Cancer is Cancer

Cancer is cancer. It doesn’t matter whether it’s below the belt or above the belt. The toxicity around word usage related to it is a problem. People get, and too often die, following silence and embarrassment from lack of validation either from themselves, others, or both.

“If you’re gonna get cancer, might as well be this one.”

“You’re good now, right?”

“It’s got a great cure rate.”

“96% of men diagnosed with this cancer survive.”

“It takes balls.”

“Grow a pair.”

“Man up.”

I heard I was diagnosed with the “good cancer” while the anesthesia took effect just prior to my first of three cancer-related surgeries. As I floated into sleep mode on the elevator ride to the operating room, the nurses were kind in their warmth to impart feelings of calm. They followed what seemed like the empathy playbook for any patient experiencing a trauma. They tried to provide a rational answer to an irrational, scary situation. Their words rang through me after that initial moment of calm and ended up having the opposite effect.

And thus began the stigma and label of having Stage 2 metastatic testicular cancer. Or “ball cancer.” People said “it takes balls” to fight cancer…or some other innuendo developed by a marketing brand to break the uncomfortable feeling of talking about the male reproductive parts.

These sayings are a problem as well as several metaphoric terms associated with the male reproductive anatomy. They are seemingly linked to the toxic nature that seems to require people to always identify with strength and perseverance in the face of adversity. It seems to require a permission slip before seeking help to avoid fear of showing weakness. It is this same toxicity that leads people with male reproductive parts every day to avoid going for regular check-ups and seeking care.

Let’s change the way we talk. End the metaphoric wordplay of “balls” in marketing ploys as much as it is fun to crack jokes around it. It perpetuates the pressure people of male-biological origins feel toward taking care of their own health. Ultimately, it can have the detrimental effect of silencing people into not talking about pain and not dealing with it when it exists.

There seems to be an unfortunate story happening: public awareness for men-centered cancers is not publicly acceptable to talk about, but treatment is often readily available and encouraged. Meanwhile, men do not talk about their bodies; if they did, they might be able to get the care they need.

I was diagnosed in January 2020 but had been feeling symptoms for about a month. I hesitated to get checked because I figured it was something else. I didn’t want it to be cancer but also never truly considered that it could be cancer. A cycling injury that manifested in soreness over time? Maybe at worst that would be a torsion that needed surgery. I had never really been athletic. I was prone to some injury. Eventually, the pain became so persistent that I felt I needed to seek input at an urgent care facility. And I was fortunate that a registered nurse on call that particular Sunday saw what she believed were symptoms and referred me for further testing. At the time, I still didn’t think it was cancer. I just thought it was an extra test to figure out what might be the cause of the cycling injury.

I was sitting in the waiting room of the emergency room to have an ultrasound done. The NFL playoffs were happening on television. Athletes and fans watching in anticipation of the next physical contact that would determine the outcome of the important game. Feelings of pain and possible injuries were a secondary thought to them. It was all something that could be worked through with toughness and grit. Any concern for pain and soreness was surely temporary. It was a similar mindset to the pre-cancer diagnosis feelings and language used as I sat in the waiting area.

It is unfortunate when words perpetuate health disparities and cause people to avoid seeking important medical care and screenings that could save their lives.

The words and how we approach cancer matter in how people seek care. It matters in how each gender approaches their healthcare teams and asks for help. And then, most importantly, it matters how the respective medical teams respond to those requests for care. The timing of a diagnosis, determination of treatment, and subsequent outcomes of treatment all will vary greatly based upon the responsiveness of the medical team to the patient. The social and emotional approach can impact greatly whether they get, and ultimately survive, a cancer diagnosis. Practically, the words that are used in the room where it all happens determine whether the right course of action gets followed. For men, the problem begins prior to entering the office because bad talk begins with bad self-talk.

But then the problematic words continue with the positive person-to-person talk. This talk includes language to establish that sense of calm and provide a rational solution to an irrational, terrifying experience.

These words might work in the moment of diagnosis or in the throes of treatment (for instance in the elevator on the way to an operating room undergoing anesthesia) but they have a long-term impact beyond treatment. Before being diagnosed, it can lead people to question their own concerns and wait to ask for help. After treatment, it can lead people to avoid seeking adequate long-term care.

I will be seeing a urologist for the rest of my life to monitor hormone levels to make sure I am “all good now.” This is just one long-term impact on a person into their survivorship as they attempt to restore their life into the future. I have to ask for blood tests to see if my medication is adequately helping my body do what it needs to do to be healthy since it cannot function naturally on its own post-cancer. The words and approach of my medical team impact whether I feel confident in them to manage my needs and express myself.

The stigma around male approaches to health continues to make it difficult for people to seek care. Society needs to stop making people feel weak and embarrassed to ask for a check-up and talk with their doctor about their bodies. Getting the more specific, the better. Use the appropriate medical body party terminology and break the awkwardness.

The dominant, tough, toxic male kills men because they won’t speak up about their bodies and seek care that could save them. Often, casual jokes are the norm to cover for people feeling uncomfortable instead of asking what might be off with their bodies.

There is a disconnect happening. The words are not always available. How medical professionals talk to their patients and how patients talk to their medical professionals is missing. Many times the connection happens and the system works. But too often the system does not work and the breakdown happens because of words.

The choice to validate a patient’s concerns regardless of how it fits into medical research, jargon, or the typical experience of a cancer survivor can determine whether or not a patient gets the adequate care they need:

“Are my testicles supposed to be this size?”

“Should my testicle be sore like this?”

“What happens if my stomach hurts?”

“What should I do if my testicles bother me?”

All seemingly basic words, but often difficult to express aloud due to the uncomfortable atmosphere when discussing sexual anatomy. It is important to drop the stigma and help to end the shameful feelings about their body issues. If someone is asking a question that sounds uncomfortable, then stop, take the time to listen, and validate the feelings that it’s OK to tell a medical professional about it.

I was sitting in my second oncologist’s office in February 2020 to discuss my course of treatment. He had just reviewed my transfer of medical records and considered my pathology results. In the room where it happened, he put it delicately, but with blunt precision, “You indeed had a tumor and there is a metastasis. This often manifests in young men. We don’t know why exactly, but it happens. And this is how we can address it.” He then proceeded to give me options and let me decide. There was no quick, rational statement to provide a quick, rational solution to an irrational situation. There was just a caring, considerate, and realistic response that validated my fears and provided support to move forward.

There does not need to be broad platitudes to fix a difficult situation. There does not need to be a quick answer to deflect from an uncomfortable situation or topic of conversation. There does not need to always be a source of logic and reason to respond to someone’s grief.

There does need to be validation. There needs to be relevant empathy. There needs to be grounded reality to talk about uncomfortable topics.