A brazen fight against testicular cancer
By Kit Stolz 11/08/2012
The most serious crisis in his life started with nothing more than a backache.
In this year’s widely admired movie 50/50, starring Joseph Gordon-Levitt, the character of Adam Lerner is late to work, but still stops for a cappuccino at the insistence of his loutish commuting buddy Kyle (Seth Rogen). Waiting in line to speak to the barista, Adam is hit by a pain, winces, and puts a hand on the small of his back.
It’s not entirely fictional. The movie was written by a young comedy writer named Will Reiser, who in fact lived through a rare form of spinal cancer, and in fact was awakened to his sickness by this symptom.
It’s an all too common occurrence. Much the same thing happened to young Fredy Jimenez, of Santa Paula, age 19, this year.
He had been trying to overlook his other symptoms.
“I had this testicle that was really swollen,” he said, “so I thought it was from when I hit myself or something? I thought it would go away, but then I started to get pains in my back that were real bad. I thought it was from work. But then one day I woke up and I was just really tired.”
Photo by Matthew Hill
Fredy Jimenez, 19, of Santa Paula, doing chemotherapy treatment at Ventura County Hematology Oncology Specialists in Oxnard.
Fortunately, Jimenez was taking a health and wellness class at Ventura College, taught by veteran Maureen Eliot, who knows from many years of experience how reluctant young men are to check themselves and take testicular symptoms seriously.
“Oh, my gosh,” she said, “absolutely young men equate their testes, their reproductive organs, with their masculinity. It’s so much easier for all of us to bury our heads in the sand, to ignore the reality, until it’s too late.”
Steve Alldredge, who had testicular cancer 34 years ago and didn’t want to think about it at the time, spoke even more bluntly about Jimenez’s experience now.
“Thank God his back finally did hurt,” he said. “It’s so easy to put these things off. If his back hadn’t started to hurt the cancer could have metastized through his entire body and then he’d be dead.”
In Alldredge’s case, his girlfriend took his symptoms more seriously than he did.
“I had a firmness in one testicle, and it just stayed that way,” he said. “I tracked it for two or three months. I was active, had been out of college only a couple of years, didn’t have a lot of money and was working for an employer who didn’t offer insurance. It didn’t hurt, and it didn’t interfere with sex. I didn’t really see any reason to act on it, but my girlfriend, to her credit, said, that’s something you need to have checked out.”
Alldredge went to see his doctor, who diagnosed the cancer immediately, and with none of the coldness of the doctor in 50/50. In the movie, the doctor is barely able to look his patient in the eye, shows him an impenetrable scan of the tumor, and snows him with medical language. Only when forced by a direct question does he utter the word “cancer.” The Adam Lerner character — as in, one who has much to learn — walks out of the doctor’s office shocked, frightened and bewildered.
In contrast, Alldredge was diagnosed on a Tuesday before Thanksgiving and was operated on to remove the cancerous testicle by the end of the week. Although his chances of survival in his era were nowhere near as good as Jimenez’s — even though, like Jimenez, his cancer had spread to his lymph nodes and his lungs — he has now survived cancer for more than 25 years.
Photo by Matthew Hill
Pictured left to right: Friend Melissa Manzo, cousin Anthony Jimenez, friend Abraham Viveros, Fredy Jimenez, friend Christopher Bolanos, cousin Edlin Jimenez and cousin Eduardo Jimenez.
Testicular cancer is different from most cancers. For one thing, it strikes young men more often than older men. It is the most common form of cancer in men ages 15-35, according to the Testicular Cancer Society. It’s also different from other cancers because it is one of the most curable of all carcinomas, especially if detected early.
“We do a pretty good job with testicular cancer, all things considered,” said oncologist David Masiello, M.D., who oversees Jimenez’s chemotherapy. “We don’t cure everybody, but the regime [of treatment] that has evolved has proved to be hard to improve on, and it really hasn’t changed in 30 years.”
According to the American Cancer Society, about 8,600 men in the U.S. will be diagnosed with testicular cancer this year, and of those, about 360 will die. In his lifetime, a man has a 1-in-270 chance of coming down with this cancer, but if he does come down with it, only a 1-in-5000 chance of dying.
But the key is early detection. If detected in the scrotum, before the cancer spreads, a man’s chance of survival is 99 percent. Once the cancer begins to spread into the lymph nodes and other organs, the survival rate begins to fall, although even after other organs are involved, it still remains at 70 percent or a little better.
From her office at Ventura College, wellness instructor Eliot explains that 85 percent of the growth of a cancer, any cancer, shows no symptoms at all to the bearer.
“What that means is that only in the last 15 percent of the cancer can we discover it, diagnose it and treat it,” she said. “That’s why early detection is so important.”
In her health and wellness classes, Eliot explains the how and why both men and women should pay attention to changes in reproductive organs.
“When I’m teaching my co-ed class, I tell the women how to detect the early signs of breast cancer, and I tell the boys that this is for the women, but you all have mothers, and many of you have sisters or girlfriends. When I’m talking about search and discovery for the men, I tell the women ‘Don’t turn off your ears! You may have a boyfriend or a husband or brothers and we all have to be aware.’ ”
Eliot, who has a degree in kinesthesiology, believes that we learn best when we are able to bring information into our minds through our bodies. She models searching for nodules — what are typically described as “lumps and bumps” in breasts -- using the back of her hand. For men, she models a search for cancerous nodules in the testicles by lifting and rolling a pinch of skin between her thumb and forefinger.
