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Testicular Cancer

Delays in seeing a specialist

The survival rate for testicular cancer is exceptionally good. In England and Wales, almost all men (99%) survive for a year or more after being diagnosed with testicular cancer, and 98% survive for five years or more after diagnosis (NHS Choices June 2016)‚Äč. Most men can now be completely cured, even if the cancer has spread beyond the testicle. However, some types of tumour spread more rapidly than others, so it is important that men seek help as quickly as possible. If the tumour is Stage 1, completely contained within the testicle, treatment is easier and less toxic than if the tumour has spread to other parts of the body.

Sometimes delay is caused by a man's reluctance to visit his GP. It is known that there may be various 'triggers', such as pain, that encourage people to seek help, or reasons that prevent a rapid consultation, such as embarrassment, or denial.

Sometimes symptoms were unclear, and some men we interviewed delayed seeking help until their wives, girlfriends, or parents encouraged them to seek help (see 'Signs and symptoms'). 

One man explained that he delayed seeking help for two years because he did not feel any pain, he felt fit and healthy, because it was hard to take time off work, and because it was an embarrassing problem.

 

Explains that he delayed seeking help because of lack of time and embarrassment.

Explains that he delayed seeking help because of lack of time and embarrassment.

Age at interview: 36
Sex: Male
Age at diagnosis: 33
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And so I basically, I worked up the courage to go and see the doctor about it. It sounds strange saying working up the courage but I think a lot of young men are in that situation where they feel they er, firstly they don't like going to see a doctor. I mean I don't enjoy going to see a doctor. If you're a young man you consider yourself to be fairly fit and healthy, it's difficult to take the time, also getting the time off work and everything to go and see the doctor if you're living a busy lifestyle. And also if it's a slightly what could be called an embarrassing problem then you know you tend to delay it I think. But I finally took the decision to go and see him. Also another thing, it was it was a new doctor, I'd never met before so I suppose that works in both ways. I mean it took a bit of courage to go and see him but on the other hand I didn't have any history with him so I could come straight out with it and say what I felt the problem was.
 
Another man said that he delayed seeking help for 18 months, because he did not want to face the fact that he was ill. He said that men do not like to make a fuss, or to be seen as weak. Another man explained that he delayed seeking help because he did not wish to be a hypochondriac.
 

Explains that he delayed seeking help because he did not want to face the problem.

Explains that he delayed seeking help because he did not want to face the problem.

Age at interview: 46
Sex: Male
Age at diagnosis: 44
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So this went on for 18 months before you actually went, did anything about it?

To be honest I would say 18 months yeah, yeah, yeah. I eventually decided to go and see my GP and

Why did you delay for so long?

Well I've thought long and hard about that and I wondered if the, deep down I knew there was a problem but I didn't like to face the fact, may be, may be. But it wasn't painful, it wasn't uncomfortable for a long time and I think men in general perhaps don't want to know.

Why do you think men in particular?

I'm not sure, I'm not sure. I don't think they like to make a fuss perhaps or be seen to be weak, caring about their bodies perhaps is, I don't know traditionally perhaps is seen as a sign of weakness in men, I don't know, I don't know. But as I say when it got to the point where I couldn't ignore it any more I went to my GP. And he didn't seem to think there was anything wrong particularly but he said he'd send me to the local hospital to have it checked out. And it was about 6 weeks later when I went down there.
 
 

Explains that he delayed seeking help because he did not want to be a hypochondriac.

Explains that he delayed seeking help because he did not want to be a hypochondriac.

Age at interview: 52
Sex: Male
Age at diagnosis: 48
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Why did you not mention it to anybody all that time?

I just thought it would go away. I just thought it was something and nothing. It's not, I don't, I've never, when I was a child I was always ill, chest infections, asthma the lot and my mother always nagged me. And I think it bred in me the fear of mentioning anything for people fussing round. That's, and I went to work and all those illnesses left me behind you know I left them, I hardly had any you know of those serious illnesses like I'd had before, odd colds and that was it. Minor injuries and very few occasions went to the doctors over the years. And I just, it's just something in the back of my mind that I didn't really want to discuss it and it would ago away and that would be it. You know I wasn't going to be a wimp, you know a hypochondriac or whatever you want to call it.
One young man we spoke to delayed seeking help because he only had one testicle and wrongly feared that if the other testicle were to be removed he would no longer be able to have sex. He did not realise that hormone replacement therapy could restore his levels of testosterone (see 'Hormone treatment').
 

