Lance armstrong testicular cancer

As Lance Armstrong crossed the finish line on the Champs Elysees in Paris to clinch a third consecutive victory at the 2001 Tour de France, the triumph was surpassed only by the defeat of a bigger competitor in the young athlete's life--testicular cancer.

In 1996, Amstrong began experiencing early warning signs of testicular cancer, but unfamiliar with the disease, the sportsman chalked up the symptoms as byproducts of his intense training regimen.

"Of course, I should have known that something was wrong with me. But athletes, especially cyclists, are in the business of denial," Armstrong writes in his bestseller, It's Not About the Bike. "Everything hurts. Your back hurts, your feet hurt, your hands hurt, your neck hurts, your legs hurt, and of course your butt hurts. So no, I didn't pay attention to the fact that I didn't feel well in 1996. When my right testicle became slightly swollen that winter, I told myself to live with it, because I assumed it was something I had done to myself on the bike, or that my system was compensating for some physiological male thing."

Six months later, Armstrong's symptoms worsened. Episodes of coughing up blood, brain-crushing headaches, blurred vision, and increasing testicular swelling finally prompted the 25-year-old to seek help from his physician. Within hours the champion's life changed forever.

After physical examination and x-rays, his physician delivered a stunning diagnosis--advanced testicular cancer--recommending surgery the following morning to remove his right testicle. Later consultations only confirmed the initial diagnosis in more alarming detail--the cancer, a rare and aggressive type called choriocarcinoma that is difficult to arrest, had spread to his lungs, abdomen, and brain. Follow-up tests revealed 40 tumors in his lungs and two in his brain.

"I was given less than a 40 percent chance of surviving," Lance wrote. "And frankly, some of my doctors were just being kind when they gave me those odds."

Armstrong became a student of testicular cancer, undertaking a crash course on the disease, reading books, articles, and scientific literature on the latest treatment strategies. One name that immediately surfaced was Dr. Larry Einhorn, who in 1974 pioneered the use of three chemotherapeutic agents that revolutionized the treatment of the disease and, in the process, saved thousands of lives. Discovering that the Indiana University Medical Center was the world's leader in treating testicular cancer, Armstrong phoned for an appointment and was scheduled for the following day. He then flew to Indiana to meet with Dr. Einhorn and his associate, Dr. Craig Nichols.

After surgery to remove the brain tumors and an intensive chemotherapy regimen, Armstrong's condition improved, as did his chances for survival. One year later, Armstrong attempted one of the most amazing comebacks in sports history, one few believed he could achieve.

Last October, Lance celebrated his five-year anniversary of surviving cancer. Now a passionate advocate for cancer research across the globe, the athlete is equally passionate about the men and women who helped him reenter the winner's circle and life, especially the team at the Indiana University School of Medicine.

To find out more about testicular cancer and the importance of early detection, the Post interviewed Dr. Lawrence Einhorn, distinguished professor of medicine at the Indiana University School of Medicine and former president of the American Society of Clinical Oncologists.

Q: Since the 1970s, the percentage of patients surviving testicular cancer has risen dramatically. What is the cure rate for testicular cancer today?

A: Thirty years ago, if you took every single patient with testicular cancer, about 50 percent of them survived their disease. Ninety percent of patients in whom the cancer had metastasized, or spread to distant parts of the body, died. Today, 95 percent of all patients with testicular cancer and 80 percent of patients with metastatic disease are cured.

Q: What an amazing reversal. How many cases of testicular cancer occur each year?

A: In the United States, there are 8,000 new cases annually.

Q: Has the incidence of the disease increased?

A: Yes. During the last couple of decades, the incidence has been steadily and clearly rising. Unlike prostate cancer, testicular cancer is still a rare disease; one man out of 400 gets testicular cancer in his lifetime.

Q: Do researchers know what is behind the increasing incidence?

A: No one knows why. Testicular cancer is among several cancers where the incidence is increasing and the reason why remains elusive.

Testicular cancer is a disease of young, healthy men who die rapidly if the disease goes undiagnosed. Left untreated, testicular cancer is not something that people live with for years and years.

Q: How are testicular cancers typically discovered?

A: Most of the time, the patient will experience symptoms such as a lump, mass, or fullness in one testicle compared to the other. Pain in the testicle, scrotal sac pain, or flank pain due to spread of the disease from the testes to lymph glands in the abdomen (causing back pain) are also symptoms of the disease.

Q: Champion cyclist Lance Armstrong has been very outspoken about testicular cancer. Have he and other athletes such as Scott Hamilton helped raise public awareness of the disease?

A: Absolutely. The situation is somewhat analogous to what occurred 30 years ago when Betty Ford and Happy Rockefeller went public about having breast cancer. Most men had never heard of testicular cancer. The fact that these well-known individuals have gone public and increased public awareness of this disease means that more men are going to be diagnosed at an earlier stage when less treatment is required, and the cure rate is almost universally 100 percent when caught early.

Q: When a lump is discovered on a testicle, does it always indicate testicular cancer, or can it indicate the presence of other conditions, such as epididymitis?

A: Most patients with an abnormality within the scrotum, or sac, will have a benign cause, such as epididymitis, rather than a malignant one. But you should not ignore any abnormality. If unsure of what you are feeling in the testicular area, you don't want to be your own doctor. Have a physician examine it to see if a problem exists. The physician will determine if an x-ray or a testicular ultrasound is necessary.

Q: During self-examination, what exactly are you looking for on the testicle, and where are lumps usually discovered?

A: Basically, when you feel a testicle, it is like feeling a clinched fist. The testicle will feel firm. As you run your fingertips along the surface of a clinched fist, you eventually hit the knuckle. You can feel a difference in consistency between the back of the hand or clinched fist versus feeling that knuckle behind the second, third or fourth finger. Basically, you are feeling to see if there is a nodule, lump, or bump inside the testicle itself.

Q: Besides a lump, what other symptoms accompany the disease?

A: Pain. But a person could have just a lump alone with no pain at all.

Q: So pain by itself is not necessarily a reliable symptom?

A: No. But if someone has testicular pain, you want to have a physician examine the testicle. If the testicle feels perfectly normal, there is no problem. But if something is there, it needs to be investigated further.

Q: Is testicular examination part of routine physical examinations?

A: It should be. But often it is not.

Q: Are other tests used to verify the diagnosis of testicular cancer?

A: If a physician suspects that something is going on in the testicle, testicular ultrasound is considered the gold standard for diagnosis. We would also order other blood tests, such as the human chorionic gonadotropin (HCG) and the alpha-fetoprotein (AFP), blood markers that help track the levels of various proteins that indicate how much cancer is in the body. These are not tests used to rule out the diagnosis of testicular cancer, because you can have testicular cancer and still have normal blood tests.

Q: In October, Lance Armstrong passed the five-year mark of being cancer-free. He noticed something was wrong six months before seeking medical attention. Did that delay cause problems?

A: Yes. When you delay responding to symptoms and arrive with more advanced disease, at best you require more aggressive and extensive therapy; at worst, you can die from the disease.

Q: Is his tremendous comeback unusual, or have treatments for testicular cancer progressed this far?

A: When Lance first sought medical attention with his advanced cancer, the extent of his disease was such that he basically was told he had a 50 percent chance of surviving the disease.

Q: Had Armstrong's cancer metastasized to his lungs?

A: Yes, as well as to the brain and abdominal lymph glands.