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

Todd Hamblin

On October 2, 1996, Lance Armstrong was diagnosed with cancer1. 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 wrist bands became synonymous with hope. Following his doping confession, he may have fallen from grace to varying degrees, but continues to be a figure for hope for many with cancer.



Lance Armstrong had testicular cancer. Testicular cancer has many different sub-types. He had a sub-type known as embryonal carcinoma. Embryonal carcinoma falls under a group of testicular cancers known as nonseminoma. It comes from the primordial cells from which normal embryonal cells are derived. By itself, it accounts for only 2% of testicular cancers. However, it is found in up to 85% of nonseminoma mixed-type testicular cancers.

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 the cancer had spread to the brain, Lance automatically had the most advanced stage III testicular cancer, a substage designated as stage IIIc.



The first part of his treatment, which is the standard approach in anyone with testicular cancer, was removal of the cancerous testis in a surgery known as radical orchiectomy.

 This was followed by chemotherapy. He received a total of 4 cycles. The initial cycle consisted of bleomycin, etoposide and cisplatin. The subsequent cycles used vinblastine, etoposide, ifosfamide and cisplatin2. 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 lesions3.



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 cure for Lance Armstrong was a given? No it was not.

When nonseminoma involves sites other than lymph nodes of lungs, it is classified as poor risk and has a 5-year survival rate less than 50%4



Most recurrences of nonseminoma happen within the first 2 years. Recurrences beyond 5 years are very rare. It has been nearly 20 years since Lance was diagnosed and an occurrence this late would be virtually unheard of. In other words, his cancer is not coming back. However, anyone who has had testicular cancer is at an increased risk for developing an entirely new case of testicular cancer in the remaining testis. Chemotherapy itself is a risk factor for developing secondary cancers years down the road.

1. http://www.nytimes.com/1996/10/09/sports/armstrong-acknowledges-cancer-battle.html

2. Armstrong, Lance; Jenkins, Sally (2001). It's Not About the Bike: My Journey Back to Life. Yellow Jersey Press. ISBN 0-224-06087-2

3. https://www.nlm.nih.gov/medlineplus/magazine/issues/summer06/articles/summer06pg6-9.html

4. http://www.ncbi.nlm.nih.gov.xlib1.intermountain.net/pubmed?term=9053482

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