Testicular Cancer
The American Cancer Society estimates that in the year 2004 about 8,980 new cases of testicular cancer will be diagnosed in the United States. An estimated 360 men will die of testicular cancer in the year 2004.
In 2003, there were 7,600 new cases of testis cancer diagnosed in the US. There were 400 deaths from testis cancer in the US in 2003.
Testis cancer has a 95% overall 5-year survival rate. However, if the disease has already metastasized to a distant site outside of the testicles (like to the brain) when it is diagnosed, only 74% of patients survive 5 years.
Testicular cancer is the most common cancer in young men between the ages of 15 and 35 years old.
We also stress a healthy lifestyle including exercise, eating properly, periodic check-ups of blood pressure and cholesterol, and most importantly, smoking cessation.
from the desk of Dr. Lawrence Einhorn, Distinquished Professor of Medicine at Indiana University School of Medicine:
Dr.Lawrence H. Einhorn, M.D. Addresses Some Frequently Asked Questions
Taken from an interview with members of Friends-4Cures
Einhorn Honored For Career In Cancer Research
Q: Why do men still die of testis cancer?
A: About 5% of young men who are diagnosed with testicular cancer still die from their disease. This includes everyone who is diagnosed with testicular cancer.
Of those patients who require chemotherapy for metastatic disease, about 20% still die from their disease. The reason for this is several fold:
a)
Some patients present with such massive disease that it is not possible to cure them.
b)
Some patients have a biological form of disease where they have extensive teratoma or malignant transformation of teratoma. These are elements that do not go away with chemotherapy and if they are not capable of being surgically resected because of the extensive number or locations of teratoma deposits, it is not always possible to surgically cure these patients.
c)
There are still some patients that have seemingly good-risk disease and respond favorably to chemotherapy, but relapse after initial and salvage chemotherapy and ultimately die from their disease. The challenge is to find the molecular differences as well as the clinical differences in these patients and develop new strategies to try to get us close to 100% cure rate. I would like to emphasize the fact that prior to our studies here at Indiana University, only 5% of men with metastatic disease survived their disease and overall, only 50% of all patients were cured. The ones who were cured in these earlier days were the result of surgical cures in early stage disease. This still remains a major medical problem as the average age of our patients is 25 and the productive years of lost life for these young men is very substantial. Furthermore, advances that have been made in testicular cancer have had direct applicability for other tumors as well.
Q: What happens if there is a late life recurrence? Are the researchers at IU working on this problem?
A: At Indiana University, we were the first in the world to recognize the problem of late relapse. We recognized the clinical situation, recommended lifetime follow-up for all patients, and also elucidated the strategy for cure, which is primarily surgery rather than chemotherapy. Approximately 3% of patients will recur after being disease-free for 2 years and approximately 2% of patients will recur after 5 years. Recognizing this, and the fact that the best chance for cure is with surgery, we have developed the successful strategy for lifetime follow-up. Most late relapses are diagnosed on an annual evaluation, which reveals an elevated serum alphafetoprotein (AFP). This then eventually leads to CT scans, which (hopefully), will reveal a small, easily surgically resectable and surgically curable recurrence as a late relapse. Unfortunately, we do not yet have the answers as to why a very small percentage of men will develop a late relapse. We are in the process of doing elegant research in this area looking at a technique called DNA microarray. This allows us to take the tumor from patients who have a late relapse and simultaneously look at thousands of genes. We have early evidence that there is a particular cluster of abnormal genes associated with patients with late relapse. This might better allow us to pinpoint those patients that are destined to have late relapse, thus justifying more frequent follow-up in these patients. Also this will allow us to develop improved therapeutic strategy for this patient population as well.
Q: What have the researchers at IU done to improve “salvage chemotherapy”?
A: Salvage chemotherapy for testicular cancer was invented at Indiana University. When we did our original studies of cisplatin + vinblastine + bleomycin (PVB), we immediately turned metastatic testicular cancer from a disease that had a 95% probability of death within 1 year of diagnosis to a disease that then had a 60% cure rate with PVB. That also meant that at that time that 40% of patients with metastatic testicular cancer were not cured with their PVB. In 1978, over 25 years ago, we developed the first successful salvage chemotherapy with cisplatin + etoposide (VP-16). This cured 25% of the patients who were not cured with their original PVB. This was the first time that an adult solid tumor had ever been cured with any form of secondary or salvage chemotherapy. We next went on to develop the strategy of high dose chemotherapy (autologous bone marrow transplant). We are the world leader in this technology. We have also continued to develop new and novel agents for patients who failed to be cured with their initial therapies. Testicular cancer is unique as even second, third, or fourth line therapy still has a chance of curing metastatic disease.
Q: Are IU’s researchers working to lessen the long-term effects of surgeries used to treat testis cancer?
A: We have always been concerned about the long-term effects of therapy. Dr. John Donohue, our retired former Chief of the Department of Urology, developed and perfected nervesparing retroperitoneal lymph node dissections that allowed 99% of patients undergoing this type of surgery to be able to have normal fertility. Dr. Richard Foster has helped perfect improved surgical techniques. In the recent past, hospitalizations were 7-10 days with significant pain and discomfort and now the average hospitalization is 3-4 days with only minor postoperative discomfort.
Q: Are IU’s researchers working on decreasing long term effects of chemotherapy?
A: The best way to avoid long-term effects of chemotherapy is to reduce the dosages and duration of chemotherapy. We have done a series of clinical trials that have allowed us to accomplish that endeavor. We, and other investigators around the world, have chronicled both the acute and chronic toxicity of chemotherapy. However, close to 100% of our patients who are out beyond 5 years lead active, healthy, productive lives with no problems of any long-term effects. Perhaps our most dramatic example is Lance Armstrong! Nevertheless, we continue to observe our patients over the decades and continue to work to reduce side effects of all forms of treatment in this young patient population.
Finally, since we are often the only doctors seeing these young men,
we also stress a healthy lifestyle including exercise, eating properly, periodic check-ups of blood pressure and cholesterol, and most importantly, smoking cessation.
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