What Kind of Cancer Did Lance Armstrong Have?

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On October 2, 1996, Lance Armstrong was diagnosed with testicular cancer. He was treated and soon after returned to the upper echelons of professional cycling, winning the Tour of France a record seven consecutive times. His story became an inspiration for many people faced with cancer, and the yellow wristbands he wore became synonymous with hope.

Armstrong may have fallen from grace following his doping confession, but he continues to be a figure of hope for many with cancer.

Lance Armstrong
Gail Oskin/Stringer/Getty Images

About Testicular Cancer

Testicular cancer is not one single disease. It is broken down into two major types:

  • Seminomas are more common in men between 30 and 55 and are further broken down into two subtypes: classical seminoma (which mainly affects younger men) and spermatocytic seminoma (which mainly affects older men).
  • Nonseminomas are most common from adolescence up to the age of 40. It is again broken down into four subtypes: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma depending on which cell types are involved.

Lance Armstrong had embryonal carcinoma. This is important to note as different types of testicular cancer behave differently and respond to treatments differently.

Embryonal carcinomas arise from germ cells from which normal embryo cells develop. They account for only 2% of testicular cancers but are found in up to 85% of nonseminoma mixed-type testicular cancers.

Stages

Testicular cancer is further classified by stage. Testicular cancer is divided broadly into three stages:

  • Stage 1: An early stage in which cancer has invaded tissues next to the testicle but has not spread to lymph nodes.
  • Stage 2: The stage in which cancer has invaded tissues next to the testicle and can now be found in at least one nearby lymph node.
  • Stage 3: The most advanced stage of cancer in which cancer cells have spread (metastasized) to distant lymph nodes or organs.

Given the fact that cancer had spread to his brain, Lance automatically had the most advanced stage 3 testicular cancer, a substage designated as stage 3C.

Generally speaking, cancer is no longer curable when it has metastasized. One of the exceptions is nonseminoma testicular cancer in which a cure may be possible even with metastatic disease.

Treatment

The first part of Lance Armstrong's treatment was the removal of the cancerous testicle in a surgery known as a radical orchiectomy. This is the standard approach for most people with testicular cancer.

This was followed by chemotherapy, which is used to treat any cancer cells that have traveled beyond the testes. In Armstrong's case, since cancer was found in his brain, it can be assumed that cancer cells may have traveled to other parts of the body but were too small to be detected.

Armstrong received a total of four cycles. The initial cycle of chemotherapy consisted of bleomycin, etoposide, and cisplatin. The subsequent cycles used a combination of vinblastine, etoposide, ifosfamide, and cisplatin.

This was done to avoid excessive bleomycin use, which is associated with the development of pulmonary fibrosis. Pulmonary fibrosis is the scarring in the lungs that can limit breathing capacity (an event that would have ended Armstrong's career as a professional cyclist).

In addition to surgery and chemotherapy, Armstrong underwent brain surgery to remove two cancerous lesions. Treating single (or only a few) brain metastases is becoming more common, even with metastatic lung cancer or breast cancer—both of which are not curable.

Removal of these oligometastases (meaning only a few metastases) may improve survival time for some cancers, even when a cure is not possible.

Survival

Most solid tumor cancer types are virtually incurable once they have spread from their primary site. Fortunately for Armstrong—and anyone else who has experienced metastatic testicular cancer—testicular cancer is one of the most curable solid tumor cancers even when it has spread well beyond its original site. 

This is due to the fact that most testicular cancers are very sensitive to chemotherapy, whereas other cancer types are typically composed of populations of cancer cells that are resistant to chemotherapy through various mechanisms. 

With that said, Armstrong's cancer is not considered "cured" but is rather in a state of remission, meaning that cancer cells may still be present even if they are not detectable by tests.

In the end, when nonseminoma involves sites other than lymph nodes or lungs, it is classified as "poor risk" and has a five-year survival rate of less than 50%.

Chance of Recurrence

Most recurrences of nonseminoma testicular cancer occur within the first two years following treatment. Recurrences beyond five years are very rare. It has been over 20 years since Lance was diagnosed, and a recurrence this late would be virtually unheard of.

With that said, there are rare occasions when cancer recurs decades after the original tumor was treated.

It is also important to note that anyone who has had testicular cancer is at an increased risk of developing an entirely new case of testicular cancer in the remaining testicle.

The lifetime risk of developing testicular cancer is around 0.4%, while the lifetime risk of developing a second primary cancer in the remaining testicle is around 2%.

Similarly, chemotherapy may increase the risk of secondary cancers (in which the same type of cancer returns at the original site). This is because chemotherapy drugs damage DNA not only in cancer cells but normal cells as well, instigating their transformation into cancer. While this is uncommon, it can occur in anyone who has received chemotherapy.

A Word From Verywell

People find it interesting to learn about cancers that celebrities have battled, especially if it is cancer they are facing themselves. Yet, it is important to point out that every person and every cancer is different.

Although you may assume that Lance Armstrong's survival was due to the fact that he was an elite athlete, being less healthy or less fit doesn't mean your chances are necessarily poorer. In the end, the molecular characteristics of a tumor may influence outcomes more than other factors.

To this end, never assume the worst if you are diagnosed with testicular cancer. With proper treatment and care, you may have a very good chance of beating the odds whatever the stage.

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