Transcription:
Talking about Testicular Cancer

Dr. John Leonard (Host): Welcome to Weill Cornell Medicine CancerCast, conversations about new developments in medicine, cancer care and research. I'm your host, Dr. John Leonard. And today on the podcast, we'll be talking about testicular cancer. Our guest for this episode is Dr. Doug Scherr, a Urologist and the Clinical Director of Urologic Oncology at Weill Cornell Medicine and New York Presbyterian Hospital.

Dr. Scherr is an expert in caring for patients with prostate, bladder, kidney, and testicular cancers, and has pioneered advances in robotic surgeries for these areas. Additionally, he conducts research to develop new surgical techniques and treatments within the field of urologic cancers. Today, we're going to focus our conversation on testicular cancer, to build awareness for this form of cancer and in general, things that men need to know regarding their health in this area.

So, Doug, it's great to have you here today. Thank you for taking the time to join us. This is an important topic. Sometimes gets a lot of attention, but sometimes at least testicular cancer, probably less attention than some of the other areas. So, it's good we're focusing on it today.

Dr. Doug Scherr (Guest): Well, thanks John, for having me. It's a real honor and a pleasure to be here today. And I look forward to the conversation and elucidating some of the aspects of testicular cancer, which is not something that many people hear much about.

Host: So, first I want to start with your background and what got you interested in urologic oncology, what got you excited about this area in particular, within medicine and within urology specifically?

Dr. Scherr: Like anything, a lot of decisions and experiences that we undertake in life are sort of random. And mine was very much a random process early on. After I graduated college, I actually wound up living and spending a year in mainland China, teaching over there. And when I had returned back, I knew I had an interest in medicine, decided to walk into a local hospital. And they gave me a list of summer doctors that were looking for some help. And one of them happened to have the same last name as me. And he was someone who was doing research in urologic oncology, specifically in prostate and bladder cancer. And so I wound up working there and got interested in this area.

I've always been someone who I knew would pursue a career in surgery during medical school. And I guess what attracted me to urologic oncology was really the multidisciplinary care that we can engage in terms of working with surgical treatments, chemotherapeutic treatments, gosh, and nowadays, even genomic and immunotherapeutic treatments.

So, it really was a field that touched upon many disciplines. And I think that was my initial interest and remains to be one of my biggest interests in urologic oncology to date.

Host: I think you've highlighted something that comes up often on our program and that is the importance for cancer patients to have, for most situations with the cancer, a multidisciplinary team. It's very rare that it's just one doctor taking care of you. It's often many doctors with different expertise and backgrounds and also many others medical experts depending on the situation, whether they're nurses, physician assistants, nutritionists, social workers, lots of other areas as well. So, you got us off to I think one of the things that we tend to come back to and something we're obviously proud of here at Weill Cornell and New York Presbyterian, our ability to provide that type of multidisciplinary care.

So, let's focus in on testicular cancer. And maybe I'll ask you first, kind of who gets testicular cancer and how often does it happen and then kind of how it presents itself.

Dr. Scherr: So, testicular cancer of course, is a disease of men, that goes without saying, but it's a disease predominantly of young men. And, you know, I would say the average age of someone who develops testicular cancer is about 33. And interestingly, that's been getting older over the years. Not entirely clear why, but specifically one of the types of testes cancer, which we'll get into later on, called seminoma, tends to occur in older men and that's becoming more common. So, I think that may in part, explain the advancing age of testes cancer, but on average 33, predominantly these are young men. It's not a very common disease. Across the United States, there's less than 10,000 cases diagnosed each year. I think by and large, a man can anticipate that one in every 250 men will develop testes cancer at some point in their life.

And the presentation is typically someone feels a mass or a nodule, a firmness or an enlargement of their testicle. And it really lends to the importance of testicular self-examination. And so we always tell men, particularly young men, when they're showering, to feel their testicles, make sure they're not feeling any nodules, any enlargement, anything that's different than they were used to feeling. Oftentimes, a spouse or significant other, may be the one that detects this. And so it's important to open lines of communication with a significant other, if something feels abnormal, it often is abnormal. If you feel an enlarged testicle, one that may be painful, believe it or not, the most common diagnosis is not testicular cancer.

There's something called orchitis, or inflammation of the testicle, something called epididymo-orchitis, which is an inflammation of the tissue surrounding the testicle, the epididymis. And these are far more common scenarios than testicular cancer. So, I don't want everyone to think if they all feel a large tender testicle, that they have testicular cancer. Really the more common scenarios tend to be infectious or inflammatory conditions, that involve the testicle or the tissue surrounding the testicle. Having said that though, an evaluation should always ensue in someone who feels that there's some abnormality in the testicle and by and large, that means they should see their doctor.

