Health: The serial killer still among us

The good news: doctors are learning how to beat testicular cancer. The bad news: there is more of it around than ever before.

Just 25 years ago, most men diagnosed with testicular cancer could expect to die. But now even tumours the size of grapefruit can disappear in 21 days, and patients doped with morphine can be taken off all painkillers and walk out of hospital within three days. Testicular cancer has proved to be exquisitely sensitive to new drug treatments, leading to a cure rate that already exceeds 95 per cent and continues to improve.

But there is a downside. The number of cases has doubled in the last 20 years - there are now almost 1,500 a year - and it has become the most common cancer among men aged 24-35.

Worryingly, most men also remain ignorant of the disease: one-third say they know "nothing at all" about it and less than one-fifth claim to know "a fair amount" or "a great deal", according to a recent Mori poll.

These problems, together with rising rates of prostate cancer (expected to become the most common cancer within the next 20 years), have led to a recent surge of interest in male cancers. This month, the Institute of Cancer Research launched a male cancer awareness month to focus attention on testicular and prostate cancers as well as to raise funds for a new research centre dedicated to male cancer.

Much of the research is focused on pinning down the causes. There are no obvious culprits, such as smoking or a high-fat diet, but there is a clear genetic predisposition; having a father or brother with the disease significantly increases the risk. (Some estimates suggest that up to one- third of all testicular cancers are caused by inheriting defective genes.) The Institute of Cancer Research, which is currently studying 100 affected families, believes identifying the relevant gene could not only help men at particular risk, but also provide insights into the genetic origins of many other cancers.

Discovering the genes that make testicular cancer peculiarly easy to treat could be especially significant. "Testis cancer is a tumour of the sperm cell, a cell that has protective mechanisms to make sure no genetic abnormality gets through to the next generation," explains Tim Oliver, professor of medical oncology at the Royal Hospitals Trust, London. Since chemotherapy appears to work by triggering existing self- destruct mechanisms in the sperm cell, finding a means of transferring the genes containing these mechanisms to other cancers might make them equally sensitive to chemotherapy and boost cure rates.

Men who have had an undescended testicle are much more likely to develop testicular cancer - the risk is one in 80, compared to an average risk of about one in 400.

But the failure of the testes to descend is not the real source of the problem; the most plausible theory is that undescended testes, testicular cancer and even the recently observed fall in sperm counts share a common cause: pollution of the environment.

It is a pregnant woman's exposure to pollutants that mimic the effects of oestrogen (including PCBs, dioxins and gases emitted by car exhausts) that could be damaging key testicular cells in a developing male foetus.

"There's a lower incidence of testis cancer among men taking regular exercise and an increased risk in those with a sedentary lifestyle, suggesting that heat in the testis is an emerging co-factor," adds Professor Oliver.

With the average person now watching over 26 hours of television a week, compared with 13 hours in the Sixties, the nation's long-term decline in physical activity could be producing side-effects beyond steadily increasing obesity levels.

Currently, the standard treatment for testicular cancer is removal of the affected testicle. In fact, excision of the testicle for biopsy is considered essential for a definitive diagnosis. This causes particular problems for men who have already lost one testicle, perhaps as the result of an accident.

Professor Oliver is investigating the use of a new semen test to detect cancer cells; if cancer is present, chemotherapy is then used as the sole treatment."We're going very cautiously with this approach since it leaves sperm cells behind and risks another tumour," says Professor Oliver. "I want to be certain men are cancer free for 5-10 years before this treatment is used more widely."

Despite recent advances, it remains essential for men to see their doctor as soon as they become aware of a problem.

"Young men expect to be in good health and some believe an abnormality in the testes will settle down on its own," says Alan Horwich, professor of radiology at the Institute of Cancer Research and the Royal Marsden Hospital, London.

"But the longer testicular cancer is left, the more likely it is to grow and spread around the body." Delay continues to be the main factor in the 130 deaths a year still caused by this disease.

For an information leaflet about testicular cancer, send an A5 SAE to Everyman, The Institute of Cancer Research, 17a Onslow Gardens, London SW73AL.

Case Study

Colin Osborne is a 35-year-old a lithographer who was diagnosed with testicular cancer.

I was leaning over a bench at work and as it pressed on my groin, I felt a pain in one of my testicles. I ignored it for a couple of days and then the same thing happened again. When I felt around, I found a hard, pea-sized lump on my left testicle.

"I wasn't all that concerned, but my wife said I should go the GP. He thought it was a cyst but wanted it checked out by a specialist. I had an ultrasound and, when I went back for the results, I could tell from the way the doctor was sitting that it was bad news. He told me I had cancer and I went into shock. That was probably the worst moment of my life.

"The testicle was removed a couple of days later and, although it was a major operation, I got over it fairly quickly. But then a blood test found high tumour marker levels and a CT scan found masses in my stomach. I was told I'd need a course of chemotherapy, but that I still had 97 per cent chance of surviving.

"After three or four courses of chemotherapy, I went into remission but then my tumour markers started to rise again. Tumours were found in my pelvis, abdomen and lungs and I began to think I wasn't going to get through this. At one point, my chances of surviving were down to about 20 per cent. It was then that I was put on a new drug, Taxol, which hadn't been used for this particular cancer before.

"Although I had a lot of side-effects - including septicaemia five times - another CT scan showed I'd turned the corner. But I still had to have a bone marrow transplant, following which I had a stroke and got diarrhoea like you'd never believe. I was in hospital for five weeks and was very weak. I could hardly stand up, let alone walk. Finally, I had to have an operation to remove the lymph nodes in my stomach.

"In all, my treatment lasted 18 months. I coped by trying not to take it too seriously. I don't know why my cancer was so severe - most men are more easily treated - but it's completely changed me. I value my life much more now, and there aren't enough hours in the day."