Testicular Cancer Survivors at Risk for Other Cancers

While testicular cancer cure rates rank high, new research shows that successfully treated patients aren’t necessarily out of the woods.

In the largest and longest follow-up study of men treated for testicular cancer ever published, survivors were found to have an increased risk for developing malignant tumors in other parts of their bodies for at least 35 years after treatment.

The risk for a 10-year survivor diagnosed at age 35, for example, was nearly twice that of the general population.

Just over three decades ago, nine out of 10 men with testicular cancer died from the disease, while today almost all patients survive.

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Testicular cancer is a disease of the young, with most men diagnosed in their 20s and early 30s.

In the years since this malignancy became largely curable, secondary cancers occurring in other parts of the body have emerged as a leading cause of death among testicular cancer survivors.

Researchers say it is the late effects of chemotherapy and radiation treatments that have saved so many lives that are mainly to blame for these malignancies in survivors.

In an effort to better understand the risks to survivors, researchers examined cancer registries from the United States and Europe. The study included long-term health and survival data from 40,576 testicular cancer survivors.

A total of 2,285 nontesticular tumors were reported among the survivors anywhere from a year to more than 35 years after their cancer treatment.

The risk of developing any cancer over 40 years, in a man with testicular cancer at age 35, was between 31 percent and 36 percent, compared with 23 percent for the general population.

The risk of developing another cancer was higher for men diagnosed with testicular cancer at younger ages and lower for those diagnosed later in life. And the risk was slightly higher for men treated with radiation and chemotherapy, versus chemotherapy or radiation treatment alone.

Cancers of the bladder, colon, lung, pancreas, and stomach accounted for 60% of the secondary cancers in testicular cancer survivors.

The study was led by researchers from the National Cancer Institute and published in the Sept. 21 issue of the Journal of the National Cancer Institute.

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It was not clear from the study how big a role treatment played in emergence of these other cancers. Although radiation treatment doses have been decreased, bladder, stomach, and pancreatic cancers have been associated with radiation treatment in past studies.

The authors say given the modification in treatment that results in lower radiation doses these solid tumors will probably have less of an impact on the lives of testicular cancer survivors. Careful follow-up is needed in these men to quantify long-term risk. Researchers say that treatment probably explains most of the increased secondary cancer risk.

“It appears that the risks are somewhat lower with the treatments we are giving today than they were with conventional therapies from a few decades ago,” study co-author Charles F. Lynch, MD, PhD, tells WebMD.

Lynch is a professor of epidemiology at the University of Iowa College of Public Health.

“We don’t have the long-term follow-up to know for sure. We probably need to wait for some more time to pass to understand the risks associated with the newer treatments.”

That means testicular cancer survivors must be followed carefully for the rest of their lives, says Herman Kattlove, MD, of the American Cancer Society.

He says many young cancer survivors don’t know they are at increased risk or ignore the risk after cancer treatment.

“They go off to school, or they get married, or move somewhere and they forget about it,” he tells WebMD. “They need to be made aware that even though their testicular cancer is gone, and they are almost certainly cured, they still need to be careful in terms of lifestyle and they need to see their doctors regularly.”

By Salynn Boyles, reviewed by Brunilda Nazario, MD

SOURCES: Travis, L.B. Journal of the National Cancer Institute, Sept. 21, 2005; vol 97: pp 1354-1365. Charles F. Lynch, MD, PhD, professor of epidemiology, University of Iowa College of Public Health, Iowa City, Iowa. Herman Kattlove, MD, MPH, oncologist, medical editor, American Cancer Society, Atlanta.