Explains that he delayed seeking help because he feared that treatment would mean the end of sex.

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Explains that he delayed seeking help because he feared that treatment would mean the end of sex.

Age at interview: 26
Sex: Male
Age at diagnosis: 24
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Okay, I first discovered I had testicular cancer 18 months ago. I found, I found one morning whilst in the bath I realised there was a lump. And I completely ignored it because, mainly because I was completely ignorant to what testicular cancer was and I was really afraid of basically losing my sexuality, I was afraid that they would obviously have to cut my testicle off. And it would make more sense if I let you know that I was only born with one testicle, and I think I was so afraid that they would cut my testicle off and I would lose my sexuality that I managed to completely block it out of my mind. And it was easier when the lump was very small, it was a very slight lump. And I did notice that I actually drank more and I think that was to put it out of my mind. I went for a lot more sociable drinks, because I'm not really a big drinker, but I went for a lot more drinks and I managed to put it out of my mind. And obviously it grew and I can't believe how stupid I was because I let it go for six months until it got really, really big. And I went to my GP finally after talking to my brother. One night I went to the pub with my brother and I let him know that I had, that I was sure I had testicular cancer. And even though he was sure it wasn't I think just saying it out loud to someone else meant that I definitely would dealt with it. And so I spend the night in the pub with my brother talking about it, got very drunk and the next day I realised I had to go. So I went to my GP.
Past experience of illness can also influence the decision to seek help. One man remembered that when his mother had been seriously ill with cancer he had been falsely assured that she would get better. He was afraid of cancer, particular metastases (tumour spread), and didn't realise that, even if testicular cancer has spread, it is usually curable. He couldn't face the diagnosis and so delayed seeking help.
 

Explains that he delayed seeking help because of fear of cancer.

Explains that he delayed seeking help because of fear of cancer.

Age at interview: 39
Sex: Male
Age at diagnosis: 36
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I was told that my mum was alright and I thought to myself well I was told she's alright, now if they tell me I'm alright and then something happens to me you know I've got a young son as well. And I was thinking you know they told her she was alright for months and she wasn't, she was getting worse and worse day-by-day. And I was frightened that that's going to be me. I didn't want to lay there like my mum was. I mean I was feeding my mother and you know we were washing her and she couldn't do anything for herself in the end and I thought well that's not for me.

So it was really fear of going to the doctor? 

Yeah it was fear of actually finding out that you have got it. You know although they say yes it can be cured and all this it doesn't give you much, it didn't give me much faith because like my mum underwent treatment and operations and radiotherapy and everything else and they said, "Right she's clear." Well if they said to me I was clear and it comes back I wouldn't have been a happy bloke.

So it was really fear of being told?

It was fear of being told it's spreading. I think that was the thing I was actually scared of the most to be told that it is spreading. But I mean I'm lucky it never so, because the wife caught it in time.
 
One patient delayed seeking help for six months. When he was eventually examined by the GP he found the examination painful, so he didn't keep his appointment with the urologist, which delayed everything further.
 

Explains that he did not keep his appointment with the urologist because he found the GP's...

Explains that he did not keep his appointment with the urologist because he found the GP's...

Age at interview: 55
Sex: Male
Age at diagnosis: 52
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OK, well I had some slight irritation you know, nothing sort of particular you know and I didn't want to be a hypochondriac and so I delayed going to my GP and for a considerable time, maybe for six months or something like that. And then when I did go and see this GP there was a locum and he gave an inspection of me and I found it sort of quite uncomfortable, the way how he went about the inspection. And so I further delayed you know he had referred me to somebody else, he'd said that he couldn't find any lumps and bumps and things like this and he referred me to somebody else. And I delayed that.

Yes, and when the GP examined you it was, she or he, it hurt a bit while they examined your testicles?

Yeah, yeah, well you know its an unglamorous sort of thing to have done and it was excruciatingly painful you know sort of the, I didn't like that you know and I don't suppose anyone does like that sort of thing you know. Anyway it was my own fault that I delayed the thing you know.

One man we interviewed said that he delayed consulting a doctor because, at his University Health Centre, those waiting to see a doctor could hear all that was being said inside the doctor's office. 

Delay in reaching an urologist may also happen because of misdiagnosis by a GP. A number of men said that their GPs hadn't referred them rapidly to an urologist because the diagnosis was difficult to make (also see 'Signs and symptoms'). Some men we spoke to said they were given false reassurance by their GPs, even when a lump could be felt. The men felt they should trust their GPs and were reluctant to question their doctors' judgements.

