The Testicular Cancer Awareness Week (tcaw.org) has compiled more information on testicles.
Testicular Cancer Cases Outpace Breast
Cancer in Califiornia
Doing a Self-Exam!
Testicular cancer risk set early in
We'll Send You a Monthly Self Exam Reminder
Get a Grip! Testicular Cancer Awareness Week Campaign April 1-7, 2004
Testicular Cancer on the Rise and Getting Younger
Infertile men at greater risk of testicular cancer
No Longer a Secret
Related Issues: Talking
With Kids About Tough Issues, Impotency,
Free Self-Exam Monthly Reminder
Testicular Cancer Self Exam shower card
Testicular Cancer Cases Outpace
Breast Cancer in Califiornia
Testicular Cancer on the Rise and Getting
(Editor: We want to STOP right now and say if you are a male, or have a brother, or a son who is between 15-40, learn the SIMPLE self examine you can do in private in the shower. 300 men will die during 2000 primarily because they ignored the symptoms or didn't catch it in time. Click here to read each side Side 1 and Side 2 RIGHT NOW and learn what to do! If you want to purchase this waterproof guide to hang on your shower nozzle to remind you to check once-a-month, Click here and we will remind you, free of charge.)
Studies have suggested that prenatal exposure to hormones may increase cancer risk. Twin pregnancies, obesity and other conditions that increase estrogen levels in pregnancy are associated with a higher risk of testicular cancer. The increased use of fertility-promoting hormones may be linked in some way to the increase, also. Some studies have found a weak relationship between testicular cancer and inguinal hernia, low birth weight, early birth order, and a sedentary lifestyle. However, Scott Hamilton (the ice skater) and Lance Armstrong (three time winner of the Tour de France) were both victims of testicular cancer and Lance was told he would not live, got treatment and won the Tour de France again following his successful recovery.
More study is needed to uncover the causes of testicular cancer,
but less than $100,000 is expected to be budgeted for such research
in the year 2000. So, let's each do are part to protect ourselves and
those we love from being a statistic.
Infertile men at greater risk of
No Longer a Secret
Scott Hamilton and
While it only kills around 300 young men a year, these brothers, sons, boyfriends, and friends probably would not have died if anyone had the guts to teach them how to test for it. It should be in every gym program. Its diagnosis should be taught in all school health programs. And, young men who were born with an undescended testicle should be informed, from the start, that they are at greater risk.
It is among the easiest to cure when detected early. However, in early stages testicular cancer may be symptomless. When symptoms do occur they include: Lump about the size of a pea on one of the testicles, epididymis or vas, enlargement of a testicle, heavy sensation in groin area or testicles, dull ache in abdomen area. If you find a lump or have any of the above symptoms, see your doctor immediately for an accurate diagnosis.
A once-a-month simple self-examination can help catch this cancer at its early stage. The most convenient time to examine yourself is while taking a shower or bath. The warm water causes the skin to relax, making the examination of the underlying tissue easier. First: Examine your testicles. Slowly roll each testicle between the thumb and fingers. Try to find any hard, non sensitive lumps. Second: Examine the epididymis for lumps. This crescent-shaped cord is behind each testicle. This area is tender so do not be alarmed. Third: Examine the VAS (the sperm-carrying tube which extends from the epididymis) of each testicle.
As a parent, provide this information to a son in this age group.
Also, talk to your high-school and college about providing this
information in gym class or anywhere else where all male students
will get the information in a positive, serious manner. Tell them
about this website and let them know that they can get water proof
informational cards from the American Cancer Society, or download it
from this website (anchor) or purchase a waterproof one from us for
use in your shower. No boy should die from this cancer. The only ones
who die from this cancer are the ones who didn't know they should do
a monthly check, or knew and didn't do it. It's a shame to loose
anyone to this disease. But who will tell them how to protect
Lance Armstrong Takes
Armstrong Wins Fifth
Lance Armstrong Inspires Cancer
Armstrong insists the cancer was the best thing that ever happened to him, because it taught him about the strength of the human spirit, and the love of family and friends. One month after his chemotherapy ended, he met his wife. Using sperm removed before his surgery, he and his wife conceived a son, who is now 3 years old.
Lance Armstrong's recent victory in the grueling Tour de France has inspired cancer victims around the world. Upon winning the race, Armstrong said, "Regardless of one victory, two victories, four victories, there's never been a victory by a cancer survivor. That's a fact that hopefully I'll be remembered for."
John Romano, columnist for the St. Petersburg Times, recently
wrote a column that describes the meaning of Armstrong's victory to
Cancer, Vasectomy Connection
Vasectomy and Cancer Risk
Testicular cancer is much less common than prostate cancer, accounting for only 1 percent of cancers in American men. This type of cancer is most often found in men ages 15 to 35. A few studies have suggested a link between vasectomy and an increased risk of testicular cancer, but it is possible that the increase in cases of testicular cancer seen in these studies may be due to factors other than vasectomy. It is also possible that the vasectomy procedure increases the rate at which an existing, but undetected, testicular cancer will progress. At this time, it is believed that there is either no association or a weak association between vasectomy and testicular cancer, but more research is needed before definitive conclusions can be made.
Men concerned about testicular cancer should talk to their doctor about the symptoms to watch for and an appropriate schedule for checkups.
This fact sheet was reviewed on 2/04/02
Doctors Say Fewer Men Dying of Testicular Cancer (6/8/01)
Their study, published in The Lancet medical journal, showed that chemotherapy treatment could help to reduce death rates for the most common cancer among men aged 25 to 29.
"Testicular cancer is a classic example of cancer that is generally curable when the right treatment is given," said Professor Peter Boyle of Britain's Imperial Cancer Research Fund, a co-author of the report.
