Cancer
Triumph of the cure
Lance Armstrong beat testicular cancer and then won the Tour de France. Was it a miracle or is he a poster boy for the power of modern medicine?
When Lance Armstrong first noticed that one of his testicles was twice as big as the other, the 27-year-old, who just won the Tour de France, did what any red-blooded American male would do. He ignored it. Even when he coughed up blood after cycling through the simmering Texas hills one day, it didn’t worry him overmuch. “I’m an athlete, I always have little aches and pains,” Armstrong said. “I thought, if I don’t do it tomorrow, it must not have been any big deal.”
In October 1996, by which time the painful swelling made it hard to mount his cycle, Armstrong went to the doctor and learned he had testicular cancer that had spread to his lungs and brain. That set the ball rolling, as it were, and it ended up in one of the most remarkable comebacks of sport and medical history. Armstrong lost a testicle, underwent four chemotherapy sessions and seven hours of brain surgery. But he rode 30 miles a day between chemo sessions, and within 18 months he was back in the velodrome. Sunday he finished the most famous bike race in the world, a grueling three-week tour of France’s mountains and valleys, with the fastest time in race history.
But this wouldn’t have happened if Armstrong had gotten testicular cancer 25 years ago. He’d probably be dead. If he’d gotten it 20 years ago, he wouldn’t have competed in a Tour de France three years later. In the late 1970s, chemotherapy for testicular cancer lasted up to two years — as opposed to today’s three months — and was as close to hell as anything imaginable. “I threw up every seven to eight minutes for 12 hours in a row, once every three weeks for a year,” recalls Peter Acquaviva of Cincinnati, who beat the cancer in 1979. “You feel like you’ve been hit by a garbage truck. Your feet and hands tingle. You’re so fatigued.”
Advances in chemotherapy and other treatment nearly assure survival for
most of the patients diagnosed with testicular cancer nowadays, a fact
obscured by Armstrong — and most of the press — when they proclaimed his
accomplishment as downright miraculous.
But “it is absolutely not a miracle,” says Dr. Bruce Roth, an oncologist at Vanderbilt University, who was on the team that treated Armstrong at Indiana University. In fact, although he had 40 tumors in his lungs and two in his brain, Armstrong’s chances were good from the start — a counterintuitive statement, but testicular cancer is a counterintuitive cancer. This year, 171,000 people will get lung cancer and 159,000 will die of it; 176,000 women will be diagnosed for breast cancer, and 43,000 will die of it. The survival rate for testicular cancer is currently 95 percent overall, and 50 percent even when the cancer is as widespread as Armstrong’s. Ask an oncologist why testicular cancer responds so well to chemotherapy when other cancers do not and the inevitable answer is, “If I knew that, I’d have a Nobel Prize.”
Only about 7,500 Americans get testicular cancer every year, but it is the leading cancer among men ages 15 to 35. The survivors owe their lives to a couple of fortuitous research discoveries. In 1965, a biophysicist named Barnett Rosenberg published a paper in Nature noting that the heavy metal platinum killed tumors. Oncologists began trying it out on their intractable cases, but success was mixed and the metal induced horrible bouts of nausea and kidney damage. (Saddam Hussein has used similar poisons to slowly kill his opponents.) The cancer world had largely written off platinum by 1974 when Lawrence Einhorn, a young oncologist at Indiana University, began using it — in combination with two other potent drugs — on testicular cancer tumors.
Einhorn, who directed Armstrong’s treatment, recalls what happened next: “When they came in for their second chemotherapy treatments, three weeks after the first, the radiologist was just amazed to see that their tumors had melted away. He kept saying, ‘What are you doing to these people?’” When Einhorn nervously presented his findings to the American Society of Clinical Oncology in May 1976 (he is currently president-elect of the society), “it led to optimism about all cancers.”
But as is the case with so many other silver bullets, the success rate of the “Einhorn regimen” was confined to testicular cancer. “In my own naive mind I thought this is step one toward curing other advanced cancers,” says Einhorn. “Unfortunately it’s an elusive target.” Testicular cancer strikes germ cells — the precursor cells of sperm. For some reason germ cells develop less resistance to chemotherapy drugs than do other types of cancer cells, and the human immune system is less weakened by testicular cancer. Why this is so “is the $64,000 question,” says Einhorn. “I’m just glad that my 15 minutes of fame has allowed Lance to win the Tour de France and thousands of other young men to pursue their own destinies.”
This is not to say that testicular cancer is a walk in the park. The inevitable first line of therapy is to lop off the testicle in question. (The procedure, called radial inguinal orchiectomy, actually involves pushing the walnut-sized testis through a pencil-shaped canal into the abdomen, where it is removed.) Doctors order the surgery done immediately after diagnosis because testicular cancer grows fast. The guillotine-like swiftness of the act accounts for the black humor, reeking of testosterone and fear, that prevails in the precincts of this cancer. (As in, “I’d give my right nut to be rid of this cancer. Actually, I did,” or in the words of advice given to other men: “Be like a squirrel — Check your nuts!”)