And it doesn't have to be a urologist per se. It could be their primary care doctor to just get evaluated. Oftentimes some urine studies can be sent to rule out an infectious or inflammatory condition, but an ultrasound of the scrotum really is the cornerstone to rule out any solid nodules of the testicle that of course would make someone more concerned that there could be a neoplasm or what we call a cancer inside the testicle. And so, again, just as an overview, it's definitely not the most common cancer we see in men, but the incidence is going up. Testicular self-exams are critically important. And if there's an abnormality, they really should be seen by a primary care doctor or a urologist to get an ultrasound and some other studies to gain a sense of what may be going on in the testicle.

Ethnically speaking, this is more common in Caucasian men, less common in African American or Asian men. The most common part of the world that gets testicular cancer is the Scandinavian countries. These are Finland, Norway, Sweden. It's unclear why, but there's definitely a higher incidence of testicular cancer in Northern Europe and the Scandinavian countries. North America has the second highest incidence and predominantly in Caucasian men.

Host: So, you mentioned the self-examination. What do you recommend that people do as far as that? And is there anything special? I know, certainly women know with breast cancer kind of a technique that they often will learn. I mean, in men, is it just kind of seeing if there's anything different or how would you advise people to approach that as far as frequency and method?

Dr. Scherr: That's a good question. The testicles are encased in the scrotum, which is a muscular organ. So, it's surrounded by something called the dartos muscle and it's very sensitive to temperature changes. So, in very cold conditions, the scrotum tends to tighten up and firm up and bring the testicles closer to the body. In warmer conditions, the scrotum tends to relax and bring the testicles further away from the body. So, the best time to examine the testicles is in a shower. When someone's in a warm hot shower, the scrotum tends to relax. The testicles are a lot easier to feel, and I think that's by far and away the best spot to do what we call a testicular self-exam.

Basically the best way to examine the testicles is using the forefinger and middle finger and with two hands just feeling the area of the testicle, whether it's you feel any nodularity, firmness. It's important, and this can be difficult to distinguish for someone that's not used to seeing these, but there's the testicle and then the tissue surrounding the testicle.

So, what's very common again, it's important for listeners to know the difference, but oftentimes you can feel a cyst or a small nodule in tissue surrounding the testicle, which is typically what we call an epididymal cyst. And epididymal cysts are very common. Sometimes they can be called spermatoceles or even a hydrocele, which is fluid surrounding the testicle.

These are very different than testicular cancer. Someone who may have a testicular tumor or testicular cancer that is concerned, typically there's a very firm, almost rock-hard area within the testicle, that's very different. And typically testicular cancers are not painful. That's an important distinguishing factor.

A painful testicle is very rarely a testicular cancer. Typically painful conditions are inflammatory, infectious in nature, but testicular tumors tend to be painless masses within the testicle, but a two-handed palpation or feeling of the testicle is the best way to do it, in a warm environment, like a hot shower, and trying to distinguish between the testicle and the tissue surrounding the testicle.

Host: What are your observations? And I know you've been working in this area a long time, but it strikes me that there may be some men who notoriously are not great at going to the doctor regularly, but do you tend to see people that ignore lumps in the testicle either because they don't think it's a big deal or they just kind of are in denial about it, or is it an area that people tend to be very sensitive about and say, whoa, I better go check this out? And you, tend to see it earlier.

Dr. Scherr: The age group that affects testicular cancer, particularly the 18 to 25 range, tend to be the people, particularly young men, who ignore their health more than anyone else. And in fact, there have been studies looking at this question and they've indicated that the average delay from the time a patient may feel something or feel that there's an abnormality, to the point at which they seek medical advice in this age group for testes tumors is about six months.

So, as you can imagine, that's a long time for someone to notice some abnormality before they either tell their significant other, or actually tell their doctor. And so, early diagnosis, like any cancer, is critical in this disease. And unfortunately, there is a delay in diagnosis in most patients, simply because they tend to ignore this part of their body. It's a sensitive area, particularly in a young age group. It's not something that they're oftentimes aware of nor willing to discuss with other people, but early diagnosis is critical. What's really fortunate about testicular cancer, unlike many other cancers, even when it is diagnosed late, we still have very high cure rates.