"In spite of the number of cases increasing, deaths from testicular cancer have been declining in North America and Western Europe since the late 70s," he added.
Death rates from the disease in men younger than 45 fell by about a third in the late 1980s compared to the 1970s.
Cases of testicular cancer, which affects one in 500 men, had been increasing since the 1930s. Denmark, Switzerland and Norway have the highest rates in the world.
After peaking in the United States in the 1960s, deaths from the illness have dropped by over 70%. In most of Europe deaths have declined by 67% since the 1970s. But in Eastern European nations the decline is only 22%--behind the United States, Japan and most of the rest of Europe.
"We must find out why testicular cancer death rates are so different in central and Eastern Europe," Boyle said, "otherwise there will continue to be several hundred preventable deaths occurring every year."
The researchers said their results indicate widespread inconsistencies in adequate treatments in central and Eastern Europe. If money is the problem, they suggested that urgent measures are needed to ensure that the best treatment is available to everyone.
Testicular cancer is curable in 90% of cases if it is caught and treated early. Symptoms include a lump or sore on the testicle, pain or soreness, a persistent cough, blood in the urine and stomach and bowel problems.
Scientists suspect exposure to high levels of the female hormone oestrogen in the womb could be part of the reason for the increase in the disease.
Familial testicular cancers account for an estimated 20% of cases.
There are also more cases among first-born sons and non-identical twins.
The Young Man's Cancer
Testicular cancer is a relatively uncommon disease, with an estimated 7,600 cases every year. Yet, it is the most common form of cancer among men between the ages of 15 and 35 and its incidence has increased sharply over the past three decades. Fortunately, testicular cancer is one of the most treatable cancers when it's caught early -- and that's simple to do because the testes are easily accessible for external examination. But don't wait until you see your doctor. You can prevent this cancer from spreading to other organs and becoming deadly by performing regular self-examinations.
What is Testicular Cancer?
The testicles are two egg-shaped glands suspended below the penis in the scrotum. After puberty, the testes produce the male hormone testosterone, which is responsible for many male characteristics, such as body hair and deepening of the voice. The testes also produce the sperm that fertilizes a woman's egg during reproduction.
Testicular cancer is the growth of a malignant (cancerous) tumor that originates in the testes. About 95 percent of masses in the testes are malignant, and if untreated, will grow and spread to other organs. Early detection is key to curing this disease.
Who's at Risk?
While any man can develop testicular cancer, especially between the ages of 15 and 35, certain factors make men more vulnerable. These include:
An undescended testicle (cryptochordism). If you have or have had an undescended testicle your risk of developing testicular cancer increases by three to 14 percent. This is particularly true if the testicle descended after age six or never descended at all.
A testicle that has atrophied (wasted away or shrunk) as a result of the mumps or a viral infection.
Family history. If you have a brother, or other family member who has had testicular cancer, you may have an increased risk for the disease.
Exposure to diethylstilbestrol (DES) may be a risk factor for testicular cancer. From 1946 through the 1970's, DES was used to treat pregnant women who had a high risk for miscarriage. Studies have already established a link between DES and vaginal cancer in the daughters of women who took DES during pregnancy. Studies are under way to see if such a link exists in sons as well (for more information, call the DES Cancer Network at 800-337-6384).
Your physician should include an examination of your testes during every routine medical examination. But since that probably occurs only once a year, you can improve your chance of detecting a problem as early as possible by performing a testicular self-examination (TSE) every month.
Testicular Self-Exam (TSE). Performing this simple, 3-minute self-examination once a month, will help you detect testicular cancer. The best time to check yourself is in the shower because fingers glide over soapy skin, and it's easier to concentrate on the texture underneath. After a warm bath is also good because the heat causes the skin to relax, making the exam easier.
As you perform these monthly self-exams, you will learn what is normal for you. That way you will be better able to detect any of the following symptoms:
If you find anything out of the ordinary, contact your doctor promptly because about 95 percent of masses in the testes are malignant. Early detection and prompt treatment is the best way to guarantee a cure.
1. Start by examining one of your testicles. Slowly roll it between your thumb and fingers, applying slight pressure and looking for hard, painless lumps.
2. Then examine your epididymis (the comma shaped cord behind each testicle). It may be tender to the touch, but it's the location of most non-cancerous problems.
3. Continue by examining the vas (the sperm-carrying tube that runs up from your epididymis), which normally feels like a firm, movable, smooth tube.
4. Repeat the same procedure on your other testicle.
If the scrotum doesn't feel normal, your doctor will probably order an ultrasound exam, which uses sound waves to make a picture of the inside of your testes. A number of other examinations and tests may be needed to rule out or confirm cancer or to stage the disease (find out how far it has progressed). The following tests may be used for that purpose:
Blood and urine samples to measure the function of other organs. Also, a blood test for tumor markers (chemicals produced by testicular tumors and released into the blood stream) can help detect the disease and monitor tumor activity before, during, and after treatment.
Chest x-rays or computed tomography (CT) scans of the abdomen and chest (a CT scan is a painless procedure in which a beam moves around the body and forms a detailed picture on a computer screen that can show any developing abnormalities).
Once testicular cancer has been confirmed, the physician has to determine what kind of cancer it is in order to decide what treatment is best. The tumors that form testicular cancer are divided into two major groups:
1. Seminomas, or cancer that originates in the sperm cells, account for 40 percent of all testicular cancers. This type of tumor is generally very responsive to radiation.
2. Non-seminomatous tumors make up the remaining 60 percent of testicular cancers and include several varieties of tumors. Approximately 30 to 40 percent of testicular cancers involve more than one type of tumor. A metastatic tumor (one that has spread to other parts of the body) may be made up of cells different from the cells of the primary, or first, tumor.
