On Sunday, July 25, 1999, Lance Armstrong cycled along the Champs
Elysees in Paris to win the Tour de France. Less than three years
before, he learned that he had testicular cancer and, worse, that it
had spread to his brain, lungs and abdomen.
Without cisplatin, Lance Armstrong would never have ridden in the
Tour de France, much less won it. He would have died.
After Armstrong was diagnosed with cancer in October 1996, he
embarked on a tougher course than any he would ever experience in
cycling. He had two operations — one to remove the testis and the
other to remove the cancer metastases from the brain — and he
underwent intense combination chemotherapy based on cisplatin.
The Early Signs of Testicular Cancer
Lance Armstrong is not alone at age 27 as a young man with
testicular cancer. The great
ice
skater Scott Hamilton discovered he had the same disease early in
1997.
Testicular cancer is a potentially deadly disease. Although it
accounts for only 1% of all cancers in males, cancer of the testis
accounts for 11-13% of all cancer deaths of men between the ages of
15 and 35.
Testicular cancer has two peaks according to age. The first peak
occurs before the age of 45 and accounts for about 90% of cases of
testicular cancer. A second much smaller peak affects men over 50.
The first sign of testicular cancer is most commonly a little
(“pea-sized”) lump on the testis. There may be no real pain, at most
just a dull ache in the lower abdomen or groin, perhaps a sensation
of dragging and heaviness. To summarize the signs and symptoms of
cancer of the testicle, they include:
- A lump in or on a testicle;
- Any enlargement of a testicle;
- Shrinking of a testicle;
- A feeling of heaviness in the scrotum;
- A dull ache in the lower abdomen or in the groin;
- A collection of fluid in the scrotum;
- Pain or discomfort in a testicle or in the scrotum;
- Enlargement or tenderness of the breasts.
The best hope for early detection of testicular cancer is a simple
three-minute self-examination once a month. The ideal time for this
exam is after a warm bath or shower, when the scrotal skin is most
relaxed.
Each testicle is gently rolled between the thumb and fingers of
both hands. If any hard lumps or nodules are felt, the man should see
a doctor promptly. A lump may not be malignant, but only a doctor can
make the diagnosis.
Hope from Cisplatin
Cisplatin is a unique anti-cancer agent. It’s development
began
in the 1960’s, as it often did in those days, purely by accident.
During an experiment done to see what happens to bacteria in
electrical fields, it was noticed that the bacteria had stopped
multiplying. It seems they had been poisoned by something that was
leaching out of one of the electrodes used to create the electrical
field. The substance was identified as platinum.
Anything that can poison cells and keep them from growing holds
potential promise as a chemotherapy drug. Cisplatin (which contains
platinum) was tested against a diversity of tumors. Overall, it
proved of little long-term value, except it appeared astoundingly
successful against one particular type of tumor, testicular
cancer.
A regime that involved combinations of cisplatin with other
chemotherapy drugs was pioneered in the 1970’s by Dr. Lawrence
Einhorn
at Indiana University. Although the combinations were effective, they
were highly toxic. Many patients died or never fully recovered from
the effects of the therapy.
Over the years the ciplatinin-based combinations have been
refined. They now yield remarkable results. The current cure rate for
testicular cancer in all but the most advanced cases is in the
neighborhood of 95%.
Lance Armstrong had advanced disease with metastases to distant
sites. Given the facts of his case, his chances for a cure were
estimated at no better than 50%.
But then again, few would have predicted Armstrong would race a
bicycle again. In the Tour de France? And win it? Life is full of
wonderful surprises, including cisplatin.
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