A winner with testicular cancer - A shinning example of the progress in medical cancer treatment

By professor dr. med. Mikael Roerth; speciality in oncology

The last three years, the tough bike race Tour de France, has been won by the American Lance Armstrong. Armstrong’s victories have been convincing and commanded great respect.

It is even more impressive, when you consider that a few years ago, Lance Armstrong was diagnosed with testicular cancer, which spread to liver, lung and brain. He underwent intensive treatment with cytostatica – a treatment, which cured him of the disease, but naturally also left him physically weak.

The fact that one can recover to such an extent, that one can win one of the world’s toughest sporting events after such an intensive treatment Lance Armstrong went through, is a shinning example of the progress in medical cancer treatment in the last 20 to 30 years.

The effective medical treatment of testicular cancer began in the USA in the mid 1970’s, and it is now the reason that more than 95% of the patients with testicular cancer are cured. The reason for the breakthrough is first and foremost the discovery of the drug Cisplatin and the excellent results from using this drug together with surgery and radiation treatment.

A lump with young men
Testicular cancer usually shows itself as a lump with otherwise healthy young men, and the treatment is primarily removal of the testicle with the lump. If the consequent examinations do not show signs of spreading, the strategy in most countries is post-examining patients and treatment if the disease turns up again. Through the utilisation of this strategy, we have not had any deaths by testicular cancer in Denmark in the past 20 years.

If the disease has spread, it is necessary to combine the tumour removal with chemotherapy or in some cases with radiation treatment.

Many cases in Denmark
Testicular cancer is a rare disease; however, it is, in our part of the world, the most frequent cancer disease with men between 15 and 40 years old. The disease is especially frequent in Denmark, around 300 cases a year. The frequency has gone up from 60 in 1943 when registration began.

We have no definite explanation for the high number of cases in Denmark, and why the frequency has increased, but a large increase can only be explained through external conditions. Exogenous factors are crucial for the development of the disease.

Testicular cancer is always preceded by a preliminary stage called carcinoma in situ. This preliminary stage can be discovered very early, and have been in testicular biopsies taken right after birth, with persons known to be at great risk of developing testicular cancer. A fair amount of research seems to indicate that the primary damage of cells turning into testicular cancer takes place very early in the foetus – maybe as soon as the first months. The damaged cells do not turn into tumours until puberty or later, when the tissue is exposed to hormonal influence.

Uncertain causes
To determine which exogenous factors the early foetus, meaning the mother, has been exposed to is difficult, and it has not been possible to pinpoint such factors.

An interesting observation is that there has been less testicular cancer in people born during the Second World War than with people born both before and after. This could indicate that the negative effect on the testicles in the foetus stage was less dominant during the War. Naturally, tobacco has been a point of interest, but it has not been possible to establish that smoking plays a role in the development of testicular cancer. A series of indirect observations would rather indicate that different chemicals with biological effects just like the female hormone (oestrogen) could play a part in developing the pre-stages of testicular cancer.

Only recently something close to a model for the development of testicular cancer has been developed, and it is expected that such models and modern molecular technological tools will be able to provide us with knowledge, which will teach us more about the development of this disease. The expectation is that such knowledge will improve prevention, and that a better understanding of the process can be used in the fight against other cancer diseases.