there were nine cases of men with three testicles. Although men normally have two testes there has been a slight variation. We know that some men only have one testicle, eg undescended testicle Although men normally have two testes there has been a slight variation. We know that some men only have one testicle, eg undescended testicle

7. What is Cancer? The organs and tissues of the body are made up of tiny building blocks called cells Normally the division and growth of cells is orderly and controlled Testicular cancer is an abnormal, uncontrolled growth of cells that forms a tumour in one or both testes. Tumours can either be benign (harmless) or malignant. Cancer is the name given to a malignant tumour If talking cancer to be able to understand What is cancer and to clarify malignant, benign tumour As these words are not always fully understoodIf talking cancer to be able to understand What is cancer and to clarify malignant, benign tumour As these words are not always fully understood

8. Causes of Testicular Cancer Not enough is known about what causes testicular cancer or how to prevent it Remember �if caught at an early stage it has a cure rate as high as 99% Not enough is known about testicular cancer What campaigns do you know of that raises awareness of testicular cancer? This was part of the Everyman campaign Who saw it? They also did a Tacheback (grow a moustache and be sponsored) Did anyone see this Yellow wrist bands �Live strong� Lance Armstrong the American cyclist who won the Tour De France 7 years on the run is a living campaigner after he had testicular cancerNot enough is known about testicular cancer What campaigns do you know of that raises awareness of testicular cancer? This was part of the Everyman campaign Who saw it? They also did a Tacheback (grow a moustache and be sponsored) Did anyone see this Yellow wrist bands �Live strong� Lance Armstrong the American cyclist who won the Tour De France 7 years on the run is a living campaigner after he had testicular cancer

9. Nutty Facts: number 3 Over the course of a lifetime, the testicles generate an average of fourteen gallons of ejaculate (cum). Human ejaculation occurs at an average speed of twenty-seven miles an hour. This young man skate boarded from Morrocco to London in Aug 2007 to raise money and awareness for testicular cancerThis young man skate boarded from Morrocco to London in Aug 2007 to raise money and awareness for testicular cancer

10. Raising Awareness At age 25 Lance Armstrong was one of the worlds best cyclists, he won the World Championships, the Tour Du Pont and multiple Tour De France stages.Then he was told he had cancer, testicular cancer. Lance ignored the early warning signs and the cancer spread to his abdomen, lungs and brain. During his treatment, before his recovery he created the Lance Armstrong Foundation (www.livestrong.org) and worked, works as an advocate for people living with cancerAt age 25 Lance Armstrong was one of the worlds best cyclists, he won the World Championships, the Tour Du Pont and multiple Tour De France stages.Then he was told he had cancer, testicular cancer. Lance ignored the early warning signs and the cancer spread to his abdomen, lungs and brain. During his treatment, before his recovery he created the Lance Armstrong Foundation (www.livestrong.org) and worked, works as an advocate for people living with cancer

