Testicular Cancer: Survival High with Early Treatment

by Food and Drug Administration (FDA)

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

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.

Besides lumps, if a man notices any other abnormality — an enlarged testicle, a feeling of heaviness or sudden collection of fluid in the scrotum, a dull ache in the lower abdomen or groin, or enlargement or tenderness of the breasts — he should discuss it with a physician right away. These symptoms can be caused by conditions other than cancer. But only a doctor can tell for sure, and it is critical to seek attention promptly.

Physicians have various methods to help diagnose testicular cancer. Often a physical exam can rule out disorders other than cancer. Imaging techniques can help indicate possible tumors. One such method is ultrasound, which creates a picture from echoes of high-frequency sound waves bounced off internal organs. Malkowicz calls this method "a painless, noninvasive way to check for a mass."

But the only positive way to identify a tumor is for a pathologist to examine a tissue sample under a microscope. Doctors obtain the tissue by removing the entire affected testicle through the groin, a procedure called inguinal orchiectomy. Surgeons do not cut through the scrotum or remove just a part of the testicle, because if cancer is present, a cut through the outer layer of the testicle may cause the disease to spread locally. Besides enabling diagnosis, testicle removal also can prevent further growth of the primary tumor.

Nearly all testicular tumors stem from germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. Other forms of testicular cancer, such as sarcomas or lymphomas, are extremely rare.

Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods. It was a seminoma that struck former Philadelphia Phillies first baseman John Kruk at age 33 in 1994. His right testicle was removed, and doctors say his prognosis is good.

Nonseminomas are a group of cancers that sometimes occur in combination, including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas. According to the American Cancer Society, 60 to 70 percent of patients with nonseminomas have cancer that has spread to the lymph nodes.

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