April is National Testicular Cancer Awareness Month

Allison Ariail, PT, DPT, CLT-LAANA, BCB-PMD is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides and Nicole Dugan among others.

When diagnosed early, testicular cancer can be very curable and have more favorable outcomes. However, the US Preventative Services Task Force recommends against regular screening for testicular cancer. It is classified as a Grade D recommendation. This means they do not recommend clinical screening in asymptomatic individuals, or teaching patients to perform self-exams because they do not have certainty that screening has a benefit. However, recently several authors are asking for reconsideration to change the rating to a Grade B. A grade B classification is recommended when there is a benefit from doing the screening. These researchers are arguing that new studies support the benefits of regular screening by patients and their physicians. They further argue that not only will earlier diagnosis help with more favorable outcomes but that the current grade confuses individuals about the importance of self-care and wellness and reinforces negative cultural attitudes about wellness and screening. 

We have several self-screens that we should be doing regularly; dermatological skin checks, vulvar skin checks, and self-breast exams. It makes sense to me to include a quick check of the testicles as well. 

This made me wonder, how often individuals were being educated in how to perform self-testicular exams? I surveyed 10 individuals with testicles from different regions across the country on whether or not they had been educated on how to perform a self-testicular exam or had a testicular exam performed during their annual physical. Of the 10 people I interviewed, only 1 was educated by their physician on how to perform a self-testicular exam, and he was a little “hazy” about the instructions of what to do. Another two had been proactive and looked up instructions of how to do this on the internet, both of them initiated the search after a friend was diagnosed with testicular cancer. Another 3 more mentioned that their physician had performed a testicular exam during their physical. The other 4 individuals only mentioned that a prostate exam was performed. 

A testicular exam does not take long to perform. Knowing how our bodies feel in health will allow us to know if there are changes over time. Feeling what the testicles feel like at baseline will allow individuals to know if there is atrophy, swelling, lumps, or shape changes occurring. As pelvic rehab professionals, we can teach our patients how to perform self-testicular exams, and to teach patients to advocate for themselves to be sure their physicians are performing testicular exams during their annual exam. Testicular cancer is most common between the ages of 15 and 35. It is important for teens to learn to do this exam as well! Here are some simple directions you can provide your patients:

1. It is best to perform this test monthly.
2. It is easiest to perform this test in the shower. The warm shower will relax the muscles holding the testicles, making it easier to perform.
3. Gently grip the top of the scrotum with the thumb on top and fingers underneath. Slightly pinch this area so that the testicle stays put and won’t move while you do the exam. You will feel the spermatic cord between your fingers and thumb. The spermatic cord connects the testicle to the rest of your body.
4. With your other hand, gently roll the scrotum between your fingers and thumb to feel the surface of the testicle. Glide your thumb and fingers from top to bottom, do this on front to back and on the sides.
5. Check for any lumps, or bumps, and report to a physician if you find something unusual. Lumps could be as small as a piece of rice or a pea. 
6. Make note of size changes over time. Swelling of the testicle or scrotum should be reported to a physician.
7. If you feel any dull soreness or heaviness in the testicle, report this as well.
8. Check both sides.
9. It is easy to mistake the epididymis for something unusual. The epididymis is a set of tubes that are coiled and line the back and top of each testicle. You will feel this as a normal lump on the top back portion of the testes. It may feel tender to the touch, but this is normal. 
10. You can learn more specifics on testicular cancer in Oncology of the Pelvic Floor Level 2A (OPF2A). We not only discuss testicular cancer, but also go in-depth learning about penile cancer, prostate cancer, anal, and colorectal cancers. The next offering of OPF2A is May 20-21.

References:

1. Fadich A, Giorgianni SJ, Rovito MJ, et al.  USPSTF testicular examination nomination-self-examinations and examinations in a clinical setting.  Am J Mens Health. 2018; 12(5): 1519-1516.  Doi: 10.1177/1557988318768597

*Certified Lymphatic Therapists may skip Oncology of the Pelvic Floor Level 1 and move on to the Level 2A and Level 2B courses.*

Oncology of the Pelvic Floor Level 1 - no partner needed for registration
Price: $550.00          Experience Level: Beginner          Contact Hours: 17.5 hours

Oncology of the Pelvic Floor Level 2A - partner needed for registration
Price: $495.00          Experience Level: Intermediate          Contact Hours: 17.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Information will be provided focusing on male pelvic cancers, colorectal cancer, and anal cancer including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient's body and quality of life. Other topics include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: May 20--21

Oncology of the Pelvic Floor Level 2B - partner needed for registration
Price: $600.00          Experience Level: Intermediate          Contact Hours: 19.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Information will be provided focusing on gynecological and bladder cancers including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life. Other topics include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: December 9-10