11. Possible Risk Factors Being Male Age Undescended testicle Family history Previous cancer HIV virus Race & ethnicity Risks and causes The following things affect a person's chances of developing testicular cancer. Being Male Having testicles Age Unlike other cancers, testicular cancer is diagnosed more frequently in the young and middle-aged than in elderly men. Cryptorchidism (undescended testicle) Normally, as a male baby grows in the womb, the testicles develop inside the body and descend into the scrotum before birth. In cryptorchidism, this does not happen to one or both testicles. This condition may increase the risk of testicular cancer by five to ten times. Having the testicle re-positioned in hospital before the age of 10 may reduce this excess risk, but men who have had their testicle re-postioned are still at slightly increased risk. In men with a history of cryptorchidism, although most most cancers develop in the undescended testicle, up to 25% of cases occur in the normally descended testicle. Family history Having a close relative who has had testicular cancer increases the risk of getting the disease. Inherited genetic factors may play a role in up to one in five testicular cancers. A testicular cancer gene�abnormality - called TGCT1 - was�found by researchers at the Institute of Cancer Research in February 2000.� The abnormal gene is on the X chromosome and so is inherited from the mother and not the father.� This is one explanation for the increased risk of testicular cancer between brothers.� The researchers carrying out this work think there could be 2 other testicular cancer genes that we haven't found yet.� They think that up to 1 in 5 (20%) of testicular cancers could be due to inherited faulty genes. Previous testicular cancer Having had testicular cancer before increases the risk of developing cancer in the other testicle. However, cancer in both testicles is rare. Human immunodeficiency virus Infection with the human immunodeficiency virus (HIV), particularly if acquired immune deficiency syndrome (AIDS) has developed, increases the risk of developing testicular cancer. Race and ethnicity Testicular cancer is most common in affluent Caucasians. With the exception of New Zealand Maoris, the disease is rare in non-Caucasian populations. Five times as many white men as black men in the United States get testicular cancer. We do not know why this is, or why testicular cancer should be more common in wealthier social groups.  There is no known link between injury or sporting strains and testicular cancer. But an injury often causes swelling and lumps in the testicle and this can make a tumour difficult to spot. If you have injured your testicles and have any swelling, go to your GP for a check up. Back to top � � Risks and causes The following things affect a person's chances of developing testicular cancer. Being Male Having testicles Age Unlike other cancers, testicular cancer is diagnosed more frequently in the young and middle-aged than in elderly men. Cryptorchidism (undescended testicle) Normally, as a male baby grows in the womb, the testicles develop inside the body and descend into the scrotum before birth. In cryptorchidism, this does not happen to one or both testicles. This condition may increase the risk of testicular cancer by five to ten times. Having the testicle re-positioned in hospital before the age of 10 may reduce this excess risk, but men who have had their testicle re-postioned are still at slightly increased risk. In men with a history of cryptorchidism, although most most cancers develop in the undescended testicle, up to 25% of cases occur in the normally descended testicle. Family history Having a close relative who has had testicular cancer increases the risk of getting the disease. Inherited genetic factors may play a role in up to one in five testicular cancers. A testicular cancer gene�abnormality - called TGCT1 - was�found by researchers at the Institute of Cancer Research in February 2000.� The abnormal gene is on the X chromosome and so is inherited from the mother and not the father.� This is one explanation for the increased risk of testicular cancer between brothers.� The researchers carrying out this work think there could be 2 other testicular cancer genes that we haven't found yet.� They think that up to 1 in 5 (20%) of testicular cancers could be due to inherited faulty genes.

12. Testicular Self Examination Best performed either in the shower or after a warm bath, when the scrotal skin is relaxed. Testes need to be hanging loosely. Not suitable to check when lying downTestes need to be hanging loosely. Not suitable to check when lying down

13. Testicular Self Examination Firstly look in the mirror at your balls, get to know them. The size & shape of each testicle. Remember we are all different so get to know yours! One testicle will hang lower than the other- this is normal What is the size and shape if you know what is normal for you then you will notice a difference Everyone is different-don�t compare yourself with others and worry about size etcOne testicle will hang lower than the other- this is normal What is the size and shape if you know what is normal for you then you will notice a difference Everyone is different-don�t compare yourself with others and worry about size etc