“It happens rather rapidly,” understates Acquaviva, who is now 49. “You’re a single man swinging free in the city and all of a sudden somebody’s gonna whack off your nut. Your response is, ‘You want to cut off my what?’” Luckily, the male sex organ is designed redundantly — with one testicle, you can still get a hard-on and an orgasm — but some patients report a loss in lust, for sex and life in general.
Depending on the cell type and advance of the cancer, about a third of all testicular cancer patients get radiation. Perhaps half get two to four sessions of chemotherapy lasting up to three months. The chemotherapy regime has improved considerably over the past 20 years, dulling many of the side effects. Experimentation has also introduced flexibility in the types of drugs that can be used. Knowing that Armstrong was a racer who required all the endurance he could get, doctors replaced bleomycin, one of the drugs in the regime, with ifosfamide, because bleomycin, while less nauseating than ifosfamide, can cause lung problems.
Armstrong was also fortunate, in a sense, not to be among the minority of testes cancer patients who require abdominal lymph node surgery. In this procedure, surgeons slice the patient open from breastbone to crotch, removing the internal organs and placing them on the chest in order to reach infected lymph node patches. “It’s kind of like gutting a fish but you want the fish to live,” says Adam Williams, an auto executive who had the seven-hour surgery this spring. Until recently, when nerve-sparing techniques were developed, the operation resulted in retrograde ejaculation — into the bladder instead of out the penis. (“Sex is a lot neater and cleaner,” says another patient, trying to put a positive spin on it. “No fuss no muss — no wet spot in the bed.” )
One of the ironies of Armstrong’s illness is that since his cancer went directly from the testicle into his bloodstream, it threatened his vital organs but not his lymph nodes. Williams, still smarting at the waist, wonders whether Armstrong could have managed a Tour de France-level tour de force after lymph node surgery. “I just can’t believe he would have recovered as quickly. Of course, I might feel differently a year from now,” he says.
Time is, obviously, critical. If Brian Piccolo of the Chicago Bears had gotten testicular cancer a few years later, instead of in 1969, “Brian’s Song” might have had a happy ending. Skater Scott Hamilton, subway shooter Bernard Goetz, Alexander Solzhenitsyn and the panda Hsing-Hsing all survived testicular cancer, but none stepped forward as role models. Armstrong has gripped the role with quiet gusto. Only six months after his diagnosis he set up a foundation to disburse grants for testicular cancer research. And his example is squarely inspirational. “We all but worship Lance Armstrong,” admits Rick Glassman, a 40-year-old lawyer in western Massachusetts and testicular cancer survivor. “To proceed after such a traumatic experience clearly requires a Herculean effort,” explains David Joel, an artist in New York who also beat the disease. “It is in the nature of this illness to hit us directly in the part of the body responsible for Herculean effort … To do what Lance has done, to conquer the potential limitations of his physicality, is that much more phenomenal.”
“Lance is huge,” says Rick Hyman, a 43-year-old Los Altos, Calif., salesman and amateur cyclist. Hyman found out in May 1998 he had testicular cancer after being misdiagnosed for two months. “I got on the Internet the morning I found out, sent a message to the foundation, they forwarded it to Lance, and he got back to me immediately saying, ‘You know, I’m not saying your docs are bad but you might want to get a second opinion.’” When Hyman called one of Armstrong’s physicians at Indiana University, the leading testicular cancer treatment center in the United States, he discovered that Armstrong had primed the doctor, who immediately agreed to see him.
A year later, Hyman was well enough to compete in the Ride for the Roses, an annual Austin, Texas, race. “I asked Lance why he set up the foundation,” says Chris Brewer, who runs two Web sites for patients, “and he just kinda looked at me and said, ‘If you can help somebody, you should help somebody.’”
Armstrong is about to face another challenge in October, when he becomes a father for the first time. He banked his sperm before undergoing chemotherapy — which causes temporary and sometimes permanent infertility — so his wife became pregnant via in vitro fertilization. There is an ever-so-slight chance of a relapse in years to come — Einhorn puts it at 2 percent — but even relapses, in testicular cancer, can be treated. “All of our patients do remarkable things. The truly remarkable thing about someone like Lance is that he came back to his sport with incredible mental and physical toughness,” says Einhorn. “This is a very, very determined young man.”
Arthur Allen writes on health, science and other issues for Salon. He lives in Washington. More Arthur Allen.