The next step is to determine the stage of the cancer, or how far it has spread. There are three main stages of testicular cancer:
Stage I. Regardless of the size of the tumor, the cancer is limited to the testes and has not spread to the lymph nodes or other organs.
Stage II. The cancer has begun to affect the area of the abdomen that lies behind the stomach (peritoneum). It also includes cancers that have spread to the lymph nodes, but not to a distant organ.
Stage III. Cancer that has spread to one or more distant organs.
The good news is that testicular cancer is among the most curable of cancers, especially when detected early. Since the majority of all testicular tumors are cancerous, the first treatment is usually radical orchiectomy, which involves the surgical removal of the affected testicle and all of the adjoining tubes.
If only one testicle is involved, radical orchiectomy will probably not affect sexual function. However, it is important to find a surgeon experienced in this particular type of surgery because if lymph glands at the back of the abdomen have to be removed, the surgeon must take special care to protect the nerves associated with ejaculation. Nerves damaged during surgery can cause infertility.
After surgery, adjuvant (or additional) therapy is often needed depending on the type of tumor and the stage of the cancer.
In general, the treatments most commonly used are:
Radiation therapy, which is usually highly effective against seminomas, may be used to eradicate the cancer or to shrink the size of tumors too large to operate.
Chemotherapy (the use of powerful anti-cancer drugs) is usually used when the tumor cannot be completely removed surgically (such as with microscopic disease), the disease has spread to other organs, or the cancer recurs. Since chemotherapy may damage testicular function and cause infertility, a man may want to consider the option of storing sperm in a sperm bank prior to treatment.
In cases where the cancer has spread to the abdomen, additional surgery may be needed to remove affected lymph nodes in the area.
If treatment is successful, the disease goes into complete remission (it is no longer present). But there is still a chance that the cancer will return, particularly during the first two years after therapy. About 10 percent of men treated for testicular cancer experience a relapse. Still, almost all of these cases can also be cured -- usually with chemotherapy -- when caught early enough. Physicians monitor patients for recurrences with regular physical exams, CT scans of the abdomen, chest x-rays, and blood tests to measure tumor marker levels.
Men who are dissatisfied with their appearance after surgery can have an artificial testicle implanted. These implants are filled with silicone gel and have the weight and feel of a normal testicle. However, though recent concerns about a connection between the leakage of silicone gel and the occurrence of rheumatic symptoms (joint aches and pains, fatigue, inflammation) have primarily been raised by women with ruptured or leaking breast implants, there have also been a few complaints from men with testicular implants.
During fetal development, a male child's testicles develop in the abdomen. Before birth they normally descend into the scrotum (a pouch of skin underneath the penis that houses the testes). In a small number of boys, especially those who are born prematurely, one or both testicles fail to descend by the time of birth. In most of them, the testicles descend during the first nine months of life.
The cause of undescended testicles cannot be explained in most cases. But according the American Academy of Pediatrics, these factors may play a role:
There may not have been enough of certain hormones from the mother or the developing testicles to stimulate normal maturation.
The testes themselves may be abnormal in their response to the hormones.
There may be a physical blockage.
In some cases, there may be a link with hormonal medications taken by the mother (one reason pregnant women are advised to avoid them).
If a child has undescended testicles, his scrotum will be small and appear underdeveloped. If only one testicle has descended, the scrotum may look full on one side and empty on the other. If the testicles are sometimes in the scrotum and at other times absent (such as when he is cold or excited), they are said to be "retractile." This condition usually corrects itself with time.
A physician should carefully examine male infants during routine medical examinations to ensure that their testes have descended. If one or both testes are undescended by one to two years of age, treatment should be started.
Undescended testicles may be treated with hormone injections and/or surgery. The lower the testes, the more likely that the hormone injections will be successful. Usually, but not always, treatment with hormones is tried first. If that is unsuccessful, a surgery called orchiopexy can be performed. During this operation, the testes are brought down into the scrotum and attached to the walls so that they will not retract.
If testicles remain undescended for over two years, a boy will have a higher than average risk of being infertile (though perhaps not impotent) when he matures. He will also have an increased risk of developing testicular cancer, particularly if the testicle is left in its abnormal position. Fortunately, with early and proper treatment, all of these complications can usually be avoided.
For More Information: AHCPR offers a free copy of their Managing
Cancer Pain. Agency for Health Care Policy and Research,
800.358.9295. Health Pages. Publication: The Young Man's Cancer.
1998. (Online) www.thehealthpages.com/ar-testi.html
Young men think they are indestructible -
a true story
So I did what most guys would do: I put it out of my mind. Or tried to. I couldn't believe it was anything serious. My wife and I had just married. We were closing on our first house. I was in the third month of a new job. Everything was going great.
Then I noticed the testicle was getting larger. Finally I made an appointment with my primary care physician -- and started what turned into a five-month battle.
The visit with my doctor took exactly 20 minutes. He set up an appointment with a urologist the next day who examined me, looked me in the eye and said, "You're a smart kid. I'm glad you came to see me."
When results from a blood test and an ultrasound came back, the urologist sat down with my wife and me and gave us the news: There was a 95% chance I had cancer. Getting kicked in the groin during the softball game hadn't caused the disease, of course; it had just prompted me to check things out in time to catch the tumor, which was already there. The testicle had to be removed right away, the urologist said. I couldn't believe my ears.
Just like that, I had become part of a trend: I had likely been stricken with a form of cancer that has, over the past three decades, increased in frequency an astonishing 60% (according to the U.S. Centers for Disease Control and Prevention), striking mostly young men like me. The doctor probably told me that it was a very curable cancer, but I was in such a state of shock, I could barely understand what he was saying.