 

Arthur Frank explains that there was delay in starting treatment because doctors could not...

Arthur Frank explains that there was delay in starting treatment because doctors could not...

Age at interview: 55
Sex: Male
Age at diagnosis: 40
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Arthur Frank said' And then I was amazed to begin to have these symptoms that I had an intuition might be cancer very early. Like about half the people I think who have testicular cancer I went through a long period of misdiagnosis. I first began to notice a lump on one testicle in July, I wasn't eventually operated on until October and during that period the secondary tumours grew very quickly as of course they do and I was in extraordinary pain, back pain and I couldn't sleep at night and so I was in pain, I was sleep deprived and physicians were insisting that they couldn't feel anything unusual around the testicle. Now of course they did not get a urologist and this went on until I'd finally been in the hospital for a couple of weeks and finally a urologist came to see me and it was very quickly and easily diagnosed. But since then the studies I've seen which were a small sample have all indicated about half men with testicular cancer do go through this period of diagnosis. I think one of the most difficult issues that that sets up is the problem of trust because then I really entered medical treatment for what finally was diagnosed with a strong suspicion of the medical system that it had failed to diagnose me through these months of as I say very extreme pain.
 

Explains that delay occurred because his GP falsely reassured him that the lump was nothing to...

Explains that delay occurred because his GP falsely reassured him that the lump was nothing to...

Age at interview: 28
Sex: Male
Age at diagnosis: 27
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It was probably about a year ago now, but I was regularly checking myself anyway due to family history of mum and dad passing on with cancer. So since they passed on I was regularly checking myself anyway. Best time to check yourself was in the bath each evening. So I was checking myself one evening in the bath and noticed there was like a hard lump in one of my testicles. It was like a hard stone-like lump, as though a stone was in the middle of your testicle. Thought not right, but I was one of these gentlemen that thought I won't do nothing about it, it'll go away sort of thing, yeah. So I left it for a couple of weeks, mentioned it to the wife and said "Look I think I've got a lump downstairs," and she said "Go to your GP and sort it out then." So eventually I did pluck up the courage to go and see the GP in September of last year. He knew the family history, knew about my mum and dad because he treated them himself and he told me there was nothing to worry about. You know "Yes there is a little bit of a lump there but don't worry about it, it's fine." So I took the doctor's word for it being that you know I trusted him. But it just didn't go away the lump, it just got, it got a little bit bigger as well as months grew on, it did get a little bit bigger. And I kept saying to the wife you know "The lump is still there, it's getting a bit bigger." And probably about 2 or 3 months before the op, in April this year, I was getting slight pains as well.

So that's 2001? 

Yes, I had, I was getting quite acute pain in the testicle area as well, pain that made me double up, I felt a little bit sick as well. So that's when I said "Right I'm going back to the doctor." But I chose a different doctor in the same practice to go and see er to which he stated "I don't think you've got nothing to worry about, I think you've got a blocked urinal gland but I'll refer you on anyway." So I waited about 4 weeks, got an appointment with the specialist.
 
Administrative delays also occurred, which added to the problem of patient delay and misdiagnosis.
 

Explains that his appointment with the urologist was delayed because of administrative problems.

Explains that his appointment with the urologist was delayed because of administrative problems.

Age at interview: 54
Sex: Male
Age at diagnosis: 52
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I went down to my doctors, he examined me and he said, "How long have you had the lump?" And I said "Well six or seven months now." He went into one [disapproval] because I'd left it so long, and he said, "I'll get you examined at the hospital." He sent off for an appointment for me to be examined at the hospital which took rather a long time actually, that was in the October and by the November I still hadn't heard anything. And I went back to my doctor and he said, "Well I sent it [request for an appointment] off," and he showed me the Internet, the thing on the screen, on his computer, saying that he'd sent it off. And he said, "I'll chase the hospital up for your appointment." And I still hadn't heard in December. By this time my firm was getting increasingly worried about it because I'd obviously mentioned to the firm and that it was causing me grief at work because I was worried about it. So they sent me to their own private doctor, the firm's private doctor, paid for it. He examined me and he said I'd be unlucky if it was cancer, that he seemed to think that it was some sort of swelling to do with the water ducts.
 
Last reviewed December 2017.
Last updated December 2017.
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