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Summary: Testicular cancer survivors have about twice the risk of developing some other form of cancer in their lifetime than men who never had testicular cancer, according to a study in the Journal of the National Cancer Institute.

Why it's important: More than 80% of men with testicular cancer are younger than 45 when diagnosed. Fortunately, around 95% of all patients are cured. That means most men can expect to live a long life even after treatment. Testicular cancer survivors and their doctors need to be aware of the higher risk of second cancers and be alert to any new symptoms. These survivors also have even more reason to avoid unhealthy behaviors, such as smoking, that can raise the risk of cancer.

What's already known: Several reports in the past have suggested that testicular cancer survivors have a higher risk of other cancers. But those studies didn't always include a long-term follow-up of patients or provide enough information on which to gauge risk. Because this study is so large and because it reports on patients who were followed for as many as 30 years in some cases, it is able to better quantify the risk, how long it lasts, and the types of cancers most likely to develop.

How this study was done: The researchers, from the US, Canada, and several Scandinavian countries, reviewed cancer registries in their countries, some of which went as far back as 1943. After identifying 40,576 survivors of testicular cancer, the researchers then looked to see if any of those men had subsequently developed other cancers. The registries contained information on the kind of testicular cancer these men had and most also recorded the type of treatment they received.

What was found: Overall, the men had a risk that was 1.9 times that of men of comparable age who did not have testicular cancer. This higher risk began to show around 10 years after treatment. The risk was highest for men diagnosed in their 20s and lower for those diagnosed later in life. The most common second cancers to develop were stomach, pancreas, bladder, and connective tissue disease, along with mesothelioma (cancer of the pleura, or outer lining of the lung).

The type of treatment the men had received (radiation, chemotherapy, or both) did not affect this risk. The researchers also didn't see much difference between men who had seminoma and those who had non-seminoma cancer, except that men with non-seminoma treated after 1975 did not have as high a risk of second cancers.

Although most doctors (as well as the study authors) think that treatment of the testicular cancer is the major cause of the later cancers, this study couldn't prove it. Radiation, which most of the men received, is known to cause cancers, particularly in the area that is exposed to the radiation. Chemotherapy is generally thought to be a less likely cause of second cancers, but even men treated with only chemotherapy had a higher risk of getting new cancers. The study authors say more research needs to be done to find out if specific treatments (particular radiation doses or certain chemotherapy drugs) are more or less likely to increase a man's risk of secondary cancers.

Another theory that couldn't be proven is that perhaps men who develop testicular cancer have a greater propensity to develop cancer in general .

The bottom line: Testicular cancer survivors and their physicians need to be vigilant and take note of any symptoms that appear unusual and that might be caused by a new cancer. Survivors should be especially sure to follow cancer screening guidelines. And it's even more important for them to lead a healthy lifestyle -- exercising, eating right, and avoiding risky behaviors like smoking that might increase their risk of cancer even further.

Citation: "Second cancers among 40576 testicular cancer patients: Focus on long-term survivors." Published in the September 21, 2005, Journal of the National Cancer Institute (Vol. 97, No. 18: 1354-1365). First author: Lois B Travis, MD, of the National Cancer Institute.