Testicular Cancer: Curing the Most Common Young Men's Cancer

Testicular cancer is the most common cancer in men ages 15-34. When detected in its early stages, testicular cancer is often completely curable.

In 1996, cycling champion Lance Armstrong felt his biggest challenge was the mental preparation it would take to get ready for the season's races against some of the world's top riders. But just months after winning the Tour DuPont and after riding in the Tour de France and the Olympics, Armstrong announced he had an advanced case of testicular cancer .

At the age of 25, with seemingly no physical worries, Armstrong was a typical patient with testicular cancer. And like Armstrong, whose illness took him by surprise, most young men are simply not aware that regular testicular self-examinations could help them catch testicular cancer in its early stages. Yet early detection often renders the disease completely curable.

"Had I been more aware of the symptoms, I believe I would have seen a doctor before my condition had advanced to this stage," Armstrong said at an October 1996 press conference. "I intend to be an avid spokesperson for testicular cancer once I have beaten the disease."

And beat it he did. In 1999, Armstrong not only had beaten cancer, but he beat the world's best cyclists to win the Tour de Francea grueling 2,141 mile (3,454 kilometer) cycling race around France. Since then, he has only gotten stronger; he returned to France with his US Postal cycling team every year from 2000 to 2005 and won the Tour each time. A Curable Cancer When Lance Armstrong told his cycling fans that he had a good chance of a complete recovery and a return to cycling, he was right. Men diagnosed with testicular cancer can expect to be cured, according to Marc Garnick, MD, an oncologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. The earlier the diagnosis, the better the cure rate. More advanced stages of testicular cancer, like Armstrong's, have a 60%-85% cure rate, while earlier stages have cure rates approaching 100%. "This used to be a uniformly fatal disease," explains Dr. Garnick, "but improvements in chemotherapy have made testicular cancer an almost uniformly curable disease." Testicular cancer responds well to treatments in part because it spreads in a somewhat orderly and predictable way, according to Seth A. Rosenthal, MD, a radiation oncologist in Sacramento, California. This makes it easier to target treatments where they'll be most effective.
The Cancer and Its Symptoms Although cancer of the testes is rare, it's the most common form of cancer in young men between the ages of 15 and 34. Men who were born with one or both testicles undescended are also more prone to the disease. This condition, where the testes form near the kidneys and don't naturally fall into the scrotum, increases the risk of testicular cancer fivefold. Still, if the cancer is found early, treatments are usually successful. The testes are the male reproductive glands and are responsible for producing testosterone and sperm. Testicular cancer almost always derives from the sperm-producing cells of the testes, called germ cells. Although testicular cancer is curable, the tumors are almost always malignant. Unlike benign tumors, malignant tumors can invade and destroy the body's tissues and travel to other parts of the body. In advanced stages, testicular cancer can travel to the abdomen, the chest, or the brain. There are two major classes of testicular tumors: Seminomas Tumors in this class grow more slowly and account for as many as 40% of testicular cancers. Nonseminomas These tumors tend to grow and spread more quickly; more than half of patients with nonseminomas already have the cancer in their lymph nodes at the time of diagnosis.
The early signs of testicular cancer can be quite subtle. If you have regularly been checking your testicles, you will be familiar with their usual consistency. If you notice a change in the texture, you should consult a doctor. A tumor may feel like a pea-shaped lump, but more likely it will be more of a hardening of the tissue. It may or may not cause pain. Some men experience backache or pain and swelling in the breast. In a more advanced case, like Armstrong's, there may be more serious symptoms. Armstrong had pain and swelling in his testicles and coughed up blood, probably from the tumors that had spread to his lungs. Any unusual swelling, hardening, or mass in a testicle should be checked out by a physician. Although in many cases the symptoms aren't caused by a tumor, the chances of recovery from testicular cancer are much greater if a tumor is caught in its early stages. Testicular Self-exam Most young men don't understand the importance of regular testicular self-examinations. Yet detecting a tumor early can help ensure that treatments will completely cure the disease. How to Do the Exam Once a month, check your testicles after a warm bath or shower, when your skin is relaxed and you testicles are lower. You'll want to look at and feel your testicles.
Look at your scrotum for any signs of swelling or discoloration. It's normal for one of your testicles to be uneven, one larger or lower than the other. If you do this regularly, you'll learn what is normal for you and will be more able to detect changes that could be a sign of a problem. Next, roll each testicle between your thumbs and fingers. Use both hands on each testicle. You're feeling for hardness, bumps, lumps, or changes in the consistency of your testicles. Above each testicle is a comma-shaped structure called an epididymis, which stores sperm. Above the epididymis is the spermatic cord or vas deferens. Don't mistake these for lumps, but become familiar with their normal structure and consistency. If you're not sure what you are feeling, ask your doctor at your next physical. If you notice changes, swelling, lumps, or hardening in any part of your testicles, call your doctor. Many changes are normal and not a sign of cancer, but having them checked out could save your life. What Treatment Involves Treatment of testicular cancer depends on the type and stage of the tumor and the age and health of the patient. If the tumor has been detected early, it may only be necessary to remove the affected testicle, a procedure called inguinal orchiectomy. Radiation, further surgery, or chemotherapy treatments would follow in some cases.
If the cancer has spread, the testicle will be removed and chemotherapy will be given. Even in such cases, the cancer is highly curable. Although losing a testicle can be psychologically difficult for a young man, sexual function should be normal, and sperm production usually remains normal after an inguinal orchiectomy because the remaining testicle makes up for the loss. Losing both testicles is very uncommon. In this case, a man would have to save and store sperm to preserve his fertility, although hormone treatments can effectively replace the testes' testosterone production. Even after successful treatment, doctors will keep an eye on things through regular checkups to be sure there's no recurrence of the disease. In many cases, men can live normal lives as they go through treatments. "I have patients who continue to work during their treatment for testicular cancer," Dr. Rosenthal says. "They're a little tired, a little queasy, but they're able to go to work. Most of my patients have continued with a pretty positive attitude. For most, this is a bump on the road." And as Lance Armstrong showed, men can not only survive this disease, but thrive after beating it. RESOURCES: American Cancer Society
http://www.cancer.org/docroot/home/index.asp National Cancer Institute http://cancernet.nci.nih.gov/ References: Learn about cancer: testicular cancer. The American Cancer Society website. Available at: http://www.cancer.org/docroot/lrn/lrn_0.asp . Accessed February 2003. Testicular cancer. MedicineNet website. Available at: http://www.medicinenet.com/Testicular_Cancer/article.htm . Accessed February 2003. Testicular cancer. National Cancer Institute website. Available at: http://cancer.gov/cancerinfo/types/testicular/ . Accessed February 2003. Memorial Sloan Kettering Cancer Center website. Available at: http://www.mskcc.org/mskcc/html/445.cfm.Accessed February 21, 2007 Last reviewed February 2007 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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