Jossy Ndung’u began experiencing persistent headaches, vomiting and unexplained weight loss before developing a scrotal swelling in May 2018. A doctor in Nakuru County instructed that he underwent urgent surgery.
“The medics removed a tumour weighing 270 grams from my scrotum,” recalls Ndung’u who at 21 had testicular cancer.
He did six sessions of chemotherapy and 25 others of radiotherapy at the Oncology unit at the Nakuru Level Five Hospital, leaving him financially and emotionally drained.
To know whether one has testicular cancer, all a man needs is to do a pregnancy test just like a woman. A positive result means one has cancer.
The reason, explains Dr Njuguna Gachoiro, a urologist at the hospital, is “because some of the testicular tumours produce a compound called human chorionic gonadotropin (bHCG), similar to that tested for in a pregnancy test.”
If diagnosed early, he says, testicular cancer is curable, and even when advanced it responds very well to radiotherapy and chemotherapy.
After removal of tumour, the medics conduct further tests to monitor the possibility of cancer recurring.
Says Dr Gachoiro: “We do tumour markers, which help us identify where the disease is coming from. It may be from the testis, abdomen or other parts where it had spread earlier on.”
The removal of both testes leaves the scrotal sac empty and subsequent radiation therapy also affects fertility.
According to Dr Gachoiro, “leaving one testis does not guarantee the patient of being fertile after treatment. During treatment, the remaining testis will be exposed to radiation. This will not stop sperm production but it is not encouraged to have children after such exposure.”
“After the second chemotherapy I would lose hair by a simple touch. Being an artist, my hairstyle meant a lot but in a few weeks I was bald, affecting my self-esteem,” says Ndung’u, who is now cancer-free. The hair is also growing back.
Pauline Kinyua, an oncology nurse, explains that Ndung’u is among only five patients diagnosed with testicular cancer since the Nakuru centre opened in 2018.
Kinyua reckons that one challenge with testicular cancer is that most men are not open to discussing genital organs, with a majority of the positive diagnoses made being incidental while managing other conditions like infections.
Dr Gachoiro explains that, based on the stage of the disease, some patients may present with a painless scrotal swelling, cough, pain in the lower back, fatigue, swollen lymph nodes, vomiting, gastrointestinal bleeding and unintended weight loss like Ndung’u.
“At stage one, the disease is localised around the testes,” explains Dr Gachoiro. “At stage two it spreads to the lymph nodes before spreading to the rest of the abdomen, lungs and even the brain at stage three and four.”
For posterity of the patient’s generation, Dr Gachoiro adds that “we encourage the patients to have their sperms deposited at a sperm bank prior to the treatment. They may suffer infertility, loss of libido, low sperm count after.”
Surgery at a public hospital costs about Sh20,000, which may escalate to six figures based on the type of surgery and the hospital. But NHIF cover come in handy.
Dr Siwillis Mithe, a clinical oncologist at the hospital, explains that testicular cancer is very rare in Kenya and globally considering “in the over 42,000 cancer cases reported in Kenya last year, there were only 35 new testicular cancer cases and 12 deaths. This is by far less than one per cent.”
Testicular cancer affects men aged between 15 and 35 when they’re sexually active and “men at this age have high levels of testosterone, which raises the risk,” argues Dr Mithe, who urges men to do regular self-assessment for early diagnosis, which makes treatment easier, cheaper and more effective.
“This is done by palpating the testis between the thumb and two fingers to note any difference in size and texture. Unfortunately, majority of men rarely do this or don’t do it right,” she says, adding that “any solid, firm and fixed mass around the testis should be treated as a suspicious testicular cancer until confirmed otherwise. This should be followed by scrotal ultrasound.”
Testicular cancer is genetic, says Dr Mithe, and is common in cases of undescended testis and previous diagnosis of it on one testis.