“I lift the skin on the back of my hand and say, look, now we’ve created the skin around the testicle,” she said. “I show the class how to do a search for lumps and bumps.”
Both Masiello and the American Cancer Society caution that self-examination has not been proven to be successful at early detection of testicular cancer. But because most such cancers are first detected not by doctors but by men or their sex partners, experts still urge patients to conduct the “search and discovery” exams described by Eliot.
“I tell my students to close the door, get naked, and look for lumps and bumps,” she said. “I just think we all have to be proactive with our health. Nobody knows our bodies the way we do. I always preface my lectures by saying that I’m not a doctor, and I can’t answer those kind of specific questions, but I can help you be aware of any changes in your body.”
The Testicular Cancer Society phrases it similarly, if more sternly.
“If you notice anything unusual with your testicles you should notify your doctor immediately,” they counsel. Other symptoms include a dull ache or pain in the lower abdomen or scrotum, a build-up of fluid in the scrotum, and pain “down there,” although only one out of ten patients experience that.
When Alldredge was diagnosed with testicular cancer in the mid-1970s, he and his girlfriend asked his doctors what were his chances of survival.
Twenty percent, the doctor told him.
Fortunately his doctor had heard of an experimental trial of a new cocktail of chemotherapy drugs — the same treatment that cured cyclist Lance Armstrong and is commonly used today — and petitioned the government to allow Alldredge to participate. Alldredge found himself going to chemotherapy treatments and going to the library to research cancer in his spare time.
He did not find the percentages patients often hear especially helpful.
“It’s almost like the odds makers you hear about in sports,” he said. “They can be pretty close to the mark, but it’s still daunting. I was really fortunate that I had a girlfriend and it was absolutely important to her that my spirit remain up and positive and moving ahead. I was going to be better, and we were going to do x, y and z to make sure I was going to get better. There was not a lot of dwelling on it or oh, woe is me.”
Jimenez does find the statistics reassuring, perhaps because advances in treatment since the l970s have greatly improved patients’ chances of survival.
“We have seen results [from the chemotherapy] and that’s really helpful,” he said. “Your number keeps going lower and lower, and when you drop a big number, it helps you stay positive.”
Jimenez, too, has had his spirits buoyed by neighbors and cousins and friends — most of them.
“A lot of people will want to be there for you,” he said. “I think most everyone does. But as time goes by, some people forget. They don’t call anymore.”
In the 50/50 movie, the character played by Joseph Gordon-Levitt had a new girlfriend who said she wanted to help, and took him to his chemotherapy appointments, and seemed sympathetic, but she couldn’t go inside the hospital – “an energy thing,” she said.
Alldredge and his girlfriend had the same experience with a couple they knew.
“People tend to fall into one of two categories,” he said. “Either they go overboard and smother you to death, or they tend to separate. We were close friends with one couple and did a lot of things with them, and they just kind of separated from us,” he said. “I think it scared them. Even though they were college-educated and knew better, eventually they did tell us they thought it might be contagious in some way.”
For Alldredge, the character in the movie and Jimenez, one of the most difficult aspects of the sickness was their mothers’ fear.
“For me that was the hardest part, because I knew she was going to take it harder than anyone else in the family,” Jimenez said. “I think she took it harder than me because I had time to prepare myself, and she wasn’t expecting that.”
On a Sunday afternoon, Jimenez hangs out with cousins and friends, visiting and laughing. His mother comes by for a visit, happy to see him with his friends, but worried, too. Rosa Jimenez has had many burdens to bear these past few months.
“At first she broke down. My dad had just had heart surgery, and it was hard for her to take it all in. But then she said she knew she had to be strong for me, to be my right-hand support,” he said. “She stays home with me, she checks on my medication. There’s some things I can’t do, but I just try to live my normal life and stay on a level plane.”
“That’s the million-dollar question,” said Victor Schweitzer, M.D., an oncologist at the Simi Valley Radiation Oncology Center. “We really don’t know. We haven’t found a familial link. We know that patients who have had cryptorchidism [undescended testicles] are at an increased risk, and we track patients who have had surgery for that, but we consider that a soft risk factor.”
A recent epidemiological study from the Keck School of Medicine at USC found a rough doubling of risk among marijuana users, as compared to a population of non-users.
Schweitzer wants young people to hear about that news.
“There is a lot of concern about substances like marijuana and tobacco that play around with genetic structure,” he said. “Especially since this is a disease that strikes the younger population, and in some places you can find a pot shop on every corner.”
At the same time, Schweitzer doubted that this would be the case with a 19-year-old like Jimenez, or a case like Steve Alldredge, who contracted the disease when he was 25.
“I think it would be fairly unlikely,” he said. “But I do think people should know about the possibility of an increased risk. We know that tobacco can alter genetic structures, and it wouldn’t be surprising if marijuana could too.”
In Alldredge’s case, his mother was prescribed a potent medicine believed in the l950s to prevent miscarriages, called DES, but which subsequently was shown to be a carcinogen and banned. Schweitzer stressed that regardless of cause, testicular cancer is a curable disease.
“October [was] Breast Cancer Awareness Month,” he said. “It’s good that women are being made aware, but it’s bad that men are not. Guys are not immune. It’s never good to come down with cancer, but I always tell my patients that if you have to, this is one of the better cancers to get. It’s highly curable, and you shouldn’t run away from it.”