That's not to say patients should not seek medical care immediately upon understanding everything, because I will tell you the treatment burden of testes cancer goes way down if it's caught early. But fortunately we have really good treatment options for patients and therefore it remains a curable disease, but definitely getting in touch with a healthcare provider if you feel any abnormality is really critical, particularly in this age group.

Host: So, as you know, I focus in lymphoma. We occasionally see, and you and I have shared patients with lymphoma involving the testes in some cases, not a very common scenario either, but occasionally happens. Are there any other tumors that can metastasize to the testes where the issue would start somewhere else and spreads there? Or is that pretty much it?

Dr. Scherr: Yeah. I mean the testes can be a site of metastatic disease. It's very rare. As you had alluded to, there have been cases of primary testicular lymphoma. The testes is considered what we call a privileged site when it relates to chemotherapy. So, like the brain, it's more difficult for chemotherapy to penetrate. There's what we call a blood testes barrier. And so oftentimes if there is a metastatic site or if there is lymphoma, we still often have to remove a testicle because sometimes chemotherapy doesn't penetrate the testicle as well as it does other parts of the body. Have we seen other sites? I have seen very rarely incidence of colorectal cancers going to the testicle. Again very rare. There are other, non-primary tumors of the testicle that can occur as well. There's other tissues down there. There's the surrounding of the testicle is lined with what's called the tunica vaginalis.

So, we have seen cancers of that which are very rare. But in fact I'm treating a patient for that right now. There can be epididymal tumors, which are very rare as well. And there could be what are called non-germ cell tumors. So, germ cells are the spermatogonia, the sperm that are produced within the testicle.

Keep in mind the function of the testicle is really twofold. It produces sperm and it produces testosterone. And primary testes cancer that we consider, is a tumor of the spermatogonia or the precursors of sperm. But you can get tumors of other cells. So, there's another cell type in the testicles called a Leydig cell. Leydig cells are the cells in the testicle that produce testosterone. And so we do on occasion, see Leydig cell tumors. And these are a far less common version of testicular tumors, but these tend to be benign, but about 10% of them can be malignant. And the most common presentation of someone who has a Leydig tumor is a young man that presents with breast enlargement.

Because what these tumors do is they create high levels of testosterone. And when testosterone circulates around the bloodstream, it can get converted to estrogen by an enzyme called aromatase. And so men, particularly young men who present with enlarged breasts or tender nipples, this could be a sign that something's going on in the testicle as well and should be evaluated.

So, although germ cell tumors, which are the classic kind of testes cancers are the more common. There are definitely other cell types, both primary in the testicle and metastatic sites. And of course the hematologic malignancies, like you had mentioned, or lymphomas and lymphomas even histologically under a microscope can sometimes be very difficult to distinguish between something called a seminoma, which is a type of primary testicle cancer. So, lymphoma is always on our differential in patients that we see with testes masses, albeit far less common than a primary germ cell tumor.

Host: So you alluded to the typical age. So, when you see a man with a mass in his sixties, seventies, eighties, how does your thinking change? How do the possibilities tend to change?

Dr. Scherr: Men in their 60, 70s and 80s are certainly not the most common phenotype or group of patients who have primary testicle cancers. However, we do occasionally see them. And as I had mentioned earlier, we're seeing an increase incidence of what are called seminomas or a type of germ cell or testes cancer.

The other type are called non-seminomas, but seminomas are ones that tend to occur in older patients. And so of course, if you see someone in their 60s, 70s with a enlarged testicle, again, germ cell or primary testes cancers are certainly not top of my differential. I would consider more of an infectious or inflammatory condition, epididymitis or epididymal orchitis are fairly common conditions in men who, as they get older, they don't empty their bladders completely. They can develop urinary tract infections and can develop enlarged and painful testicles which are typically treated with antibiotics. But again, I don't think we should ignore the primary testes cancers because they can occur in older patients. I've seen certainly many seminomas in men in their 60s, 70s. I've even seen a non-seminoma, which is far less common in someone in their 70s. So, it's very uncommon, but should be on your differential when evaluating men of that age. And a basic ultrasound of the scrotum can distinguish between any of these.

Host: So let's get into you see a man, they come to you with a mass, let's say it's a younger man in the more typical age range for testicular cancer, in their thirties or late twenties as an example, and you're suspicious that this is cancer based on, your exam and evaluation. What are the steps that usually take place as you start to evaluate and think about treating and making the diagnosis in these patients?