That next Monday -- just after moving into our new house -- I went in for surgery. I was home that afternoon, with a huge bandage on my crotch and a gigantic ice pack in my pants. The procedure, called an orchiectomy, involves removing the testicle through an incision in the groin. A week later the biopsy report came back: "Nonseminomatous mixed germ-cell tumor primarily consisting of embryonal carcinoma."
In other words: Cancer.
Luckily, the report said the cancer hadn't spread to my lymph nodes or bloodstream. Even so, I was faced with a tough decision. I could watch and wait to see if the cancer was truly cured. Or I could undergo what's called a retroperitoneal lymph node dissection, or RPLND. In short, a surgeon opens you up from below the navel to the middle of your chest, lifts your internal organs out of the way, and removes all the lymph nodes that could be cancerous if the tumor has spread.
The prospect terrified me. But so did the idea of doing nothing.
Surfing for Survival
I got on the Internet, looking for help and information. I found plenty of it, along with moral support. I also found out about Indiana University, known for its expertise in treating testicular cancer. I made an appointment, and a week later my wife and I hit the road.
I've since learned that testicular cancer is often misdiagnosed. The problem -- as I was about to learn firsthand -- is that because it's so rare, most doctors don't see it all that often. The ones back home had told me the cancer hadn't spread. But when the same slides were reviewed at Indiana University, the report indicated that, in fact, it had. I had learned one important lesson: Always get a second opinion. Always.
With this latest round of bad news, I decided to have the dreaded RPLND. I wanted to kill this beast while I had the upper hand.
At the age of 23, I never thought I'd have to make my peace with God. But on the morning of the surgery, I did. Saying goodbye to my wife before entering the operating room was hard enough. But one of the most difficult moments was when I saw my dad for the first time after surgery. He looked shaken, and as he took my hand, he asked in a low voice how I was doing. I gripped his hand as hard as I could and told him not to worry.
Feeling Like Burnt Toast
The six days I spent in the hospital were pretty tough. At first I needed help getting out of bed. By the third day, I was just beginning to feel better when my primary care doctor came to see how I was doing. He happened to mention in passing that my urologist had found one node that was positive for cancer. And then he left.
There I was, in the middle of a visit with my wife, when this guy walks in, drops a bomb, and then walks out. I was devastated.
My urologist laid out the situation the next day. There was a 70% to 80% chance that I was cured already. Two rounds of chemotherapy would raise those odds to 95%. I wanted the best odds I could get, but I'll admit it: I was really afraid of chemotherapy. Fear of the unknown, I guess.
The first couple of days on chemo were pretty easy. But by the end of the first week I felt horrible -- like burnt toast. The drugs had affected my hearing and made me feel like I was in a tunnel. The knuckles on my hands turned dark. My skin felt thickened. And I felt as if I had just smoked 100 cigars in a row -- my lungs hurt that badly. Then my hair started falling out.
In all, I did two rounds of chemotherapy, three weeks each. On Oct. 21, 1997, the treatments ended. I couldn't have been happier. Now it was time to get back to my life.
In an odd way, I feel lucky. Testicular cancer is among the most treatable ones around. But even though 95% of patients with the condition beat it and survive at least five years, according to the American Cancer Society, that still leaves 5% who don't. Men do die of this disease. And most of them are young and in the prime of their lives.
If I had waited much longer, my story might have ended differently. One key to beating this disease is detecting it early. That's why I tell everyone: If you think something is wrong, don't wait. Go to your doctor. Another key is following up to make sure it doesn't come back.
Since the surgery I've struggled a bit to get my life back in order. Sometimes I feel a little bitter that I had to go through this. But mostly I know that this experience made me realize what a gift my life is. I have a loving wife, a wonderful family, great friends, and all kinds of opportunities. And my wife and I just got the best gift possible. Our first child, a girl, is due to be born this November. (Just so you know: We conceived her the old-fashioned way.) Believe me, I'm planning to be around a long, long time to enjoy being a dad.
Source: Like most young men, the writer thought he
was indestructible. Then he was diagnosed with cancer and found
himself in the battle of his life. By Erik Strand. Medically reviewed
by Dr. Craig H. Kliger. Erik Strand is a mechanical engineer in
Plainfield, Ill., where he still enjoys playing softball.
Fertility problems linked to
testicular cancer risk
While previous studies in Denmark have suggested there is a link between infertility and testicular cancer, those studies measured a man's fertility by the number of children he had. The new study looked at sperm quality and showed that men with abnormalities were two to three times more likely than other men to develop testicular cancer, researchers report in the September 30th issue of the British Medical Journal.
The incidence of testicular cancer has risen in Europe and the US in recent decades, and some evidence suggests semen quality has declined over the same time period.
Dr. Rune Jacobsen of the Danish National Research Foundation in Copenhagen and colleagues looked at sperm count, as well as the shape and movement of sperm, among more than 32,400 men who had semen samples taken between 1963 and 1995. Each man was part of a couple with fertility problems.
Overall, the men had a higher-than-average risk for testicular cancer. Among men with sperm abnormalities, the cancer risk was two to three times higher than average.
Poor sperm quality and testicular cancer may share an underlying cause, the authors suggest. Because testicular cancer strikes young men, experts have speculated that the risk of the disease begins early in life or even in the womb. For example, exposure to maternal hormones during pregnancy may trigger cell malformations that later show up in men as fertility problems and testicular cancer.
Despite this possible new risk factor for testicular cancer, it is important for men to keep the risk in perspective, according to Jacobsen's team. Only 89 of the more than 32,000 men developed testicular cancer, making a man's risk for the disease "very small," the researchers note.
SOURCE: British Medical Journal
High-dose chemo battles recurrent
Most men with testicular cancer can be cured with the combination of surgery and chemotherapy. However, as many as 30% may require additional treatment, according to Dr. Lawrence H. Einhorn and associates from Indiana University Medical Center in Indianapolis.