14. Hold the scrotum in the palms of your hands. Examine one testicle at a time. Use both hands to gently roll each testicle (with slight pressure) between your fingers. Place your thumbs over the top of your testicle and gently roll. Gently feel each testicle individually Check for any lumps or swellings as both testicles should be smooth except where the duct that carries sperm to the penis, the epididymis, runs. This lies along the top and back of the testicle and normally feels bumpy You should be able to feel the epididymis (sperm carrying tube), which feels soft, rope-like, slightly tender to pressure. This is a normal lump at the back of each testicle. You should feel a firm, smooth tube of the spermatic cord which runs up from the epididymis Each testicle should be smooth, with no lumps or swellings. Check for any small irregularities, enlargements or changes in firmness.A lump that might be dangerous can be anything from the size of a pea. It's not usually painful, though there may be a dull ache. Compare and contrastMen don't usually develop cancer in both testicles at once, so if you are worried about something on one of your testicles, compare it with the other.What if you find something?If you find any lump or swelling or change in your testicles, go to your doctor.  Remember that it is normal to have one testicle slightly larger than the other. Gently feel each testicle individually Check for any lumps or swellings as both testicles should be smooth except where the duct that carries sperm to the penis, the epididymis, runs. This lies along the top and back of the testicle and normally feels bumpy You should be able to feel the epididymis (sperm carrying tube), which feels soft, rope-like, slightly tender to pressure. This is a normal lump at the back of each testicle. You should feel a firm, smooth tube of the spermatic cord which runs up from the epididymis Each testicle should be smooth, with no lumps or swellings. Check for any small irregularities, enlargements or changes in firmness.

15. What to feel for A hard lump on the front or side of a testicle Swelling or enlargement of a testicle An increase in firmness of a testicle Pain or discomfort in a testicle or in the scrotum Remember the back of the testicle is lumpy and this is normal Not all swellings will be malignant- think about cysts, hydroceles Pain eg torsion of testes Remember the back of the testicle is lumpy and this is normal Not all swellings will be malignant- think about cysts, hydroceles Pain eg torsion of testes

16. What to feel for (cont) An unusual difference between one testicle and the other. A heavy feeling in the scrotum A dull ache in the lower stomach, groin or scrotum. Dull ache this was the point that Lance Armstrong noticed he had a problem but did not relate it to testicular cancer Remember early detectionDull ache this was the point that Lance Armstrong noticed he had a problem but did not relate it to testicular cancer Remember early detection

17. This is a quote from an educated man and this is how he felt A day week month or worst still a year is too long to wait: seek advice earlyThis is a quote from an educated man and this is how he felt A day week month or worst still a year is too long to wait: seek advice early

18. Do not be nervous or embarrassed about seeing a doctor or nurse Do not wait for the symptoms to go away Do not be nervous or embarrassed about consulting your doctor. Do not wait to see if the symptoms go away. More than 50% of sufferers consult their doctors after the cancer has started to spread Do not be nervous or embarrassed about consulting your doctor. Do not wait to see if the symptoms go away. More than 50% of sufferers consult their doctors after the cancer has started to spread

19. Be Self Aware Notice Your Nuts! Early detection Regular self examination Get to know your own testicles Seek advice Some research suggests that regular exercise may prevent testicular cancer from developing. Certainly if a boy with an undescended testicle has it corrected before the age of ten then his risk drops back down to the average risk a man has of developing testicular cancer which is around one in 450.However, since little is known and understood about why testicular cancer develops. The emphasis focuses on being more aware and examining the testicles regularly. Then, if cancer does develop it can be detected and treated early on. Ideally self-examination is done monthly. First of all, get used to what your testicles feel like normally by getting to know them. If you're not sure what they are supposed to feel like then ask your doctor to show you.Self-examination is best done after a bath or shower when the scrotum is relaxed. It's no good examining them when you have an erection because the scrotal sac is too tight preventing you from feeling them properly. Holding your scrotum in the palms of the hands use your fingers and thumbs to examine the shape, size, consistency, and smoothness of the testes. It's not unusual for one testicle to be larger than the other or for one to hang lower than the other. See the section "How to examine yourself".� Most lumps found on the testicles are benign but any changes in size, shape or weight should be checked by your GP. 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. Each testicle has an epididymis at the top which carries sperm to the penis. Don�t panic if you feel this - it�s normal. Regular self examination will help you become more aware of the normal feel and size of your testicles so that any abnormalities can be spotted early on. Some research suggests that regular exercise may prevent testicular cancer from developing. Certainly if a boy with an undescended testicle has it corrected before the age of ten then his risk drops back down to the average risk a man has of developing testicular cancer which is around one in 450.