Testicular cancer is the most common malignancy to affect men in the 18-40 years age group and affects about 1 in 250 men.
Typically presenting with a lump in the testicle, the disease can spread rapidly through the blood and lymph system to other parts of the body, particularly the lungs.
In such cases the disease used to be fatal until the development of successful chemotherapy in the 1970’s. The introduction of a chemotherapy drug known as cisplatinum, however, transformed the cure rate of the disease and is one of the notable successes in the development of chemotherapy for cancer.
Today more than 95% of men are cured of testicular cancer, even when the disease has spread to other sites of the body. The cyclist, Lance Armstrong, is perhaps the most famous testicular cancer survivor who, despite spread of testicular cancer to his lungs and brain, was cured by chemotherapy and went on to win the Tour de France Cycle Race six times.
At Weston Park we see approximately 70 men a year with testicular cancer from Sheffield, Doncaster, Barnsley, Chesterfield and Rotherham. All patients attend a specialist clinic run by Professor Coleman and Dr Hatton. Over the last 15 years the proportion presenting with advanced widespread disease has steadily fallen as men become more aware of the condition and less embarrassed to seek help from the healthcare system.
Many patients only require a single course of out-patient chemotherapy or a short course of radiotherapy to prevent spread of the disease. Nevertheless some 20 patients a year will have obvious spread of cancer and require a course of chemotherapy. This will typically involve 3-8 cycles of treatment given as an inpatient and causes hair loss, tiredness and sickness as well as susceptibility to infection.
The main thrust of research has shifted from developing effective chemotherapy to minimising the amount of treatment required to cure these men and try to prevent, identify and treat any complications of therapy.
Over recent years the number of courses of chemotherapy that most men need to receive has steadily fallen, making the treatment much more tolerable and with less of an impact on quality of life, work, family and careers.
Here in Sheffield we are particularly interested in the long-term consequences of treatment and have ongoing studies looking at the effects of chemotherapy on bone health, male hormone levels and sexual function.
Additionally we are aiming to re-design the clinical service to enable effective and efficient long-term follow-up for men so that their physical, psychological and socio-economic needs can be addressed in an appropriate long-term fashion.
Today, looking after the survivors is in many ways a greater challenge than dealing with the disease in the first place.