In a 3-year study of 65 men suffering a cancer relapse, the men received high-dose chemotherapy followed by either a bone-marrow transplant or stem-cell transplant to replenish the immune system damaged by the chemotherapy, which can be extremely toxic.
More than 40% of patients had a complete response to the high-dose chemotherapy, the authors report, and another 20% had no evidence of tumor after additional surgery. Fifteen additional patients had a partial response.
Overall, nearly 60% of patients were continuously free of cancer after high-dose chemotherapy either alone or combined with other treatments, according to the report in the October issue of the Journal of Clinical Oncology.
Some of the side effects of the chemotherapy were fever, diarrhea, nausea, mouth sores or kidney toxicity, though none of the patients died from the treatment.
"This is a message of hope," Einhorn said in a statement issued by the journal. "For patients who are not cured with the initial chemotherapy, we can now tell them with confidence that there is more than a 50% chance they can still be cured with second-line therapy."
SOURCE: Journal of Clinical Oncology
New drugs may hold promise for testicular
cancer undescended testicle
"Previous research with vanadocenes has shown them to be potent spermicides," according to Dr. Osmond J. D'Cruz of Parker Hughes Institute in St. Paul, Minnesota. "This finding caused researchers to consider their ability as an anti-testicular cancer agent."
The drugs are also known to kill many types of cancer cells in laboratory culture dishes, including testicular, mammary, ovary, lung, stomach, colon and skin cells.
In a new study, D'Cruz and colleague Fatih Uckun injected four different types of vanadocenes into the testes of mice daily for 28 days. The investigators found that the drugs caused a preferential loss of maturing sperm cells, mainly by inducing the cells to undergo a naturally occurring cell suicide program. Other cells did not appear to be harmed by the drugs.
The authors conclude that less toxic types of vanadocenes may be a potential alternative to chemotherapy drugs currently used to treat testicular cancer. However, much more study is needed to determine if the drugs are safe and effective for humans, and if the drugs are "likely to cause impaired fertility," they note.
"We still need to study the feasibility of whether or not this treatment can be used in humans," D'Cruz told Reuters Health.
In about 90% of cases, the first signs of testicular cancer are a painless or uncomfortable lump on a testicle, or testicular enlargement or swelling. Men with testicular cancer often report a sensation of heaviness or aching in the lower abdomen or scrotum, according to the American Cancer Society. An estimated 6,900 cases are expected to be diagnosed in the US this year.
SOURCE: Toxicology and Applied Pharmacology
2000;166 by Keith Mulvihill www.healthanswers.com/Centers/Disease/NewsStory.asp?newsid=8298&id=testicular+cancer&parent=cancer
Testicular Cancer Likely to Be Cured, Even
When It Recurs
Armstrong is not alone in his victory, though. Even though the treatment may be arduous, winning against testicular cancer is becoming more common, both among world-class athletes and the guy on the street.
"My own experience with testicular cancer parallels Lance's," says Chris Brewer, spokesperson for the Lance Armstrong Foundation and founder of the Testicular Cancer Resource Center. Brewer tells WebMD, "For both of us, the disease had already spread by the time it was detected. But we have both responded well to treatment and are disease free, and are praying we stay that way."
Even if the unthinkable happens and testicular cancer returns for Brewer or Armstrong, there is still a better than 50% cure rate for recurrent disease, according to a paper published in the current issue of the Journal of Clinical Oncology.
"For patients who come to me for the first time and require chemotherapy to treat their disease, I tell them that there will be certain problems associated with their therapy, but life will quickly go back to normal," Lawrence Einhorn, MD, tells WebMD. "But even for patients who relapse I can look them in the eye and say with a great deal of confidence even though you weren't cured the first time we still have over a 50% chance we'll cure you this time." Einhorn is Distinguished Professor in the department of medicine, Indiana University Medical Center in Indianapolis, and the study's senior author.
Einhorn and colleagues reviewed the records of more than 60 men treated for recurrent testicular cancer with therapy using high-dose chemotherapy and bone marrow transplantation. "This approach is possible in testicular cancer because we can escalate the dosage of the drugs we use by five or six times the dosage normally given and see something significant," Einhorn says. "This is not possible with drugs used for other solid tumors, such as breast cancer."
But the high-dose chemotherapy kills many of the parent cells in the bone marrow, which are necessary to make both red and white blood cells. This requires that the bone marrow be repopulated with parent cells using a technique called bone marrow transplantation.
"The technology surrounding bone marrow transplantation has greatly improved," says Einhorn. "We look at three things: death from treatment, which did not occur in this study; long-term toxicity such as ringing in the ears or tingling in the hands and feet, which also did not occur; and short-term toxicity. We can tell patients, who are for the most part young men, 'Look, you're looking at a very tough six to eight weeks with a high probability of cure.'"
Although Einhorn is convinced that this treatment regimen offers the highest possibility of cure for men with recurrent testicular cancer, Bruce Roth, MD, is a little more cautious. Roth tells WebMD, "I don't think we can say yet that this is the standard regimen that ought to be followed when someone has recurrent testicular cancer. Even though bone marrow transplantation is much better than it used to be and we don't usually kill anybody anymore, it is still extremely difficult for the patient and is quite expensive. The burden of proof is on us to prove that it's better than standard therapy." Roth is professor of medicine and urologic oncology and section chief of solid tumors at Vanderbilt University in Nashville.
Both Roth and Einhorn call themselves quite optimistic about the outlook for men with testicular cancer. "How many solid tumors are there where you can say to the patient on day one, you have a 90% chance of cure?" says Roth. "With any other solid tumor we'd be thrilled to give those odds. One thing I think is necessary, however, is for men with the disease to be treated by someone who regularly deals with this tumor, not someone who sees one or two cases a year. It's really necessary to understand the disease process."
