What Kind of Cancer Did Lance Armstrong Have and How Did He Survive?

live strong bracelet and Lance Armstrong surviving cancer
Todd Hamblin

On October 2, 1996, Lance Armstrong was diagnosed with cancer. The rest is history. He was treated and returned to the upper echelons of cycling, winning the Tour of France a record 7 consecutive times. His story became an inspiration for many people faced with cancer. The yellow wristbands became synonymous with hope. Following his doping confession, he may have fallen from grace to varying degrees, but continues to be a figure of hope for many with cancer.

Let's talk about Lance Armstrong's cancer, but then talk about why what he experienced may differ from another person, even someone with the same type and sub-type of cancer at the same stage of the disease.

Lance Armstrong and Testicular Cancer

Lance Armstrong had testicular cancer. Testicular cancer is not one single disease. It is broken down into two major types, seminoma and nonseminoma. Seminoma is more common in men between the ages of 30 and 55 and is again broken down into two subtypes. Nonseminomas are most common in men between the age of adolescence and age 40. it is again broken down into four subtypes, embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. Lance Armstrong had embryonal carcinoma. This is important to note in that the different types of testicular cancer behave and respond to treatments differently.

Embryonal carcinoma comes from the primordial cells from which normal embryonal cells are derived. By itself, it accounts for only 2 percent of testicular cancers. However, it is found in up to 85 percent of nonseminoma mixed-type testicular cancers.

Stages

Cancer types are further classified by stage. Testicular cancer is divided primary into 3 stages: I, II and III. Stage III is the most advanced and means the cancer has spread beyond a group of lymph nodes in an area termed the retroperitoneum. Given the fact that his cancer had spread to his brain, Lance automatically had the most advanced stage III testicular cancer, a substage designated as stage IIIc.

This is another important point when talking about cancers. Most of the time when a cancer spreads (metastasizes) it is no longer curable. This is true for common cancers such as lung cancer, breast cancer, and most solid tumors. One of the exceptions is testicular cancer, in which a cure may be possible even with metastatic disease.

His Treatment

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

This was followed by chemotherapy, which is needed to treat any cancer cells which have traveled beyond the testes. In Armstrong's case, since his cancer had traveled to his brain, it's assumed that cancer cells may have traveled to other regions as well but yet be too small to be detected. He received a total of 4 cycles. The initial cycle consisted of bleomycin, etoposide, and cisplatin. The subsequent cycles used vinblastine, etoposide, ifosfamide, and cisplatin. This was done to avoid further bleomycin use, which is associated with lung toxicity, specifically a condition known as pulmonary fibrosis. This condition involves scaring in the lungs which can limit breathing capacity and would end the career of any professional cyclist, as their lungs must be in top condition to compete at high levels.

In addition to surgery, to remove the cancerous testis, and treatment with chemotherapy, Lance underwent brain surgery to remove two cancerous lesions. Treating single (or only a few) brain metastases is becoming more common, even with metastatic tumors such as lung or breast cancer which are not curable. Removal of "oligometastases" (only a few metastases) may improve survival for some cancers, even when a cure is not possible. 

How He Survived

Most solid tumor cancer types are virtually incurable once they have spread (metastasized) from their primary site. Fortunately for Lance, 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. 

Does this mean a cure for Lance Armstrong was a given? No, it was not. When nonseminoma involves sites other than lymph nodes or lungs, it is classified as poor risk and has a 5-year survival rate less than 50 percent. 

Could His Cancer Come Back?

Most recurrences of nonseminoma testicular cancer happen within the first 2 years. Recurrences beyond 5 years are very rare. It has been over 20 years since Lance was diagnosed and an occurrence this late would be virtually unheard of. That said, even though it would be extremely uncommon with testicular cancer, there are times when cancers recur even multiple decades after the original tumor was treated.

It's 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 testis. The lifetime risk of developing testicular cancer is around 0.4 percent, but the lifetime risk of developing a second primary cancer in the remaining testicle is 2 percent.

Finally, chemotherapy may result in the development of secondary cancers down the road. These medications work by damaging DNA in cancer cells, but can also damage DNA in normal cells, beginning the process of those cells transforming into cancer cells. This is true for people who have had chemotherapy for almost any type of cancer, though it is relatively uncommon.

Every Cancer and Every Person is Different

Many people find it interesting to learn more about the cancer a celebrity has battled, especially if it is a cancer they are facing themselves. Yet it's important to point out that every person and every cancer is different. 

No two cancers behave the same way or respond to the same treatments. Two cancers may appear similar under the microscope but may be very different on a molecular level. If you were to take 200 people with the same type of testicular cancer at the same stage of the disease, you would have 200 unique cancers. The more we learn about cancer, the more we are learning about these differences, which has given rise to the whole field of precision cancer treatment.

In addition to differences in the tumor, no two people are alike, and everyone responds differently to treatment. Lance Armstrong's testicular cancer had a 5-year survival rate of less than 50 percent, but it doesn't mean that he is healthier or in better shape than someone who might succumb to the disease. Someone who is very healthy may do poorly, whereas someone who does little to take care of themselves might do well. It's often hard to know how well someone will do, and it's important to keep this in mind when talking to our loved ones with cancer. It's not a person's fault if they develop cancer, and it's not their fault if they don't respond well to treatment. Outcomes often have much more to do with the specific molecular characteristics of a tumor than the person who has that tumor.

Bottom Line on Lance Armstrong's Testicular Cancer

Lance Armstrong, though he had a fall from grace, stands as an encouragement to anyone who has been diagnosed with cancer. He survived his testicular cancer and fairly aggressive treatment, and not only survived but went on to cycling fame. Testicular cancer is somewhat unique among solid cancers, as it may be curable even after it has metastasized. It is a tumor, however, that often hits men in their peak years, and can be devastating in this way. We can credit Armstrong for raising awareness that cancer can be survivable and that there can be life after cancer for many people.

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