. . . is rare: in the United States, between 8,400 diagnoses of testicular cancer are made each year. Over his lifetime, a man’s risk of testicular cancer is roughly 1 in 250 (four tenths of one per cent, or 0.4 per cent). It is most common among males aged fifteen-40 years, particularly those in their mid-twenties. Testicular cancer has one of the highest cure rates of all cancers: in excess of 90 per cent; essentially 100 per cent if it has not metastasized. Even for the relatively few cases in which malignant cancer has spread widely, chemotherapy offers a cure rate of at least 85 per cent today.

Testicular cancer has several distinct features when compared with other cancers. Firstly, it has an unusual age-distribution, occurring most commonly in young and middle-aged men. Secondly, its incidence is rising, particularly in white Caucasian populations throughout the world, for reasons as yet unknown. And thirdly, testicular cancer is curable in the majority of cases. The number of deaths from testicular cancer in the usa is around 380 annually.

It is essential to discover the growth in good time. Very often testicular cancer causes few symptoms, at most a feeling of heaviness. Occasionally there is sudden pain because of a haemorrhage in the

growth. One diagnostic trap is swellings that persist after a trauma or an inflammation of the epididymis.

In almost half of cases there is metastasis at the moment when a diagnosis is made. Possible symptoms are back pain, a swelling in the abdomen and breathlessness. Fortunately the prognosis is very favour­able, even where there is metastasis. In most cases the metastases sim­ply melt away with chemotherapy or radiotherapy. The choice between the supplementary treatments depends on the kind of cancer involved. Pathologists distinguish between seminome and non-seminome. In the first case the prospects are slightly more favourable than in the second.

The success stories of therapeutic chemotherapy in testicular cancer with metastases (for instance, Lance Armstrong) originate from cis – platinum. In 1966 the American biophysicist Barnett Rosenberg was playing around with a colony of intestinal bacteria, which he exposed to various levels of current between two platinum electrodes. The closer the bacteria came to the electrodes, the less able they were to divide. That was caused, thought Rosenberg, not by the electric current but by a substance on the platinum electrodes. That cell-inhibiting sub­stance proved to be cisplatinum. When he went on to test the effec­tiveness of the substance on rats with cancer his intuition was confirmed. Further research showed that cisplatinum had an extra­ordinarily favourable effect on women with ovarian cancer and men with testicular cancer. When cisplatinum was first used on patients in the early 1970s it did, however, turn out to have a series of serious side – effects, including kidney damage, hearing loss and unbearable nausea. Nowadays those side-effects are successfully kept in check, for example by a combination of drugs, though long-term research indicates that premature heart problems may occur.

Besides cisplatinum, etoposide and bleomycine are used in the treat­ment of patients with testicular cancer. The number of courses is determined after a risk classification. During treatment so-called tumour-marker substances are identified in the blood, and in this way the success of the treatments can be assessed. In any case the side-effects of the chemotherapy remain severe: nausea, hair loss, reduction in bone marrow, anaemia, haemorrhages, pins and needles in feet and fingers, and lung damage.