Dr. Scherr: Right. So, the cornerstone of course is a good history and physical exam. Like anything else. I think you want to know, do they have any risk factors for testicular cancer and probably the number one risk factor we see is someone with what's called cryptorchidism. Cryptorchidism is a syndrome where someone is born with an undescended testicle.

So, as baby is being sort of generated in utero, there's an embryological development where the testicles believe it or not, start up all the way by the kidneys and over embryologic development begin to descend down into the scrotum. But there's a small subset of children who are born where the testicles are not inside the scrotum. And the reason the testicle needs to be in the scrotum, it's about one to two degrees cooler than the rest of the body temperature. And that's really optimal temperature for sperm development. And so sometimes when a testicle is not in the scrotum, it could be up in the groin area, or it could be up even all the way up into the abdominal cavity.

And so if a testicle is brought down surgically after the child's born and put into the scrotum, the risk of testes cancer goes away. If however, the testicles are not descended, there is a slightly increased risk of testicular cancer in these patients. So, if someone tells me they have this history of cryptorchidism, obviously my radar goes up that this could be a testes cancer. But by and large, after examining the patient, if I feel a mass, the first thing I'll do is get an ultrasound of the scrotum to visualize any areas in the testicles that may be abnormal consistent with a mass. If we do find a mass, then included in the workup is to get a set of what's called testicular tumor markers.

And these are blood tests that are specific to what we call germ cell tumors, testes cancers. And so these are a beta HCG, an alpha fetoprotein and an LDH. And these are tumor markers that are very classically elevated in testicular cancer. So, in conjunction with an ultrasound, a physical exam and a history, I will also draw testicular tumor markers to give me some sense or indication as to what's going on.

Host: So, I have to ask you, I remember and you're bringing me back years in my training about the cryptorchidism connection. Is there anything new about the thinking of the pathophysiology of why that is? Is it a marker or is it cause and effect?

Dr. Scherr: It's definitely a cause and effect. I think what happens is when the testicles are not inside the scrotum and not at the proper sort of one to two degrees lower body temperature that they need to be in, the sperm don't develop. And what happens is you have precursors of sperm of the spermatogonia that don't ultimately develop into mature sperm and the longer period of time that they spend in that immature phase, the more prone they are to malignant degeneration.

And so I think for any period of time where the testicle is not at the proper temperature, it runs the risk of developing a malignancy from those premature spermatogonia. So, there's definitely a cause and effect that occurs within the testicle that makes that a risk factor.

Host: It seems like surgery is always a big part of treatment or at least the assessment, is that the typical path that follows?

Dr. Scherr: So, assuming we do see a solid mass within the testicle, whether the tumor markers are elevated or not; if someone who's in the age range, so someone who's in their 20s say, with a solid mass of the testicle, I could safely say that there's a 99.5% likelihood that mass is going to be a testicular cancer.

And so the next step is to remove the testicle. And that's often both diagnostic and therapeutic and that's done through what we call an inguinal approach, not through the scrotum. So, the scrotum and the skin overlying the groin area actually drain two different lymphatic roots. So, if we suspect a testicular cancer, we never removed the testicle through the scrotum.

We remove it through almost like a hernia incision in the groin, because then we're not violating a separate lymphatic drainage root of the scrotal skin. And so if someone does have a solid mass of the testicle, we would bring them to the operating room at some point and perform what's called an orchiectomy.

It's about a 20 minute surgery, relatively straightforward. We make a small incision in the groin. We remove the testicle. We do offer all patients the opportunity to get a testicular prosthesis. These are saline implants that could be put in and a good number of men opt for them. Many, however, do not.

It has no bearing on the cancer or treatment efficacy, but it's more of a cosmetic aspect that some men want. And once the testicle is removed, about seven to 10 days later, we'll find, the histology or the pathology report to determine whether this represents a seminoma or non-seminoma, and then that would dictate next steps.

As part of that process, we always obtain what's called an extent of disease evaluation with a CAT scan and a chest x-ray. And the CAT scan is looking at what we call the retro peritoneal lymph nodes. These are lymph nodes deep inside the abdominal cavity, that would be the first landing site of any testes cancer, if it were to spread outside the testicle. And then the chest x-ray looks at the lungs to make sure there are not any pulmonary nodules. The lungs is also a relatively commonplace where these tumors may spread to. And then we look at the tumor markers, the blood tests that I had spoken about earlier. If any of these are elevated, we also look for these to normalize after the testicle is removed.

