By Tom Weede

In the annals of sports history, Lance Armstrong’s comeback story ranks with the all-time greats. Diagnosed with testicular cancer in his mid-20s, the Texan went on to beat the disease and conquer the Tour de France—winning the ultimate cycling race seven times straight.

Out of Armstrong’s courage and high-profile status has come an increased awareness of the condition—something that no doubt has saved lives. “Men who think they may have the disease actually are coming in to their doctor earlier than they did in the past,” says UAB urologist Christopher Amling, M.D. “Because of this, testicular cancer is being found in earlier stages.”

And that’s fortunate, because the disease is very curable when caught early. “Testicular cancer is a model for how improved treatments can result in better outcomes for cancer patients,” Dr. Amling explains. “In the 1970s, only 60 percent to 70 percent of men survived when they were diagnosed with the disease. Today the survival rate is more than 95 percent.” What’s more, he adds, experts continue to refine the treatment options available—including surgery, chemotherapy and radiation therapy.

Still, while this form of cancer is so frequently curable, its rate in white males has more than doubled over the past 40 years, although the reason for this is unknown. More recently, the disease has started to increase among African-American men, according to the National Cancer Institute. Now there are about 8,250 new cases in the U.S. annually, typically striking males between the ages of 15 and 40. “It’s an uncommon cancer,” Dr. Amling says. “But for men who are in the 15-to-35 age bracket, it’s the most common cancer.”

Detection Details
Early detection not only makes treatment success more possible, it also allows doctors to possibly use less-aggressive treatment options with fewer side effects.

Usually, although not always, in early stages testicular cancer does not cause pain. “In general, there is a painless, hard mass of the testicle that’s detected on self-examination, or often sexual partners note it,” Dr. Amling says. “We advocate screening by self-examination on a regular basis, once or twice a month.” This can be done in a warm shower, when the scrotal tissue is more relaxed. Unfortunately, despite the increased attention to the disease, men can still often ignore a lump in their testicle for a long period of time before they see a doctor, he adds. “If you feel something abnormal, see your physician,” he says.

While symptoms can vary individually, other common indications for testicular cancer are:

• enlarged testicle
• feeling of heaviness in the scrotum
• dull ache in the lower abdomen, back or groin
• fluid collecting suddenly in the scrotum
• enlargement or tenderness of the breasts

In most cases, a mass in the area of the testicle is not cancerous, Dr. Amling says. “This is particularly so if the lesion that you’re feeling is outside of the testicular tissue itself,” he explains. “People often feel small cysts around the testicle, which are relatively common. These are called spermatoceles or epididymal cysts. They’re benign and don’t need to be removed.” This must be determined, however, by your doctor.

The cause of testicular cancer is unknown, and at this point prevention through diet or other lifestyle factors hasn’t been shown. But there are some factors that put a man at higher risk—these include:

• having an undescended testicle or an atrophic testicle (where the testicle is small and firm)
• having had testicular cancer in the past in one testicle
• certain occupations, including miners, gas workers, leather workers, food and beverage processing workers, and utility workers
• race and ethnicity—the testicular cancer rate is higher in Caucasians
• HIV infection
• having a mother who took the hormone DES (diethylstilbestrol) while pregnant

Even with risk factors, the chances of getting testicular cancer remain low. Also, most men who have the disease have none of the known risk factors.

Diagnosis and Treatment
In diagnosing the disease, doctors may conduct any of several tests in addition to a physical examination. An ultrasound, for example, creates an image of the internal organs through high-frequency sound waves. “If there’s any question at all on a physical exam as to whether disease may be present, we get an ultrasound,” Dr. Amling says. “This is one of the primary types of imaging studies that we use to assess for testicular cancer.”

Also, blood tests may be done to look for cancerous cells by analyzing certain proteins and enzymes in the blood.

If a tumor is found, treatment generally will depend on how localized or advanced the cancer is. Typically, with surgery called an orchiectomy, the testicle is removed to prevent the spread of the disease. “Some people have the misconception that your sexual function or libido is compromised with the loss of a testicle, but that’s not the case,” Dr. Amling explains. “Testosterone and other male hormones are maintained at normal levels.” A man can opt to have a prosthetic device replace the removed testicle for cosmetic purposes, either at the time of surgery or later.

Surgery also may be performed to remove lymph nodes in the abdomen (this may impact fertility by affecting ejaculation). Other treatment options could include radiation therapy, in which high-energy rays destroy cancer cells and reduce tumors. This affects sperm production, but many men recover their fertility in one to two years. Also, doctors may use chemotherapy after surgery or if the disease has spread to other places in the body. This involves circulating anticancer drugs in the bloodstream to kill cancer cells. Some of these drugs can impact sperm production, although again, many men recover.

Because of these potential impacts on fertility, it’s important for a man to talk with his doctor about how treatment might affect this. If a procedure will be used that may cause infertility or if a man has pre-existing problems with fertility, he may want to consider “banking” sperm in advance.

With the inspiring history of Lance Armstrong now the stuff of legend, the story of testicular cancer can be one of hope. As doctors continue to combine effective treatments and men become more aware of the need for early detection, advances against the disease become more and more possible.

For more information on the testicular cancer services available at UAB or to schedule an appointment, call UAB Cancer Answers at (205) 975-8222 or 1-800-UAB-0933. For more information about testicular cancer, visit our Web site at uabhealth.org/testicularcancer.

---

Care Close to Home
Urologic oncology services are now available close to home. UAB urologist Christopher Amling, M.D., is now seeing patients at The Kirklin Clinic^® at Acton Road. For more information, please call (205) 996-8765.

---

Looking for Answers
The UAB Cancer Answers Program provides free resources and information about cancer prevention, detection and treatment, as well as support for patients and loved ones. The benefits include subscriptions to ehealth magazine and the monthly Cancer Answers e-newsletter. You’ll also receive notice of upcoming seminars and screenings. You can find a membership form online at uabhealth.org/canceranswers or to request a membership brochure, call (205) 996-6000.