Testicular cancer among athletes raises awareness of the disease

Earlier this month, Olympic swimmer Eric Shanteau decided to defer treatment for testicular cancer until after his Olympic competition. Although no one can put themselves in another’s position, the ramifications of this decision could not be greater.

Shanteau’s delay could be life-threatening.

Several other well known athletes have fought testicular cancer, among them Mike Lowell, John Kruk, and Lance Armstrong. Fortunately, these three received treatment and were able to return to their sport, often reaching higher goals than in their pre-cancer careers.

Cancer of the testicles is rarely mentioned in public. In fact, Chicago Bears player Brian Piccolo, whose death became the subject of a popular book as well as the movie “Brian’s Song,” died after testicular cancer spread to his lungs. The movie never mentions the word “testicular.”

It is past time to put embarrassment aside and have a frank discussion about this serious topic.

Thankfully, open dialogue has aided in the tremendous strides made in fighting breast cancer in women of all ages. Breast self-examination has had a dramatic impact on early treatment and cure. The many displays of breast cancer awareness in the form of pink ribbons, charity walks, and other fundraisers have positively impacted this effort.

The statistics are astounding. Testicular cancer is the most common cancer in men between the ages of 15 and 34. Eight thousand new cases are reported each year. It is one of the most highly curable cancers, but can rapidly spread to the lymph nodes, lungs, bones, liver, and brain. This invasion of cancer cells dramatically increases the difficulty of achieving a cure.

There are two types of testicular cancer:

• Seminoma-this can occur in all age groups. It is the less aggressive of the two types and is more sensitive to radiation.
• Non-Seminoma-this is also called a “germ cell tumor.” It grows and spreads rapidly. This tumor is less sensitive to radiation and often requires chemotherapy.

Parents must be vigilant because the group with the highest risk of testicular cancer is children born with cryptorchid or undescended testes. These infants are at a significantly greater risk of developing testicular cancer later in life.

The only way to know the cell type of the tumor is by removal of the testicle (orchiectomy). This procedure is not only diagnostic but also therapeutic since the cancer source is removed. It allows oncologists (cancer specialists) to establish a treatment plan to attack the cancer.

Dr. George Bosl, Chairman of the Department of Medicine at Sloan-Kettering Memorial Cancer Center, is a medical oncologist and considered among the world’s experts in the treatment of testicular cancers. Although the overall cure rate for testicular cancer is 90%, Dr. Bosl references an article he published in a medical journal noting that after two months, the cure rate drops to 80% in non-seminomas.

“Men who note pain, swelling, or a nodule in a testis should get to a physician immediately,” Dr. Bosl urged. Self-examination is the best simple and direct way men can notice early testicular abnormalities.

Monthly testicular self-examination should include the following steps:

1. Perform the exam after a warm bath or shower, allowing the scrotum to relax and permitting a more thorough exam.
2. Stand in front of a mirror to look for swelling of the scrotum.
3. Roll each testicle with the index and middle digits on one side and the thumb on the other.
4. Make note of any palpable masses and report these to your doctor.

A physician will repeat the exam in the office and most likely order an ultrasound of the testicles. This test is not invasive and not painful. It gives a clear image of the testicle and determines if surgery is indicated.

Headline articles often prompt readers to personalize decisions made by those involved in the story. While many observers and medical experts doubt the wisdom of Shanteau’s decision to delay performance of a crucial diagnostic procedure, all support his quest for Olympic gold and, more importantly, the health battle ahead.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.