And not only do we want them to normalize, but we want them to normalize by half-lives, meaning alpha fetoprotein and beta HCG. So for example, beta HCG every 24 hours should drop about half of its value. So, if we remove the testicle and we see the patient a week later, the beta HCG should be normal. Similarly, the alpha fetoprotein has about a five to seven day half-life so that takes a little longer to normalize. But we're looking for these blood markers to come down to normal, but also to look at the trends by which they come down. Cause they should normalize by half-lives.

Host: So, going from there and I know it's hard to generalize, but just to give people a flavor of things, what percent of patients are ending up with chemotherapy, radiation, additional surgery? How does that tend to break down at a very high level, and I know there are a lot of details with that.

Dr. Scherr: Sure. So fortunately the vast majority of patients will present as what's called a stage one cancer, meaning that the cancer is confined to the testicle. And so based on that, if you're a stage one and it turns up to be a seminoma, then we put the vast majority of those patients on what's called active surveillance. Meaning we simply follow them with periodic scans and blood work. And the likelihood of recurring is about less than 15%. If it's a non-seminoma stage one, then I would also say the vast majority do go on surveillance. However, there are certain subtypes of non-seminomas that carry with them some higher risks for spreading.

So, sometimes in a high-risk non-seminoma, we may offer the patient what's called a retroperitoneal lymph node dissection. And this is a fairly sizable surgery where we go in and remove all the lymph nodes deep inside the abdominal cavity. Because if someone has a greater than say, 50% chance of harboring microscopic disease in those, then it's important to gain control of those lymph nodes early on. And so we sometimes offer high-risk non-seminomatous patients an upfront lymph node dissection, because if you look at any patient who dies of testicular cancer, and fortunately there are very few, but the ones that do, they all have disease in the retroperitoneal lymph nodes.

And so it's certainly important to control these lymph nodes early on in proper patients. So, by and large, stage one patients are predominantly observed, except if you fall into a high-risk category of non-seminoma. In higher stage patients, meaning patients that present with either enlarged lymph nodes inside the retroperitoneum or metastatic disease, then chemotherapy plays a role.

And so fortunately these tumors tend to be very sensitive to chemotherapy. In fact, they're one of the most sensitive tumors that we know of and testes cancer is your prototypical multidisciplinary disease, in that it does require medical oncologists, pathologists, urologists, sometimes radiation oncologists, because there's a multitude of treatments that could be done for patients with more advanced disease.

And so the example of a patient who presents, for example, with retroperitoneal lymph nodes or pulmonary disease with lung nodules, these patients would get upfront chemotherapy and typically they get a three-drug regimen called bleomycin, etoposide and cisplatinum. And most often in these patients, the disease will shrink away to nothing after chemotherapy.

Occasionally after chemotherapy, we have to also add in surgery to remove any level of residual disease. Of course, many people heard of the Tour de France champion, Lance Armstrong. He's your perfect example of someone who presented with very advanced testicular cancer. And he ultimately received chemotherapy and surgery and he's cured and went on to win many Tour de Frances after that. So, even in the most advanced stages, this disease is quite curable.

Host: So, I know you and your team are involved with a number of different research projects. What are some of the new areas that are coming along in the treatment or diagnosis or any aspects of testicular cancer that people should be aware of that are on the horizon?

Dr. Scherr: Well, testicular cancer, fortunately is really a success story over the last 20 years. And I think the reason it's so successful is that it's very algorithmic, meaning we have very well thought out and well-devised treatment plans that we know are very successful. And it's the patients that fall off these treatment algorithms that are the ones who don't get cured from testes cancer.

But I can safely say if you present with testes cancer and you fall into the proper treatment algorithms, very few individuals should not be cured of this disease. And that's partly because, we have a team approach with chemotherapy, radiation, surgical therapy, et cetera. In terms of research going on, I think right now there's a lot of stuff being done in the infertility world. And we know that infertility can be caused by the treatments for testicular cancer, but also infertility is a risk factor for men developing testicular cancer. And so, particularly here at Weill Cornell, we have lot of input and research going on into preserving fertility in patients with this disease. And that includes something as simple as sperm banking before treatment. But it also includes sperm retrievals. There are sometimes men who have very tiny foci of sperm within their testicle, and we have researchers and urologists here, that are able to go in and harvest these sperm and allow men to participate in in vitro fertilization, even with just one or two sperm that are found at the time of surgery.