Einhorn agrees, saying, "I really do think that when you're dealing with a rare, curable disease there are subtle nuances in its treatment. Large, central academic medical centers with a great deal of experience offer advantages related to having an entire infrastructure in place to support treatment. This is why we're always going to do better."
Source: Greater Than 50% Cure Rate Reported in
Recurrent Disease By Elizabeth Tracey, MS. Reviewed by Dr. Gary D.
Survival High with Early Treatment
He had just finished working out. In the shower, he noticed his right testicle seemed enlarged.
"I thought I had strained something," says Knies, an insurance adjuster in Schwenksville, Pa. He was 23 and barely out of college at the time.
"I wasn't having any discomfort or symptoms to speak of," he says. "I was strong as ever, and there was nothing else to indicate a problem."
He mentioned the condition to his mother, a nurse, who urged him to see a urologist quickly. She suspected something more serious than a hernia was bothering her son.
His doctor determined the enlargement was cancer, and he removed Knies' right testicle, the standard first-line treatment for testicular tumors. Later, after tests showed that cancer may have spread to the lymph nodes deep within the abdomen where the testicles drain, doctors also removed the nodes.
But the lymph nodes were "clean," free of cancer, Knies says. It was the first sign that he probably was going to be OK, that his doctor likely had gotten all the cancer after removing the testicle. To make sure, a regimen of regular examinations followed--monthly at first, tapering off to annually after five years. Eleven years later, he still has a yearly exam but considers himself a cancer survivor.
Most Common Cancer in Young Men
Cancer of the testicles--egg-shaped sex glands in the scrotum that secrete male hormones and produce sperm--accounts for only about 1 percent of all cancers in men, according to the National Cancer Institute. About 7,000 Americans were expected to get the disease in 1995, with an estimated 325 deaths. Compared with prostate cancer, estimated to kill 40,400 of its 244,000 victims in 1995, testicular cancer is relatively rare. However, in men aged 15 to 34, it ranks as the most common cancer. For unknown reasons, the disease is about four times more common in white men than in black men.
Only 15 years ago, a diagnosis of testicular cancer was grim news. Ten times as many patients died then as now. But dramatic advances in therapeutic drugs in the last two decades, along with improved diagnostics and better tests to gauge the extent of the disease, have boosted survival rates remarkably. Now, testicular cancer often is completely curable, especially if found and treated early.
The Food and Drug Administration has approved several drugs to treat testicular cancer, including Ifex (ifosamide), Vepesid (etoposide), Velban (vinblastine sulfate), Blenoxane (bleomycin sulfate), and Platinol (cisplatin).
Many medical professionals regard Platinol as the "magic bullet" for treating certain forms of testicular cancer. FDA approved the platinum-based drug for use after surgery or radiation. Platinol almost always is used in combination with other chemotherapy drugs.
"[Platinum-based treatment] is truly the great success story for solid-tumor chemotherapy," says S. Bruce Malkowicz, M.D., co-director of urologic oncology at the University of Pennsylvania Medical Center. These drugs have helped cut testicular cancer's death rate and bolster its cure rate, he says, adding that many patients "respond very nicely" to platinum-based drug treatments, which are effective even when cancer has spread beyond the testicle.
"That is not a death sentence," Malkowicz says. About 70 percent of men with advanced testicular cancer can be cured, according to the National Cancer Institute.
Detection and Diagnosis
Most testicular tumors are discovered by patients themselves--either by accident, as Knies did, or while performing a self-examination on each testicle. "The usual presentation is of an enlarged, painless lump," says Malkowicz. "Occasionally there can be pain." The lump typically is pea-sized, but sometimes it might be as big as a marble or even an egg.
Besides lumps, if a man notices any other abnormality--an enlarged testicle, a feeling of heaviness or sudden collection of fluid in the scrotum, a dull ache in the lower abdomen or groin, or enlargement or tenderness of the breasts--he should discuss it with a physician right away. These symptoms can be caused by conditions other than cancer. But only a doctor can tell for sure, and it is critical to seek attention promptly.
Physicians have various methods to help diagnose testicular cancer. Often a physical exam can rule out disorders other than cancer. Imaging techniques can help indicate possible tumors. One such method is ultrasound, which creates a picture from echoes of high-frequency sound waves bounced off internal organs. Malkowicz calls this method "a painless, noninvasive way to check for a mass."
But the only positive way to identify a tumor is for a pathologist to examine a tissue sample under a microscope. Doctors obtain the tissue by removing the entire affected testicle through the groin, a procedure called inguinal orchiectomy. Surgeons do not cut through the scrotum or remove just a part of the testicle, because if cancer is present, a cut through the outer layer of the testicle may cause the disease to spread locally. Besides enabling diagnosis, testicle removal also can prevent further growth of the primary tumor.
Nearly all testicular tumors stem from germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. Other forms of testicular cancer, such as sarcomas or lymphomas, are extremely rare.
Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods. It was a seminoma that struck former Philadelphia Phillies first baseman John Kruk at age 33 in 1994. His right testicle was removed, and doctors say his prognosis is good.
Nonseminomas are a group of cancers that sometimes occur in combination, including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas. According to the American Cancer Society, 60 to 70 percent of patients with nonseminomas have cancer that has spread to the lymph nodes.
Physicians measure the extent of the disease by conducting tests that allow the doctor to categorize, or "stage," the disease. These staging tests include blood analyses, imaging techniques, and sometimes additional surgery. Staging allows the doctor to plan the most appropriate treatment for each patient.