Kate Hudson’s cancer horror show
The bubbly actress's horrific movie, "A Little Bit of Heaven," turns terminal illness into a twee joke
Kate Hudson in "A Little Bit of Heaven" Ladies and gentlemen, we are gathered here today to mourn a sad loss. A luminous, unique presence who ably graced our lives and then was snuffed out far too early. A moment of silence, please, for Kate Hudson’s career.
It seems like only yesterday we were beguiled by the lively, bohemian Penny Lane in “Almost Famous.” But it’s been a painful decade since, as I know many of you gathered here can bear witness. Those of you who steadfastly supported Hudson over the years, who paid good money for “Bride Wars,” for “How to Lose a Guy in 10 Days,” for “Raising Helen,” “You Me & Dupree,” “Fool’s Gold,” “My Best Friend’s Girl,” “Alex and Emma,” “Le Divorce,” and “Something Borrowed” — you know what I’m talking about. You’re heroes for sticking around this long. That’s why it’s both tragic and necessary to come to the end of our journey now, to let her go off to a better place. The D-list. It’s called “A Little Bit of Heaven.”
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Lessons of a baby bucket list
Avery Lynn Canahuati accomplished a lot in her six months of life. Imagine what the rest of us can do in a lifetime
Avery Lynn Canahuati (Credit: http://averycan.blogspot.com/) What have you accomplished since November? What dreams have you fulfilled? In that time, Avery Lynn Canahuati threw out the first pitch at a baseball game, got a letter from the president and dressed up like a troll doll. She experienced deep love, and changed the lives of her family and friends. And that’s just what Canahuati got done in the first six months of her life. They were also the last.
Canahuati was born in Texas on Nov. 11. This past Good Friday, she was diagnosed with spinal muscular atrophy (SMA), a group of rare neuromuscular diseases that, in her case, were terminal. “We asked our doctors specifically if there is anything. Is there trial drugs, anything out of the country?” her mother, Linda, told CNN this week. So after “sitting around for two days crying and being devastated, since there is no cure and there is nothing we can do,” her father, Mike, decided to make the most of what was left of his daughter’s cruelly brief expected lifespan. Writing in Avery’s voice, he created a blog — and set a few goals.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Words we had after he died
When we lost my husband to cancer, my family's world went upside down. We made sense of it the best we could
(Credit: Tinga via Shutterstock) On the day my husband died, our daughter Allison started screaming my name from her bedroom, where she’d taken refuge. I burst open the door, imagining she had hurt herself, but she was just standing there in the center of the room. “Mom. Mom,” she said. “You are a widow now. A widow. I don’t want you to be a widow. You can’t be a widow.” I had to agree: It just didn’t seem possible.
I tried to hold her, but she was hyperventilating a bit. “I’m ‘the girl whose dad died when she was 13′?” she choked out. “Oh my God. That’s who I am now. When people ask me what my dad does, or how we get along, or anything, that’s how I will have to answer: ‘My dad died when I was 13.’”
Continue Reading CloseKathleen Volk Miller is co-editor of Painted Bride Quarterly, co-director of the Drexel Publishing Group and an Associate Teaching Professor at Drexel University. She is a weekly blogger (Thursdays) for Philadelphia Magazine's Philly Post and is currently working on a collection of essays. Follow her @kvm1303. More Kathleen Volk Miller.
Look at my scars
The remnants of my own illness have taught me that when it comes to difference, don't stare -- but don't turn away
(Credit: Natalia Klenova via Shutterstock) “Do I freak you out?” she had asked.
It was the kind of question adults rarely pose. But Abigail (a pseudonym, like some other names in this piece) is 8, and she doesn’t have any qualms about being direct. The person she was asking, my daughter Beatrice, likewise didn’t hesitate in her reply.
Abigail is new to our school this year. She is in every way a typical second-grader, except that she was born without a left hand. It’s a trait that makes her undeniably noticeable, and so, sometimes, people ask questions. Sometimes Abigail has questions of her own. Sometimes, when you’re different, you want to know.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Confronting cancer webcast
Full videos posted for Salon Core conversation on "coming out of the sickness closet" VIDEO
My oncologist says that whoever came up with the phrase “the gift of cancer” has the worst taste in gifts she’s ever heard of. But though it’s not exactly a set of car keys under the seat, cancer has, for the past year and a half, been the gift I’ve been given. And from an initial malignant diagnosis of melanoma through surgery through a Stage 4 rediagnosis through a last-ditch, Phase 1 clinical trial to a recovery that has stunned the research community, I’ve shared this adventure with the readers of Salon. And along the way, you’ve given so much in return. You’ve told me your own experiences with illness, with the healthcare system, with grief and frustration, and with the ways a shattering experience — either your own or that of someone you love — can turn life around. Sometimes even for the better. So it was a unique privilege to get to talk to a few of you recently for a Salon webcast, and answer your questions on life here in Cancer Town. For those of you who couldn’t make it live, videos of the full webcast are posted below.

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
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