TC vs Epididymal Cyst

Well, I was on my honeymoon in the caribbean and after doing a self-examination in the shower because I was feeling a slight pain, I felt a definite lump near the area where my epididymis attaches to my right testical.  I think it has since grown (2 weeks) and is now about the size of a kidney bean (larger than a pea). It does not feel like a smooth fluid filled lump, it feels more like a hard rough lump with an odd shape.  This worries me to a great extent because when I was born, the same testical was undescended and everything I've read indicates that if it is hard and firm it is very likely a tumor, not a cyst).  I had an operation to lower the testical within the first few months, but I think the risk of TC is still higher than average.  I just turned 31.  I went to see my physician as soon as I arrived back home(today) and he said he is quite sure it is a epididymal cyst, and I have an appointment for an ultraound tomorrow (in another city) and would like some questions answered in the meantime....

My questions:

1.  Is the risk of TC later in life much lower if you have the operation to descend the testical at a very early age (<1 yo)?  My MD said it is very high if you dont have it lowered at all, but quite low if you do it early.
2.  I have described the lump...it sounds to me to be too large and firm to be a cyst and this worries be greatly...can cysts be large and firm also?
3.  If it was TC, would I be noticing any other symptoms for sure (ie. tender breasts, etc) or could it be TC with only the symptoms I've noticed to date (firm lump and minor pain)
4.  To what degree (range if you have no exact answer) does the removal of the testical (if it is TC) affect my fertility (ie.  >75% of males post surgery still have a good chance of having children)
5.  Does an epididymal cyst have any effect on fertility?
6.  If it is TC, in general, how long (time)does it take for the cancer to spread?  ie.  Into the lymph nodes and/or lungs
7.  If it is TC and I have the testical removed, what are the odds of living >65 and/or are the chances of recurrence greater?

I realize there are many questions and some are unreasonable, but I am very concerned (mostly because my wife and I just decided to try to have children 1 week before this happened!).  Any insight you can add would be greatly appreciated!

Thanks.

[Kevin Pho, MD]

To answer your questions:
1) It is true that the risk of cancer is lowered if you had the surgery at an early age.

2) Cysts can have varying characteristics.  However, they do tend to be softer than cancer.  The only way to know for sure would be the ultrasound.

3) Gynecomastia (i.e. breast growth) can be associated with testcular cancer.  Typically, the masses are firm and nontender.  They normally do not transilluminate.

4) Fertility can be maintained after removal of the testicle.  Studies have shown that about 85 percent maintain normal testosterone levels after removing one testicle.

5) I am not aware of an epididymal cyst having an effect on fertility.

6) There is no "set" time that cancer can spread - it can vary from patient to patient.  

7) Again, I cannot comment on this without knowing the stage of the cancer.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Annette116]

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