A physical exam and ultrasound revealed a tumor in his right testicle. "I'm not going to see my kids grow up," thought Brewer, now 36, an Internet designer with the US Air Force. "I'm facing my mortality much too soon."

Brewer is among a small percentage of men who have been diagnosed with testicular cancer. The American Cancer Society (ACS) estimated about 7,600 new cases of testicular cancer would be reported in the US in 1998. An estimated 400 men will die from the disease this year.

Although testicular cancer is rare, it is the most common cancer among American men ages 15 to 35 years old. What Brewer did not know at the time was that the odds were on his side. Testicular cancer is a highly treatable form of cancer, with a cure rate exceeding 90 percent. If caught early, approximately 95 percent of the cases of testicular cancer are eventually cured.

"There is no stage in which we don't have optimism that we can cure the disease," said Craig Nichols, MD, professor of medicine and chairman of hematology and oncology at Oregon Health Sciences University.

Testicular cancer risk has more than doubled among white Americans in the past 40 years, but has remained virtually the same for African-Americans. White men have a risk for testicular cancer that is about four times higher than that of African-American men. The reasons for these differences are unknown.

More than 90 percent of testicular cancers develop in "germ cells" or seed cells, which help produce sperm. There are two types of germ cell tumors in men: seminomas and nonseminomas.

About half of all testicle germ cell cancers are seminomas. Typical seminomas are the most common and are usually found in men between the ages of 30 and 60. Ten percent of seminoma tumors are spermatocytic, which grow very slowly and do not spread to other parts of the body. These are usually found in older men.

Nonseminomas tend to develop early in life, usually occurring in men in their 20s. The main types of nonseminoma germ cell cancers are embryonal carcinomas, yolk sac carcinoma, choriocarcinoma; and teratomas. Some testicular cancers are combinations of two or more of these types.

Who is at risk?

One risk factor is a history of one or both the testicles failing to drop into the scrotum properly before reaching school age, a condition known as cryptorchidism. A family history of testicular cancer and a patient's own history of testicular cancer are also risk factors.

Still, these risk factors are not as clearly associated with testicular cancer as risk factors linked to other types of cancer, such as smoking and lung cancer; or prolonged, unprotected exposure to sunlight, and skin cancer. In fact, many men who develop testicular cancer do not exhibit any risk factors.

For most men, the clearest symptoms of testicular cancer are changes in the testicles, including one being larger or firmer than the other, said Gabriel Feldman, MD, director of prostate and colorectal cancer for the ACS. Men normally detect these changes if they regularly perform self-examination.

Brewer, like many men, did not exhibit the usual risk factors. But he was one of the few testicular cancer patients whose symptoms included pain. The absence of pain should not be regarded as a sign of non-cancerous growth.

"Whether there is pain or not, a change in the size or consistency of a man's testicles is a reason to go see the doctor," said Dr. Feldman.

Treatment

In order to remove the cancer from the testicles, surgeons may remove the entire testicle if the tumor develops in the spermatic cord. The spermatic cord contains the blood and lymph vessels that may act as a pathway for cancer to spread to other parts of the body from the testicle. Surgeons remove the tissue through an incision in the inguinal canal. In addition to surgery, radiation or chemotherapy may be necessary.

There are several drugs used to treat testicular cancer, including Ifex (ifosamide), Vepesid (etoposide), Velban (vinblastine sulfate), Blenoxane (bleomycin sulfate), and Platinol (cisplatin).

As with any treatment that requires surgery, there are some risks. Patients should ask about their reproductive capabilities and sexual function before having testicular cancer surgery. Because surgery may require the removal of a testicle, there is a chance for diminished or lost fertility, but there is no risk to normal sexual function, said Dr. Nichols. "Occasionally, dry ejaculation is associated with the surgery," Dr. Nichols added.

Brewer underwent six weeks of chemotherapy after surgery and boasts a complete recovery. "Attitude makes a big difference,"he said. "I kept a positive attitude. I would not let myself get down."

Testicular Cancer