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Lance Armstrong, Scott Hamilton, Tom
Green. At first glance, they are an eclectic trio: the
seven-time Tour de France champion, the men’s
Olympic figure skating great, and the controversial
comedian. And yet, the men have a common bond: They
are all survivors of testicular cancer, a disease that
often occurs in younger men (the most common cancer
in men ages 15 to 34). The good news, as the three celebrities
mentioned above and many other men can attest, is that
testicular cancer is easily detectable and can be highly
curable.
Until Armstrong’s battle with
testicular cancer was made known, there was not much
public discussion of testicular cancer. Part of the
reason might have been that testicular cancer is not
a common condition. In the United States each year,
there are only about 7,600 new cases of testicular cancer
diagnosed, and about 400 men die from the disease. Possibly,
it was an uncomfortable subject for men to discuss before
an athlete of Armstrong’s stature shared his story.
And yet, it’s a
condition with which males even in their mid- to late
teens should be familiar. “As with other cancers,
early diagnosis of testicular cancer is very important,”
says Dr.
Mark Jordan, professor and chief, division of urology
at New Jersey Medical School and head of the urology
department at University Hospital, “and that is
more likely when men perform a monthly testicular self-exam
(TSE).” A man’s doctor can explain how to
perform a TSE, but generally speaking, it’s a
way to detect by touch any unusual painless lumps in
the testicles. In addition to lumps, the symptoms of
testicular cancer can include a sudden build-up of fluid
in the scrotum, dull achiness in the groin or lower
abdomen, pain in the testicle or scrotum or simply a
change in the way the testicle feels.
A family history of testicular cancer
increases a man’s likelihood of developing the
disease, which is more common in whites (particularly
those of Scandinavian descent) than in blacks, but another
important risk factor is that of having had an undescended
testicle.
“Usually, the testicles develop
in the fetus’s abdominal cavity and descend to
the scrotum before birth. When this does not occur with
one or both testicles, it is referred to as an undescended
testicle. Often, an undescended testicle will descend
on its own by the child’s first birthday, but
if it does not, it should be surgically corrected before
the child turns two,” says Dr. Jordan. Having
the operation, known as orchiopexy, at that young age
could reduce the risk that certain types of germ cell
tumors will develop in the testicles. Later in life,
having the testicles in their proper position can make
them easier to examine. Nonetheless, men who had an
undescended testicle that remained in the abdomen have
a 1 in 20 chance of developing testicular cancer, while
those whose undescended testicle was in the groin face
a 1 in 80 chance.
Treating the Cancer
A man whose testicular
self-examination raises questions or who has any of
the symptoms of testicular cancer described earlier
should see his doctor. If it’s warranted, the
physician will order a blood test to detect increased
levels of tumor markers including alpha-fetoprotein,
beta-human chorionic gonadotropin and lactate dehydrogenase.
An ultrasound can enable the doctor to confirm the presence
of a tumor. If a tumor is found, it’s generally
not advisable to perform a biopsy at this time, says
Dr. Jordan. “There’s only a very small chance
that the tumor is benign, and the concern is that cancer
cells will spread into the scrotum or lymph nodes as
a result of performing a biopsy,” he explains.
The next step in treating testicular
cancer is virtually always the same, regardless of the
type of testicular cancer the man has: removal of the
testicle. That may be an emotional issue for the man
to contend with at first, but from a health perspective,
it’s necessary and from a lifestyle view, it does
not make a man any less a man. “The removal of
a testicle does not interfere with masculinity,”
says Dr. Jordan. “There’s no loss of hair,
and the remaining testicle takes over the production
of testosterone and sperm.” That said, if a man’s
treatment plan for testicular cancer includes chemotherapy
and he would like to become a father, it’s highly
recommended that he “bank” sperm before
the testicle is removed.
After the testicle is
removed—a procedure known as radical inguinal
orchiectomy—the cells of the tumor can be examined
under a microscope. There are different types of testicular
cancer, and the specific type that the man has, in addition
to the stage the cancer is in, help to determine what
treatment he receives.
The overwhelming majority
of primary testicular cancer — more than 90 percent—originates
in sperm-forming cells known as germ cells. Germ cell
tumors fall into two general categories, seminomas and
nonseminomas, and can be classified even further. There
are other types of testicular cancer, such as testicular
lymphoma, which is a secondary cancer that originates
in other organs, travels to the testicles and is most
common in men over 50.
Seminomas account for
about 35 percent of all germ cell tumors, says Dr. Jordan,
and these slow-growing cancers often are diagnosed in
Stage 1, where the cancer still is confined to the testicle.
After removing the testicle, the usual treatment for
men with Stage 1 seminoma is a one-month course of radiation,
with five days of radiation therapy a week. “The
results for patients who have Stage 1 seminoma and undergo
the complete therapy are excellent—98 percent
are cancer free at five years,” says Dr. Jordan.
Ideally, testicular cancer is detected
and treatment is initiated when at an early stage. When
the cancer does spread beyond the testicle, it first
travels to the retroperitoneal lymph nodes in the abdomen
located below the diaphragm. In certain instances, these
lymph nodes are removed in a procedure called retroperitoneal
lymph node dissection. For example, a man who has Stage
II nonseminoma, a type of testicular cancer that is
more aggressive than seminoma, might be a candidate
for this procedure, possibly followed by chemotherapy.
“There are many
variables that the physician considers when planning
treatment for a man with testicular cancer, and the
course of treatment hinges on the type of cancer, and
if it has spread beyond the testicle,” says Dr.
Jordan. “We can be very successful in treating
testicular cancer, with many of the five-year cancer-free
rates in the 90 percentage range.”
Testicular cancer can end in a success story, but it
also can unfortunately spread to the lungs and other
organs and prove deadly. What men need to do for themselves,
says Dr. Jordan, is to learn and practice testicular
self-exam and see their doctor when there’s even
the slightest concern. “I can’t overemphasize
the importance of screening and self-exam,” says
Dr. Jordan. “Even when the diagnosis is testicular
cancer, it’s a disease that is very curable.”
To make an appointment with Dr.
Jordan or any of the other experts in the Division of
Urology, please call 973-972-4488.
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