There are three stages of testicular cancer:
Stage 1--Cancer confined to the testicle.
Stage 2--Disease spread to retroperitoneal lymph nodes, located in the rear of the body below the diaphragm, a muscular wall separating the chest cavity from the abdomen.
Stage 3--Cancer spread beyond the lymph nodes to remote sites in the body.
Through blood tests, doctors can check for tumor-associated markers, substances often present in abnormal amounts in cancer patients. Comparing levels of markers before and after surgical treatment helps doctors determine if cancer has spread beyond the testicles. Likewise, measuring marker levels before and after chemotherapy treatment can help show how well the chemotherapeutic drugs are working.
FDA has approved a test that checks blood levels of alpha-fetoprotein (AFP) as a tumor-associated marker. Other tests, such as those that gauge levels of beta-human chorionic gonadotropin (bHCG) or lactate dehydrogenase (LDH), are widely used as tumor-associated markers, but FDA has insufficient data to approve these tests.
Imaging techniques provide doctors with pictures of internal organs, giving visual clues to cancer staging. Chest x-rays can tell doctors if disease has spread to the lungs. Lymphangiography allows the lymph nodes to be visualized on an x-ray. CT scans create detailed views of cross sections of the body and can indicate possible tumors at various body sites.
Surgery to remove the retroperitoneal lymph nodes, into which the testicles drain, often is necessary for testicular cancer patients. Doctors examine lymph tissue microscopically to help determine the stage of the disease. Also, removing the tissue helps control further cancer spread.
No one treatment works for all testicular cancers. Seminomas and nonseminomas differ in their tendency to spread, their patterns of spread, and response to radiation therapy. Thus, they often require different treatment strategies, which doctors choose based on the type of tumor and the stage of disease.
Because they are slow growing and tend to stay localized, seminomas generally are diagnosed in stage 1 or 2. Treatment might be a combination of testicle removal, radiation, or chemotherapy. But surgical removal of lymph nodes usually is not necessary for seminoma patients because this type of tumor is what the University of Pennsylvania's Malkowicz calls "exquisitely sensitive" to radiation. Normally directed to the retroperitoneal lymph nodes but sometimes to other lymph nodes, radiation can effectively remove cancer cells there. Stage 3 seminomas are usually treated with multidrug chemotherapy.
Though most nonseminomas are not diagnosed at an early stage, cases confined to the testicle may need no further treatment other than testicle removal. These men must have careful follow-up for at least two years because about 10 percent of stage 1 patients have recurrences, which then are treated with chemotherapy. Stage 2 nonseminoma patients who have had testicle and lymph node removal may also need no further therapy. Some doctors opt for a short course of multidrug chemotherapy for stage 2 patients to reduce the risk of recurrence. Most stage 3 nonseminomas can be cured with drug combinations.
Any kind of cancer treatment can cause undesirable side effects. But not all patients react the same way or to the same degree. One of the main concerns of young men is how treatment might affect their sexual or reproductive capabilities.
Removing one testicle does not impair fertility or sexual function. The remaining testicle can produce sperm and hormones adequate for reproduction. Removal of the retroperitoneal lymph nodes usually does not affect the ability to have erections or orgasms. It can, however, disrupt the nerve pathways that control ejaculation, causing infertility.
Modern "nerve-sparing" surgical techniques have increased the odds of retaining fertility. Many surgeons are abandoning a "total scorched-earth policy where you take out every single lymph node," Malkowicz says.
"We now can limit the amount of dissection necessary to get a good therapeutic cure, but not overdissect to disrupt every bit of nerves," he says, adding that "ejaculation can be preserved" in as many as 80 percent of cases.
Testicular cancer patient Knies points to his twin sons as proof that though his reproductive capacity was temporarily lost, it was restored.
Chemotherapy can cause increased risk of infection, nausea or vomiting, and hair loss. Not all patients experience these. Some drugs may cause infertility, but studies have shown that many men recover fertility two to three years after therapy ends. Radiation patients may experience fatigue or lowered blood counts. Infertility may also occur, but this usually is temporary.
Doctors emphasize that even though the cure rate is very high for all types and stages of testicular cancer, many of the drastic measures taken to cure later-stage disease can be avoided if the tumor is caught early enough. The best way to do this is through regular self-examination, a message that Knies says might be difficult to convey to the prime risk group.
"You have a real sense when you're in your late teens and early 20s of invincibility," he says. "The last thing you're thinking then is that something can stop you. But as I know, it can."
Source: John Henkel is a staff writer for FDA
Male Fertility Problems Linked to
After several months of trying, the Baltimore-area couple sought medical help -- and learned that Tim had a low sperm count. In spite of this, Elizabeth became pregnant a few months later and eventually delivered a healthy baby girl.
When couples have infertility problems, it is usually the woman who first seeks help, but her partner may be tested as well. He is asked to provide a sample of semen, which is examined for certain characteristics that may indicate problems. Although many couples in which the man has such semen abnormalities will go on to conceive a child, some may end up with something else to worry about: A study recently published in the British Medical Journal shows that men with these abnormalities run a higher risk of developing testicular cancer and some abdominal cancers than other men.
"We are certainly not suggesting that every man with a semen abnormality needs to be aggressively screened for testicular cancer," says Rune Jacobsen, MS, the study's author. "But we do feel that this study points to an association between the two conditions, suggesting a common cause," perhaps something that happened while the man was still in his mother's womb. Jacobsen is a researcher at the Centre for Research in Health and Social Statistics, Danish National Research Foundation in Copenhagen.
It's not clear what kind of prenatal event might cause these conditions. But the idea that things that happen during pregnancy may affect the baby's life later is not new. Research on maternal consumption of alcohol, drug use, and cigarette smoking clearly shows that they affect the baby's health. Now research is starting to show a connection between more subtle events during pregnancy and the offspring's ultimate health.
