After months of in vitro fertilization (IVF) treatments, Eric and Katherine Hall were celebrating the news that she was pregnant with their first child.
Eric Hall, a professor of exercise science at Elon University, and Katherine, a geriatrics researcher and assistant professor with the Duke University School of Medicine and the Durham Veterans Affairs Medical Center, were looking forward to joyful days, even if sleepless nights lay ahead.
But something else was already keeping Eric Hall up at night. About a month before, he’d started noticing some painful swelling in his testicle. He’d put off going to the doctor because he was “fearful of adding extra stress to the family.”
The next day he went to see a physician’s assistant to get it checked out. After an ultrasound, he was told to go see his urologist.
“I was diagnosed with testicular cancer on Friday, August 1, 2014, a day before I was to turn 42,” recalled Hall. “Finding out on Monday about the pregnancy, then finding out on Friday about the cancer, took me on a rollercoaster of emotions.”
He had surgery to remove his testicle within a week and then a scan to check for any spread. His seminoma — the most common type of testicular cancer — had metastasized to the intra-abdominal lymph node. Hall’s urologist recommended chemotherapy and made a local referral, but Hall looked further afield; 45 minutes away to Andrew Armstrong, MD, a renowned medical oncologist specializing in the treatment of aggressive prostate, kidney, bladder and testicular cancer and associate director for clinical research in Duke Cancer Institute's Prostate & Urologic Cancers Program.
“I had heard good things about the Duke Cancer Center and specifically good things about Dr. Armstrong,” said Hall. “When we finally sat down to meet, he and his resident discussed the latest research and showed me articles and data graphs. I’m a scientist myself and I immediately thought ‘this guy is talking my language.’ I was impressed. I was sold.”
Most common in men between the ages of 18 and 30, testicular cancer is “the number one cancer of men in that age group” said Armstrong. The biggest risk factors include undescended testicle (s), a family history of testicular cancer, and some genetic syndromes like Klinefelter syndrome, but the majority of men have no such history.
“Fortunately, testicular cancer is a disease that’s largely curable,” said Armstrong, explaining that the primary treatment — and for most men, cure — is removal of the affected testicle (radical orchiectomy) and its surrounding areas. “It’s a quick recovery; as little as three weeks.”
Testicular cancer has a 95 percent cure rate, with slightly fewer than 9,000 cases diagnosed each year, and less than 400 deaths.
Armstrong said that only a small proportion of men will have metastatic testicular cancer (spread to lymph nodes or organs), which requires both surgery and either radiation or chemotherapy. Some men with early stage testicular cancer do, however, have a high risk of relapse and those men will commonly choose a short course of chemotherapy to prevent it from coming back.
“Testicular cancer is one of the few cancers that chemotherapy can actually cure even when the cancer has spread; even patients with advanced stages of testicular cancer can enter remission with chemotherapy that is commonly durable,” said Armstrong. “The development of platinum-based chemotherapy was the real turning point for testicular cancer treatment. A three-drug regimen (BEP) developed in the 1970s was incorporated into our guidelines over the past 20-25 years and transformed this disease from a commonly fatal cancer to a cancer where survivorship is the standard expectation.”
Hall started and completed a chemotherapy regimen under Armstrong’s care in Fall 2014 and their much-awaited son was born in February 2015.
But then, another surprise. A little more than a year after their son was born, Hall's wife became pregnant again, this time naturally, without the aid of IVF. Their daughter Gemma was born on Christmas Eve 2016.
“In June 2016 when I saw Dr. Armstrong I told him that my wife was pregnant, and he looked at me and said ‘I guess no permanent damage was done’,” laughed Hall. “I hadn’t followed my urologist’s recommendation to bank sperm before the operation, but it turned out I didn’t have to.”
“Some men do have problems with their sperm counts when they have testicular cancer, but sometimes surgery removing a single testicle helps improve the functioning of the other one,” explained Armstrong. “Men who are survivors of testicular cancer, even after chemotherapy, can successfully have children, but taking precautions ahead of time to bank sperm is reasonable.”
Armstrong advised that testicular self-exams once a month can pick up the vast majority of all testicular cancer cases, which usually present as a painless but sometimes as a painful mass or swelling. He cautioned that when men don’t do self-exams and get annual physicals, this could lead to a higher risk of spread if they do have it.
“With early detection, early treatment can be applied successfully, and testicular cancer has become more of a survivorship cancer now; for most patients, after about two to three years, if a relapse hasn’t occurred, it means they’re likely cured,” he said. “At our survivorship clinic in the Duke Cancer Center we’re doing active surveillance commonly in men after surgery who have low risk disease; most men who are cured with surgery can just be followed with imaging and exams and bloodwork over time. While late relapses beyond five years can occur, follow-ups for up to five years is reasonable in most men to determine whether a relapse will occur.”
Survivors who’ve had chemotherapy or radiation, he added, are also being monitored as part of a care plan. Some of the long-term risks of chemotherapy and radiation include cardiovascular disease and secondary cancers.
Hall is scheduled for monitoring every six months. So far, his scans have come back clear. This August will mark three years since the couple’s world was turned upside down.
“A lot has changed, but we couldn’t be happier with the outcomes,” said Hall. “We are very fortunate.”
April is Testicular Cancer Awareness Month.
To make an appointment with Dr. Armstrong or another Duke testicular cancer specialist, please call 888.275.3853 or 919.373.3526. CLICK HERE for more information on testicular cancer care at Duke Health. The testicular cancer survivorship clinic is located on the 5th floor of the Duke Cancer Center.