While testicular cancer (cancer of the testicle) is not common, it usually strikes young men. Researchers reported recently in the journal Cancer (Vol. 94, No.6: 1668-1676) that modern treatment may cure many men of the disease.

Chemotherapy will usually cure testicular cancer, but not always. The authors said some men could benefit from surgery.

Almost one out of every three men treated with chemotherapy for this cancer will have masses or enlarged lymph nodes in the abdomen (belly) at the end of their treatment. This is a problem in treating testicular cancers, especially in ones that are more aggressive, referred to as "non-seminomatous germ cell tumors."

William F. Hendry, MD, a urologist with the Royal Marsden National Health Service Trust in Surrey, England, and colleagues looked at 442 men who had been treated at their hospital from 1976 to 1999.

These men had either masses or enlarged lymph nodes in the abdomen which measured a bit less than one-half inch (1 cm). All of the men with these masses had surgery to remove them.

Of these men, 330 had the surgery within three months after ending chemotherapy. The remaining 112 men had surgery following additional drug treatment after their disease had come back.

In the men who had surgery right after they finished chemotherapy, two out of three had evidence of harmless, non-cancerous tumors called mature teratoma in their lymph nodes; one out of four had scar tissue; and the rest (28 men) had continued cancers.

For the men who had surgery after treatment for when their testicular cancer returned, about four in 10 had mature teratoma, one out of 10 had scar tissue, and 43 men (just under half of the group) still had testicular cancer in the abdomen.

The authors noted that even when full-grown teratomas were found in these men, they should be removed. This is because they are "unstable" or have the potential to become cancer at a later time.

Survival was improved for both groups. In the "early" treatment group, eight out of 10 men passed the five-year survival mark without evidence of cancer. For the "late" surgery group, six out of 10 men were alive without evidence of cancer at five years.

Cancer of the testicle produces substances called tumor markers that can be measured in the blood. Usually, these tumor markers match the course of the disease. They increase as the amount of disease increases, and go away when the disease is treated successfully.

In this study, only half of the patients with cancer in their lymph nodes had elevated tumor marker levels in their blood tests before surgery. What this means is that negative tumor markers don't necessarily mean that enlarged lymph nodes in men treated with testicular cancer are benign.

Experts said only surgery can tell for certain if the enlarged nodes or masses contain cancer after treatment.

The authors said, "Complete excision (removal of all remaining mass) offers a highly significant survival advantage" in men who have undergone a second round of chemotherapy and had their cancer come back.

Cancer of the testicle is uncommon. According to the American Cancer Society, 7,500 cases will be diagnosed in the United States in 2002, and there will be 400 deaths this year.