Cycling and Cisplatin

On Sunday, July 25, 1999, Lance Armstrong cycled along the Champs Elysees in Paris to win the Tour de France. Less than three years before, he learned that he had testicular cancer and, worse, that it had spread to his brain, lungs and abdomen.

Without cisplatin, Lance Armstrong would never have ridden in the Tour de France, much less won it. He would have died.

After Armstrong was diagnosed with cancer in October 1996, he embarked on a tougher course than any he would ever experience in cycling. He had two operations -- one to remove the testis and the other to remove the cancer metastases from the brain -- and he underwent intense combination chemotherapy based on cisplatin.

The Early Signs of Testicular Cancer

Lance Armstrong is not alone at age 27 as a young man with testicular cancer. The great ice skater Scott Hamilton discovered he had the same disease early in 1997.

Testicular cancer is a potentially deadly disease. Although it accounts for only 1% of all cancers in males, cancer of the testis accounts for 11-13% of all cancer deaths of men between the ages of 15 and 35.

Testicular cancer has two peaks according to age. The first peak occurs before the age of 45 and accounts for about 90% of cases of testicular cancer. A second much smaller peak affects men over 50.

The first sign of testicular cancer is most commonly a little ("pea-sized") lump on the testis. There may be no real pain, at most just a dull ache in the lower abdomen or groin, perhaps a sensation of dragging and heaviness. To summarize the signs and symptoms of cancer of the testicle, they include:

  • A lump in or on a testicle;
  • Any enlargement of a testicle;
  • Shrinking of a testicle;
  • A feeling of heaviness in the scrotum;
  • A dull ache in the lower abdomen or in the groin;
  • A collection of fluid in the scrotum;
  • Pain or discomfort in a testicle or in the scrotum;
  • Enlargement or tenderness of the breasts.

The best hope for early detection of testicular cancer is a simple three-minute self-examination once a month. The ideal time for this exam is after a warm bath or shower, when the scrotal skin is most relaxed.

Each testicle is gently rolled between the thumb and fingers of both hands. If any hard lumps or nodules are felt, the man should see a doctor promptly. A lump may not be malignant, but only a doctor can make the diagnosis.

Hope from Cisplatin

Cisplatin is a unique anti-cancer agent. It's development began in the 1960's, as it often did in those days, purely by accident. During an experiment done to see what happens to bacteria in electrical fields, it was noticed that the bacteria had stopped multiplying. It seems they had been poisoned by something that was leaching out of one of the electrodes used to create the electrical field. The substance was identified as platinum.

Anything that can poison cells and keep them from growing holds potential promise as a chemotherapy drug. Cisplatin (which contains platinum) was tested against a diversity of tumors. Overall, it proved of little long-term value, except it appeared astoundingly successful against one particular type of tumor, testicular cancer.

A regime that involved combinations of cisplatin with other chemotherapy drugs was pioneered in the 1970's by Dr. Lawrence Einhorn at Indiana University. Although the combinations were effective, they were highly toxic. Many patients died or never fully recovered from the effects of the therapy.

Over the years the ciplatinin-based combinations have been refined. They now yield remarkable results. The current cure rate for testicular cancer in all but the most advanced cases is in the neighborhood of 95%.

Lance Armstrong had advanced disease with metastases to distant sites. Given the facts of his case, his chances for a cure were estimated at no better than 50%.

But then again, few would have predicted Armstrong would race a bicycle again. In the Tour de France? And win it? Life is full of wonderful surprises, including cisplatin.

For more information, visit MedicineNet's Disease and Treatment Forum on Testicular Cancer.

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