What you should know about lesser-known cancers

Understanding the signs and symptoms for males of all ages

Although breast cancer is usually a women’s disease, men get it too. A bone cancer, Ewing sarcoma,usually peaks in teens during a growth spurt, but men can get it too.

Like all cancers, the more rare forms of the disease are best caught early to arrest the uncontrolled growth of abnormal cells. So local physicians who treat some of the lesser known cancers talked with us about the signs and symptoms.

Breast Cancer

Breast cancer in men is rare. It involves less than one percent of breast cancer cases. The most prevalent form of cancer in women—breast cancer—will strike an estimated 2,360 men in the United States this year, according to the American Cancer Society.

“Usually a lump is detected.  But many times diagnosis is delayed,” saysDr. Arvind Soni, director of Radiation Oncology at Tampa’s St. Joseph Hospital and president of the Polk County Medical Association. “Lesions are easier to find in men due to the smaller breast size; however, lack of awareness may postpone seeking medical attention.”

Treatment is generally similar to women who develop breast cancer in the postmenopausal years, with similar results. “Surgery, chemotherapy, and radiation are common treatments,” explains Dr. Soni. “The initial treatment is surgical.”

The disease may be masked in men by gynecomastia, or the benign enlargement of male breast tissue. “Lesions are less contained in men as they do not have to travel far to infiltrate skin, nipple, or muscle tissue,” he elaborates.

Because of its low incidence, there are limited data and studies on the disease in males.

Ewing Sarcoma and Desmoplastic Small Round Cell Tumors

Ewing sarcomausually peaks between 12 and 22, but it can strike boys three years old and men in their 50s, says Dr. Damon Reed, an assistant professor at Tampa’s Moffitt Cancer Center. Classified as a bone disease,Ewing sarcoma can affect muscles or the lungs, the kidneys, or virtually anywhere but the brain or the heart. The classic symptom is pain, which eventually fails to respond to aspirin and other over-the-counter pain relievers. A biopsy, needed to diagnose the disease, usually makes it worse. “Typically it takes many months to figure out what it is,” Dr. Reed says.

Ewing sarcoma doesn’t have all the stages of other cancers; either it’s a Stage 3 because it’s localized or Stage 4 because it has spread elsewhere in the body, he says. When the disease is localized, treatment consists of chemotherapy and surgery or radiation, with a70 percent survival rate. The treatment protocol is not as clear when it spreads, and the survival rate drops to somewhere between 10 and 15 percent.

What’s the cause? “We know biologically what happens. Almost every time there is a break in your DNA [Deoxyribonucleic acid, or molecule with genetic codes],” Dr. Reed says. “Part of chromosome 11 and 22 break off and stitch to each other.” The result is confusion. “A large part of the genes that are supposed to be turned on are off,” he says.

Men may be slightly more susceptible than women to the rare disease afflicting 250 annually, he points out.

Another cancer treated similarlyis Desmoplastic Small Round Cell Tumors,which is usually a man’s disease. Difficult to treat and cure, it causes abdominal pain and extension. Doctors try to cut it out or radiate it and then do chemotherapy. It is more common for men in their 20s and occurs when the DNA breaks. “There’s no way to prevent these. We have no idea where to start,”Dr. Reed states.

Testicular Cancer

A radiation oncologist at Lakeland’s Watson Clinic Cancer Center and a Polk County Medical Association member, Dr. Sandra Sha, says signs of testicular cancer are a lump or swelling of the testicle (which produces sperm), a heavy feeling in the scrotum (where the testicles reside), or low abdominal pressure or discomfort. Some 8,820 likely will be diagnosed with the disease this year.

“Doctors and scientists do not know why the disease develops,” Dr. Sha says. “In general, treatment starts with removal of the testicle (inguinal orchiectomy). Depending on the stage and extent of disease, this can be followed with radiation therapy or chemotherapy.”

Risk factors include an undescended testicle, meaning the testicle did not descend from the abdomen into the scrotum before birth. “Although it can affect a man of any age, most testicular cancers develop in men in their 20s and 30s,” she notes. “Caucasian men are more likely to develop the disease, then Black, Asian or Hispanic men.” Those with a close relative with the disease have a higher risk as well.

“Most of the risk factors […] cannot be changed,” she says. “So there is little a man can do to avoid the development of the disease. There is some data that shows having surgery at about the first year of life to correct an undescended testicle may possibly decrease the risk of testicular cancer. Catching the cancer early is certainly important.”

Sometimes young men are embarrassed to tell anyone about a lump or swelling of the testicle. “This can delay the diagnosis of testicular cancer, which can in turn lead to a more advanced stage when the cancer is discovered. This, in turn, can cause the man to require more intensive treatments than would have been necessary if it were caught earlier,” she says.

Because some treatments can cause infertility, young men who wish to have children may want to consider sperm banking before undergoing treatment. “This entails collecting his sperm, freezing it, and storing it for later use. When the couple is ready to have children, the sample is thawed and used with fertility treatments,” Dr. Sha says.

The good news is, the long-term prognosis for recovery is good.  “If the disease is localized only to the testicle, his chance of surviving at five years is almost 100 percent.  If the disease has spread to the lymph nodes, his chance of surviving is about 95 percent,” Dr. Sha says.  “If the cancer has spread to other organs, he still has a good chance of surviving the disease—75 percent.”

Penile Cancer

Some 1,640 men will develop cancer this year in the penis, the external male sexual organ, the Cancer Society estimates. A rare cancer, the signs include a change in skin color, soreness, lump, and rash. Factors that affect recovery include the stage of cancer, location and size of the tumor, and whether it is recurrent.

More than 60 percent of penile cancer is believed to be linked to Human Papillomavirus (HPV), according to the U.S. Centers for Disease Control and Prevention.

The Cancer Society estimates there will be 855,220 new cases of cancer in men in the United States this year. The most common form is prostate cancer, with 233,000 cases, followed by lung cancer with 116,000. To reduce overall risk, the Cancer Society advises men to avoid tobacco, maintain a healthy weight, be physically active, eat healthy, limit alcohol intake if you drink, protect their skin, know your risks, and get regular checkups as well as screenings.



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