Christopher Coe, PhD, professor of psychology at the University of Wisconsin, has been studying the effects of the intrauterine environment on offspring in rhesus monkeys. "We have been studying a 50-year-old colony of monkeys, encompassing five generations and more than 15,00 births, and have been examining systematically the effects of the mother's gestational experience on her offspring," he tells WebMD. "Such factors do indeed play a role in the size of the offspring, the age at which they reach puberty, their risk of pregnancy complications, and their ability to handle glucose [sugar]. All of these associations have also been suggested in humans.
"We're now starting to examine the effects of maternal nutrition and stress on the health of the offspring," Coe says. "We know the placenta isn't a perfect barrier, but the question remains, which factors are important and how long during pregnancy do they have a consequence? There appears to be some wisdom to our grandmothers' advice that, during pregnancy, a woman wants to be more careful and moderate her lifestyle."
The current study by Jacobsen and colleagues looked at the results of semen analysis in more than 30,000 Danish men, and correlated them with the development of various cancers. Men who had abnormal semen-analysis results were roughly twice as likely to develop testicular cancer. "We think this association may be due to a disruption in the mother's hormonal status during pregnancy," Jacobsen says. But researchers don't yet know what might cause such a disruption. "The next step is to study that association," Jacobsen says.
Right now, no one is suggesting that abnormal semen characteristics cause testicular cancer, since not all men with abnormal results will develop the disease, but Jacobsen does say that testicular cancer may be preceded by semen abnormalities.
"We see some interesting associations with semen abnormalities," Fady Sharara, MD, a reproductive endocrinologist with the Fertility and Reproductive Health Center in Arlington, Va. "or example, recently, a study reported such abnormalities in long distance truck drivers. My feeling is that such abnormalities arise from both a genetic component and an environmental one, and the hypothesis of a factor operating during pregnancy makes sense."
Whether or not they have semen abnormalities, experts say, men should do regular self-examinations for signs of testicular cancer. They should also see their doctor or a urologist if they have problems or questions about their risks.
For information about how to do a self-examination, see WebMD's article "Many Young Men Unaware of Importance of Testicular Exam."
Source: Study Finds Men with Semen Abnormalities
Have Greater Cancer Risk By Elizabeth Tracey, MS. Reviewed by Dr.
Pamela R. Yoder
Experts Raise Eyebrow at Link Between
Exercise in Teen Years and Testicular Cancer
The Canadian researchers, Anil Srivastava and Nancy Kreiger, MD, sent out a survey to more 200 men who had been diagnosed with testicular cancer and asked a number of questions relating to recreational exercise, occupational exercise, diet, marital status, years of schooling, household income, smoking habits, and height and weight. Out of this survey, the researchers found what appeared to be a significant associated risk between frequent moderate (more than five times a week) to strenuous recreational activity during the teen years and testicular cancer.
From their results, published in the current issue of the American Journal of Epidemiology, Srivastava and Kreiger theorize that this associated risk factor could possibly be due to several factors. They suggest a rise in hormone level during physical activity may have more of an effect on younger men than on older, or that testicular trauma associated with some sports such as cycling and horseback riding may cause the increase risk. Their final hypothesis is that muscle mass is associated with higher androgen (male sex hormone) production. They point to androgen levels in relation to prostate cancer for support.
"That hasn't been shown to be true for prostate cancer, so that is why I doubt this paper," says Joseph R. Wagner, MD, who reviewed the study for WebMD. Wagner is physician in charge of the urology/oncology department at Beth Israel Medical Center in New York.
Still, Srivastava and Kreiger conclude in their paper, "Important insights might also be gained from further investigation of the relation between hormone levels and physical activity, particularly with respect to frequency of exercise."
Wagner and Craig Nichols, MD, who was also asked to comment on the study, see major flaws in the study design.
"They just cast a broad net and something came out," Nichols explains. "Statistically that will happen if you ask enough questions -- something will be significant." Nichols is professor of medicine at Oregon Health Sciences University and a leading authority on testicular cancer.
Wagner says that a better-designed study might indeed give credence to the researchers' claim, but he feels that based on this study, high school athletes needn't cut back on activity.
"Are you going to tell all these young men not to exercise?" Wagner asks. "There's probably greater risk in that than for getting testicular cancer. The prevalence of [testicular cancer] is only 0.5 in 100,000."
The known risk factors for testicular cancer are undescended testicles and a family history of the disease. Too much exercise, on the other hand, is so far not supported by the body of medical literature, say Nichols and Wagner.
WebMD contacted Kreiger's office and was told that she would not comment on either the study or Nichols' and Wagner's comments.
A new study shows that there may be an association between frequent, moderate exercise during the teen-age years and the development of testicular cancer later in life.
Researchers claim that a rise in male hormone levels or testicular trauma could explain the increased risk.
Two outside experts question the design of the study, and say that young men should continue to exercise, since the absolute risk of testicular cancer is so low.
Source: Association Not Completely Dismissed, but
More Study Needed. By Candace Hoffmann
One Hung Low
A: Whether youre a lefty or a righty, relax. Having one testicle hang lower than the other one is not uncommon at all.
Now, about the pain you mentioned. Its most likely nothing; you probably knocked your nuts a bit playing basketball. But be careful -- any time you have pain in a testicle or feel a lump there, it should be checked out by a doctor.
Dont panic; there are lots of testicle problems that can be
easily fixed. Even testicular cancer is highly curable when caught
early. It isnt common, but it can start in your teens. Your
best bet is to have an examination. Your doctor can tell whats
causing it, and hell know what to do for treatment. Then, learn
how to do a self-exam every
month. Your life may depend upon it.
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