Curable. often ignored
By Bob Calandra
Dec. 18, 2000 -- The strange, heavy feeling in Jacob Nass' lower stomach started about two years ago. At first he assumed it was a hernia. But while vacationing in the Cayman Islands, he went diving and felt a sharp pain, like someone had just kicked him in the groin.
When the newly married Nass got home, he went to see his doctor. Three weeks and several tests later, doctors at Fox Chase Cancer Center in Philadelphia told him the bad news: He had a particularly aggressive form of testicular cancer.
"I was shocked," says Nass, 29. "You envision yourself as a healthy person, and to find that you have something life-threatening kind of throws you a curve."
It's a curve that 6,900 men each year don't see coming, according to the American Cancer Society (ACS). And while that number ranks the testicular type among the rarest forms of cancer, it remains the most common malignancy in young men aged 15 to 35.
Egg-shaped, the testicles are sex glands in the scrotum that secrete male hormones and produce sperm. As late as the 1980s, a diagnosis of testicular cancer was grim news for a young man. But over the years, advances in chemotherapy and other treatments have dramatically reduced the number of deaths from this killer. Notable survivors include world-class athletes like two-time Tour de France winner Lance Armstrong and Olympic gold medallist ice skater Scott Hamilton, and comedian Tom Green, who chose to chronicle his treatment experience for the potentially affected age-group -- including the surgical removal of a testicle -- on his MTV program.
Cases of testicular cancer worldwide had been on the rise for about the past three decades, according to the ACS. Today, however, researchers are split on whether those numbers are continuing to grow.
"There has been some consensus that the number of cases is on a worldwide increase," Uzzo tells WebMD. "[But] I don't think there is definitive [evidence] to suggest that that is true."
The reason for the continued increase -- if indeed it real -- is the subject of debate as well. Some have even pointed to global warming as a possible cause. Uzzo points out, however, "I don't think anyone is convinced that there is a definite [increase] that can be attributed to global warming,"
Doctors also aren't completely sure why testicular cancer fancies young men. Some believe the rapidly dividing sperm and testicular cells of men in their sexual prime may result in cellular mistakes that become cancerous.
What doctors do know is that a man born with an undescended testicle (one that remains in the abdomen rather than ending up in the scrotum during fetal development) appears to have a significantly greater chance of testicular cancer, even if the flaw is surgically repaired.
"Those testicles that don't descend seem to be predisposed for testicular cancer later in life," says Uzzo, adding that not every man born with the condition will develop testicular cancer. "It gives us the idea that these testicles are predisposed."
Testicular cancer usually manifests itself as a painless swelling or a mass in the affected testicle. A man also may experience a dull ache or the heavy feeling in the lower stomach, scrotum, or groin area, similar to what Nass experienced. Treatment depends upon whether the disease has migrated to other parts of the body.
"The first thing to do is remove the testicle and then stage the patient with a chest X-ray and CAT scan to see if the cancer has spread," Uzzo says.
To determine if lymph nodes are involved, surgery may be required to remove them. The good news is that tumor cells are very sensitive to chemotherapy and radiation, primarily because they divide and multiply so quickly. That means that nearly all -- even advanced --testicular cancer is curable.
The ACS reports that the cure rate for disease that is detected early is approaching 100%, and 90% for testicular cancer of all stages (degrees of spread) combined.
"It is one of the most eminently treatable types of cancers we have," Uzzo says.
The case of Lance Armstrong is a good example. In 1996, the world-class cyclist ignored early symptoms, including groin soreness. Before long, however, he was suffering headaches, blurry vision, and coughing up blood. A visit to his doctor revealed that testicular cancer had spread throughout his body, including to his brain. Doctors gave the elite athlete only a 50/50 chance of survival.
Nevertheless, he underwent an aggressive course of treatment: surgery to remove the affected testicle and to debulk tumors in his brain, and chemotherapy. A year later, Armstrong was pronounced cancer free.
Uzzo and others hope celebrity cases will not only alert young men about testicular cancer but also convince them to begin performing self-examination so they are familiar with the size and feeling of their testicles and will be more likely to detect subtle, early changes. But if a study done at the University of Hiddersfield in England and appearing in the September 1999 issue of the European Journal of Cancer Care is any measure, most men still don't know much about the signs, symptoms, or risks of this cancer.
In the study, researchers found that an overwhelming majority of the 203 male undergraduate and postgraduate students (20 to 45 years old) interviewed about testicular cancer either were uninformed or misinformed about the disease. More worrisome to researchers was the fact that only one man in the study group knew how to properly perform a testicular self-exam and actively practiced the procedure.
Today, "I think there is an increased awareness because of the high profile cases," Uzzo says.
With cure rates so high, attention is now being directed to improving treatments. Specifically, doctors would like to find ways of minimizing risks to a patient's fertility. A position paper by the National Cancer Institute indicates that many (though not all) of those undergoing chemotherapy can sufficiently recover sperm production to allow a patient to father a child. Similarly, radiation treatment for spread of certain types of testicular cancer can cause fertility problems because of radiation spillover to the remaining (normal) testicle, but again, this may resolve in some patients. Fortunately, in both circumstances, if fertility recovers, there appears to be no increased risk of birth defects as a result.
Of course, there is no way to predict in advance who might be infertile. "Any cure can affect fertility," says Uzzo, noting that most patients bank their sperm before undergoing treatment. "While the No. 1 goal is to cure the patient of the disease, we are now concentrating our efforts on decreasing the morbidity of the types of treatment offered on fertility and minimizing any [problems] associated with chemotherapy."
Nass chose to have a child prior to having surgery, two rounds of chemotherapy, and radiation to cure his cancer. A year after the treatment, he's fully recovered but no closer to knowing why he became ill.
"The doctors told me that in my case there is no direct cause," says Nass, father of a baby boy.
Nass says all he wants to do now is focus on the future and on making others aware of the dangers of testicular cancer.
"It was the hand that I got dealt," he says. "I look at me now as an advocate for this cause. I definitely will continue to advocate awareness."
Bob Calandra is a freelance writer whose work has appeared in several magazines including People and Life. He lives in Glenside, Pa.
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