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Win-win situation

Armstrong's cycling win is a medical victory, too

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Posted: Tuesday July 27, 1999 09:00 PM

  The level of Armstrong's cancer was considered stage three. AP

NEW YORK (AP) -- Lance Armstrong's victory in the Tour de France was made possible by another incredible triumph -- medicine's ability to beat advanced cancer.

In 1996, Armstrong's doctors in Austin, Texas, gave him the most feared of medical diagnoses: At age 25, he had cancer. Not just that, but it had already spread throughout his body.

In a way, though, he was lucky, because his form of malignancy, cancer of the testicles, is one of the unusual types of cancer in adults that can often be cured once it has spread.

For Armstrong, like most victims, the first sign of trouble was a painless lump in one of his testicles. He ignored it for 5 1/2 months, thinking it was probably irritation from his competitive bicycle training. But when it grew sore and he began to cough up blood, he went to see a doctor.

He had never heard of testicular cancer, which strikes 7,400 men in the United States annually and represents just 1 percent of all male cancers. But for men in their 20s and 30s, it is the leading form of cancer.

Armstrong underwent surgery to have his right testicle removed and received one round of chemotherapy. Then he was sent to Indiana University Hospital in Indianapolis to see Dr. Lawrence Einhorn, an expert in testicular cancer.

What Einhorn found was especially ominous. Doctors grade this kind of cancer by how far it has spread. Stage one disease is confined to the testicles and is completely curable. Stage two has spread to the abdominal lymph glands and is 98 percent curable. Stage three has traveled through the bloodstream to the lungs or beyond. Typically doctors can cure 80 percent of these patients.

"Stage three is the worst," Einhorn said. "He was a bad stage three."

His cancer had spread extensively throughout his lungs, and there were also traces of it in his brain that had begun to cause headaches.

Einhorn estimated that he had a 50 percent chance of being cured. Still, for an adult with widely spread malignancy, those are good odds.

Twenty-five years ago, such a diagnosis would have led quickly to death. That was before the development of cisplatin, a platinum derivative that has become standard treatment for many kinds of tumors but is especially effective against testicular cancer.

That fall and winter, Armstrong underwent three more five-day sessions of chemotherapy. Besides cisplatin, doctors gave him the drugs etoposide and ifosfamide. Ordinarily, they prefer the drug bleomycin to ifosfamide, because it is equally effective and less likely to cause nausea. But bleomycin can slightly injure the lungs.

"That damage is trivial for most people, but if someone is a world-class athlete, a slight reduction in lung function would lower their standing by several notches," Einhorn said. So the doctors settled on the nastier but ultimately safer ifosfamide.

Armstrong continued to ride between treatments, and by late December his chemotherapy was over. But it was still unclear whether he was saved. Doctors monitor progress with chest X-rays and blood tests.

His X-rays still showed abnormal growths in his lungs, but that could have been scar tissue, not cancer. Also, his alpha-fetoprotein levels were still high. Normally, this reading on blood tests is 1.5. Before treatment, his was 100,000.

However, the blood protein returned to normal in February 1997, and two months later, his chest X-ray was clear, too. He had reached an important milestone: cancer-free a year after treatment.

"This disease grows so very rapidly that if you fail to kill all the cancer with chemotherapy, it doesn't come back years later," Einhorn said. "It comes back months later. When a patient is one year cancer-free after chemotherapy, he has a 95 percent probability of a cure."

Now, 2 1/2 years later, his chance of cure is about 98 percent.

The one possible long-term side effect is sterility. About half of patients cannot father children. However, Armstrong's wife is expecting a child in October. While babies can be conceived with sperm stored before treatment, Einhorn said he assumes Armstrong is fertile.

Armstrong's determination to get back into competitive cycling is staggering to the physician. Most patients are sapped by fatigue for months, sometimes even years, after chemotherapy.

"I really thought that Lance had so much determination, he would be back on his bicycle competing," Einhorn said. "But to win the Tour de France is mind boggling. Just to enter is incredible. It could not have happened to a better person."


 
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