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Release: Aug. 13, 1999

Early diagnosis is key to treating testicular cancer

IOWA CITY, Iowa -- American cyclist Lance Armstrong has proven that testicular cancer survivors are champions. With his recent victory in the Tour de France, Armstrong's story has brought public attention and helped spread the word about a disease that is the most common type of cancer affecting young men between the ages of 15 and 40.

While the facts about testicular cancer indicate how rare it is, and how successful doctors have been in treating it, the disease is often misperceived and misunderstood. Between 5,500 and 6,000 cases of testicular cancer are reported annually, giving males a 0.2 percent chance of developing it, according to Richard D. Williams, M.D., Ruben H. Flocks Chair and head of the University of Iowa department of urology.

The cause of testicular cancer is not known for certain. One possible source is linked to the hormone diethylstilbestrol (DES), which many women took during pregnancy to prevent miscarriages. Males whose mothers used DES have increased susceptibility to testicular cancer. Similarly, men who are born with one or both of the testicles undescended (not in the scrotum), have a 20 to 40 times increased chance of developing the disease. However, there is little evidence to conclude that genetics play a role in the occurrence of testicular cancer.

There are five types of testicular cancer and three phases of its development. Men with early stage seminoma, the most common type of testicular cancer, are easiest to treat because the cancer cells are localized for long periods of time. For patients in phase I, the cancer is confined to the testicle; in phase II the cancer can spread to the retroperitoneal lymph nodes just behind the abdomen and in phase III the cancer spreads to remote parts of the body such as the lungs or brain.

In many ways treatment of testicular cancer begins with the patient, since early detection is crucial to ensuring a positive outcome. Williams, who is also a urologic oncologist at the UI Cancer Center, stresses the importance of regular self-exams so that warning signs of testicular cancer are not overlooked.

"It is extremely important that men do monthly self-exams and learn how to do them correctly," Williams said. "An early diagnosis is very helpful."

Testicular cancer symptoms include enlargement in the breasts, a feeling of heaviness in the scrotum or the presence of a lump in either testicle. Medical advancements achieved in the past 20 years have brought good news to testicular cancer patients, who have more than a 90 percent chance of survival after treatment.

"This cancer is a success story in terms of determining new treatments and then applying them," said Williams, who has been a practicing urologist for 25 years. "We've learned how the cancer is spread, how to determine if it has spread and then how to treat it very effectively. Now that we've been so successful in treating cancer, we're learning about new treatment methods with decreased side effects. Every cancer should have such a good story."

The first step in the healing process begins with a visit to the doctor, an examination of the testicles and blood marker studies, followed by an ultrasound to determine if any mass felt by the doctor is typical of a tumor. If a tumor is present, the affected testicle is surgically removed in an outpatient procedure that may require an overnight stay in the hospital.

Once the pathologic diagnosis is returned, diagnostic imaging studies -- including a CAT scan of the abdomen and a chest X-ray -- are done to determine the extent of the cancer. In addition, blood marker studies are repeated to help in assessing the stage of the disease. Therapies are developed in accordance with the patient's level of testicular cancer and the advancement of the disease. If the cancer has spread beyond the testicle, surgery may be performed on the lymph nodes behind the abdomen to determine if they are cancerous.

In seminoma cases, radiation treatments to the retroperitoneal lymph nodes may be done instead of surgery. If the lymph nodes removed during surgery are positive for cancer, if they are markedly enlarged on the CAT scan or if there is evidence of cancer in the lungs or elsewhere in the body, chemotherapy treatment most likely will be used instead of surgery or radiation.

Williams said that chemotherapy is a superb treatment for testicular cancer, but at a price. The toxicity of the treatment causes long-term infertility, but in William's view this is one of the few "dark clouds" patients must face after treatment.

"People should understand that this disease is not a death sentence; the prognosis is now excellent. The real issue is getting diagnosed early," Williams said.

For more information about testicular cancer screening and treatment options, call the UI Cancer Information Service at 1-800-237-1225.