Testicular Cancer: Survival High with Early Treatment

Introduction

Glenn Knies wasn't thinking the worst when he felt the abnormality in his groin area 11 years ago. It was probably a hernia, he guessed.

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

[male anatomy] 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.



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