How a Combination of Therapies Has Significantly Elevated Survival Rate in Testicular Cancer
Testicular cancer is the appearance of a painless lump that represents an aggregation of testicular tissue which continues to divide seemingly without any control. What provokes testicular cells to behave abnormally is still in the realm of speculation, and most specialists veer to the opinion that genetic factors and externally influenced high-risk triggers tend to play a big role in the genesis of this disease. If testicular discomfort (pain, swelling, hardness) is not addressed immediately, and cancer spreads to other parts of the body, it can create a potentially fatal situation.
How testicular cancer changed from an incurable disease to a low fatality ailment
About thirty years ago, cancers afflicting testicular germ cells were considered to be incurable and fatalities were on the higher side. Though the ratio of testicular cancer patients to the overall population was extremely low, the mortality rate was much higher. This trend changed remarkably with the introduction of multi-drug BEP chemotherapy regimens that were designed specifically to attack fast-growing testicular cancer cells. BEP is an acronym for Bleomycin, Etoposide and Cisplatinum (a derivative of Platinum), which are drugs that are injected separately through veins in the arm and chest along with other fluids over a specific period. This is repeated in cycles after intermittent rests.
How BEP therapy significantly elevated testicular cancer survival rates
BEP therapy singlehandedly changed our perception of testicular cancer from an incurable ailment high on fatalities to a curable disease with substantially reduced mortality rates. Seminomas, which constitute the biggest chunk of testicular cancers, grow slowly but these abnormally growing cells are extremely receptive to BEP therapy. It is the sensitivity of testicular germ cells to BEP treatment that has significantly raised survival rates for testicular cancer.
Combination treatments considerably reduced fatalities in testicular cancer
The BEP treatment was very effective as it interfered with cancer cell division, stopped their growth, and eliminated these cells. Gradually, testicular cancer treatment involved a panel of specialists including the urologist diagnosing cancer, the surgeon who would be removing the affected testicle, the medical oncologist administering BEP chemotherapy and the radiation oncologist specializing in the targeted irradiation of testicular tumors with gamma radiation. These regimens that were developed and refined over the decades dramatically reduced the mortality rate of testicular cancers.
The discovery of Cisplatinum has been compared to the discovery of Penicillin. Cisplatinum not only revolutionized chemotherapy, but radically reduced fatality rate in testicular cancer by targeting germ cells which are responsible for over 90 percent of all testicular cancers.
Overcoming fatal side effects of BEP therapy
Once the BEP chemotherapy regimen was streamlined, it became possible to tackle testicular cancer in an aggressive manner using three drugs individually or in combination. The major drawback was that treatment drastically altered the blood count of white blood cells, red blood cells and platelets, which compromised the immune system’s capacity to fight infection. Reduced red blood cell volume also blocked vital oxygen from reaching tissues.
What prevented fatalities on both these counts was the resilience shown by men in the prime of their youth, men aged 15 to 35, that are targeted most by testicular cancer. As chemotherapy administration became controlled, timed and titrated, excessively heavy dosages could be avoided. Nausea and vomiting too could be controlled with new drugs, and the vast majority of patients could lead a relatively normal life, going about their official and personal routine in between chemo sessions. Even hair loss, which was an emotively embarrassing outcome of chemotherapy, could be stemmed, and hair growth restarted once the chemotherapy sessions were ended.
Potentially fatal long-term side effects of BEP therapy
In the initial stages of the evolution of chemotherapy as an established treatment for testicular cancer, leukemia was considered as the long-term threat. Leukemia is cancer that attacks the stem cells in the bone marrow, and it remains one of the leading causes of cancer-related deaths. The decade-long follow-up, consultations and medical intervention following chemotherapy were necessary to reduce fatalities.
- Cardiac disease
Another side effect of BEP therapy in testicular cancer is the higher incidence of cholesterol in the blood and elevated blood pressure, both converging to trigger cardiovascular disease. The risk is high in predominantly younger testicular cancer patients receiving BEP therapy and requires periodical check-ups and monitoring.
- Lung and respiratory impairment
Bleomycin continues to be one of the most prominent drugs leveraged to treat germ cell tumors as in testicular cancer, but its major side effect is a life-threatening condition called Bleomycin-induced pneumonitis or BIP, which damages the inner lining of the lung bronchioles, thereby compromising the respiratory process. The condition is feared to cause at least 10 percent fatality in testicular cancer patients receiving Bleomycin therapy.
Even after testicular cancer is cured, patients need to follow up with periodical blood tests and scans to detect recurrence of cancer. One of the most reliable indicators of cancer over the long-term is white blood cell, red blood cell and blood platelet counts, which shift abnormally in leukemia.
Elevated levels of tumor markers like alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (ß-HCG) and lactate dehydrogenase (LDH) are very specific to testicular germ cell cancers. Chest X-rays and CT scans may also be necessary to detect the spread of cancer and prevent fatalities. A panel of doctors specializing in urology, oncology and radiation therapy would be ideally equipped to follow up post cancer treatment check-ups.
Treatments following recurrence of testicular cancer
- Salvage chemotherapy
It is important to understand that testicular cancer has a high cure ratio and 100 percent survival rate which reduces only marginally to 98 percent if complications follow the second and third stage cancer transmission to other organs in the body. In what is referred to as salvage chemotherapy, drugs in a higher dosage are administered to protect the patient from deteriorating health.
- Stem cell transplantation
Another major fatality-reducing procedure is stem cell replacement, a procedure that systematically substitutes diseased bone marrow tissue with healthy stem cells that manufacture cells vital to the immune system.
A combination of these treatments generally prevent fatalities in testicular cancer and goes a long way in upgrading the quality of the patient’s life.
The challenge of preventing fatalities through recurring testicular cancer
Even after complete eradication of testicular cancer following the surgical removal of the testes (an operation called inguinal orchiectomy), remnants of tumors may become active elsewhere in the body as in the case of the lung, liver or brain. The biggest threat for any patient is to see germ cells in the testes transform into an aggressive and highly invasive form of cancer called testicular sarcoma or adenocarcinoma. These are radically different from the original primordial germ cells which are prototype versions that are normally supposed to grow into mature sperms. The only way to diagnose and confirm this condition is through extraction of testicular tissue in a biopsy. Chemotherapy, surgical removal of lymph nodes and targeted radiation provide efficient methods to stem fatalities.
It is estimated that around 8,000 Americans will be diagnosed with testicular cancer annually, out of which roughly 400 may succumb to the disease for reasons (mostly genetic in origin) that may move beyond the control of modern therapeutic options. But those affected by the malaise would be cheered by the fact that fatality rates are at their lowest in recent decades, and patients have every reason to believe that they can lead a normal and fruitful life after testicular cancer.