Q: Why is testicular cancer here on the Sport Medicine Site?
A: There are two main reasons why testicular cancer should be discussed here. (1) As the most common cancer among young healthy males, it is rarely talked about, although early detection is the best way to combat it, and (2) as you may know, promising and successful cyclist Lance Armstrong is being treated for advanced testicular cancer.
Q: How common is testicular cancer?
A: Although testicular tumors are rare, there are about 2-3 new cases per 100,000 males in North America each year. For each male, this translates to a probability of about 0.2% of developing cancer of the testes in a lifetime.
Cancer of the testes is associated with cryptorchidism, or undescended testes. Thus, males with a testes that remains in the abdomen or groin are at a higher risk.
Q: Why is testicular cancer so difficult to detect?
A: In fact testicular cancer is not always hard to detect, but you do have to look for it. All males should examine their testes on a regular basis. Look for changes in the size of the testes, or for any bumps or irregularities. See your doctor quickly if something suspicious is present.
The most common symptom is painless swelling of the testes, usually occuring slowly over time. Nonetheless, in about 10% of cases the cancer is discovered incedently, with no apparent symptoms.
Q: How is testicular cancer treated? What is the chance of dying from this?
A: The first treatment will always be orchiectomy (removal of the testis). Following this, other treatment is usually necessary. For early cancers, orchiectomy followed by radiation treatment to the lymph nodes of the lower abdomen/back (retroperitoneal) will cure 95% of cases. For more advanced cancer, or for certain cancer cell types, chemotherapy may be necessary.
Survival rates for cancer of the testis have increased dramatically over the last several years with the development and refinement of chemotherapy. In general, overall, about 91% of males developing cancer of the testis will survive past the five year mark.
Early detection and treatment are the key to survival from this cancer. Spread to other organs of the body can mean much more difficult treatment and a poorer prognosis. There is a direct relationship between the length of time to medical attention and the chance of spread to other organs. The moral of the story: examine the testes often, and see your doctor immediately if anything suspicious appears.
Q: I have heard of athletes who die suddenly during sporting events. Is this common? What Causes it?
A: In general sudden death during college age athletes is not common, and occurs only to about 1/100 000 to 1/300 000 athletes. In general, most cases are caused by cardiac, or heart related, deaths. Males seem to be at a much higher risk. The most likely cause depends on age.
Among athletes younger than 35 years, about 40% of sudden deaths are caused by "Hypertrophic Cardiomyopathy". In this disease, certain areas of the heart have a muscle wall much thicker than normal, and this can lead to obstruction of the outflow tracts. This is usually a hereditary, or genetic, disease, and is not caused by exercise but rather exercise can bring out the symptoms. Of people with Hypertrophic Cardiomyopathy, about 2-4% will die of this disease as young adults. In general, people with Hypertrophic Cardiomyopathy are often advised to avoid all vigorous sporting activities. Anyone with this disease must consult a physician before partaking in any sports.
Among athletes older than 35 years, about 57% of sudden deaths are due to coronary artery disease or "heart attacks".
Unfortunatly, simple screening tests are not very good at predicting those at risk for sudden death. Although this is rare, it is obviously devestating.
Q: What causes penile numbness during cycling, and how can it be prevented.
A: An excellent study done in Cologne, Germany attempted to answer questions regarding penile numbness. The study showed that blood flow to the penis was significantly reduced in 70% of cyclists while pedaling in the seated position. If the cyclists continued to ride but this time standing on the pedals, the penile blood flow returned to normal. 61% of the cylists reported genital numbness and 19% of those cyclists who rode more than 400 km/week had reported erectile dysfunction. This study suggests that penile numbness is due to decreased blood flow to the penis because of compression of the penile artery. The authors suggest that cyclists experiencing penile numbness or erectile dysfunction should reduce training distance and stop frequently on long rides.