Further we're tending to look at the immune system. And of course, like every cancer, the immune system is very much involved in control of cancer and there's something called the endoplasmic reticular stress. And we know that the tumor microenvironment or the area where the tumor exists is a very stressful environment. And oftentimes this sort of co-opts or inhibits the ability of the immune system to work and attack cancer cells. So, there's all kinds of research going on right now in immunotherapy. But what we're involved in now is also looking at inhibitors of this stress pathway that perhaps could ultimately be synergistic with some forms of immunotherapy to enhance the ability of the natural immune system to attack any cancer cells.

So there's certainly lots going on. It's a really exciting field, both from a basic science and from a fertility perspective. I think Weill Cornell is really at the forefront of a lot of this research, which makes it even more exciting to be a part of.

Host: So I want to finish with this theme of fertility that you talked about. It's great that there are these advanced techniques and certainly things to offer people that may have complicated situations. But I would imagine that when you're talking about young men in their 20s and 30s, many of them won't have even thought about their fertility. They may not have tried to start a family so far. They're obviously, in many cases concerned about this, or at least wondering about this issue as well as their long-term sexual function and whether or not this will have any impact, and I'm sure that is impacted in part by the treatment. But what do you tell people to expect sperm banking sounds like a pretty straightforward thing. What are the general expectations that the average person recognizing that there are exceptions, should anticipate as they go down this path, as far as their long-term sexual functioning and fertility?

Dr. Scherr: So, John, that's great question. It's interesting. We always discuss fertility with patients with testes cancers. And, unfortunately a lot of men with a testes tumor present with infertility. And so what happens is there's definitely some cytokines and aspects being released from the testicle with tumor in it that actually affect the other testicle itself.

So, believe it or not, when the bad testicle is removed, the good testicle tends to get better. So, sometimes patients who have low sperm counts, when you remove the bad testicle, over time, assuming they don't need chemotherapy or other treatments, the good testicle tends to increase its production of sperm.

And oftentimes these patients can conceive children based on the functioning of their good testicle. Having said that, in some patients where they need secondary therapies such as chemotherapy or surgery, we always recommend sperm banking before that. I think it's important to understand that any of the treatments for testicular cancer, although it can affect sperm production, they do not affect erectile function. And that's a misconception we often hear from young men that they're worried about getting treatment because they won't be able to get erections or anything like that afterwards. And there's no correlation whatsoever to any of the treatments of testicular cancer that will have to do with erectile dysfunction.

And so it's important to clarify that. Fertility on the other hand, I think it's important to bank sperm and get what's called a semen analysis beforehand, to assess where they start out in terms of their sperm counts. Some of the surgeries that may be involved, particularly the large retroperitoneal lymph node dissection, one thing that we're able to do now is do what's called a prospective nerve sparing operation. So, the nerves that are deep inside the abdominal cavity next to these lymph nodes are the nerves that allow a man to ejaculate. And so if those nerves are disrupted, a man can lose their ability to ejaculate.

And of course, if you can't ejaculate, you can't conceive children naturally. So, one thing that we've really been pioneers in here is really understanding the neuroanatomy of that region. And we're able to spare the nerves that give a man the ability to ejaculate. So I can safely tell a patient, if they do need one of these lymph node surgeries, there's about a 98% likelihood that they'll maintain their ability to ejaculate afterwards, which is very different than it was 20, 30 years ago.

But fertility is an important aspect. It's definitely something that needs to be discussed. And I think there's a whole slew of options available to patients nowadays that weren't available in years past that really allow fertility to be a major aspect of their treatment.

Host: Well, thanks. This has been a great discussion, any kind of key takeaways that you want to emphasize for our listeners to know regarding testicular cancer and where things are in this area?

Dr. Scherr: Well, I think that the major takeaway, I hope at least for the young listeners out there, is early diagnosis and self-exams. So, really it's important for whatever age you may be to just, I would say on a weekly or at least monthly basis, feel your testicles, make sure you don't feel any nodules, firmness, anything abnormal.

And if you do, please go out and say something to your partner, to your healthcare provider, whoever it may be, just to get evaluated. Don't ignore things because oftentimes there's something that could be done effectively for that patient.

Host: Well, thanks very much for your comments. This has really been great. And I think again, highlights the importance of a multidisciplinary team that really focuses on all the different aspects of cancer care. I want to invite our audience to download, subscribe, rate, and review CancerCast on Apple podcasts, Google podcasts, Spotify, or online at weillcornell.org.

We also encourage you to write to us at cancercast@med.cornell.edu with any questions, comments, and topics you'd like to see us cover more in-depth in the future. That's it for CancerCast, conversations about new developments in medicine, cancer care and research. I'm Dr. John Leonard. Thanks for tuning in.

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