At 15, Ooltewah High School sophomore Blake Mallett loved playing his Xbox 360, could text 60 words a minute on his cell phone and enjoyed playing basketball with his friends on the weekend. An avid football fan, he followed the University of Tennessee. He was known for being able to predict who was going to be in the Super Bowl and even who would win.
Early Detection is Key
By Marcia Swearingen
Throughout the summer of 2008, Blake played baseball and that December signed up for recreation league basketball with some of his friends. Soon after practices began, he became congested and started to cough up blood. Alarmed, his parents took him to the family doctor. After a chest X-ray and routine blood work, Blake was diagnosed with an upper respiratory infection and sent home with antibiotics.
Two days later, on December 31, the doctor’s office called to say the radiologist found something in the chest X-ray; a CT scan was taken later that day. Afterwards, the family was sent to T.C. Thompson Children’s Hospital, where Blake was diagnosed with stage IV testicular cancer. The disease had spread to his abdomen, liver and lungs. Surgery to remove the affected testicle was performed and Blake began his first chemotherapy treatment on January 13. Tragically, two days later, the tumor in his liver ruptured, and the young man died. Today, his parents are still processing the shock.
Testicular cancer is a very uncommon type of cancer that begins in the testicle. The earliest cells to develop in the testes are known as germ cells. These cells will one day develop into sperm. Nearly all cases of testicular cancer occur when there is an abnormal growth pattern of germ cells, which can cause a tumor to form. The result is one of two types of germ cell tumors. One third of cases have cells that grow more slowly, known as seminomas. The rest, known as nonseminomatous or NSGCTs, are more aggressive.
Although rare, testicular cancer is the most common type of cancer in men ages 15-35. Each year 8,400 new cases are reported in the primary age group of 20- 54. Caucasian men are three times more likely to develop the disease than African Americans.
Chattanooga Urologist Dr. Oliver Benton only sees the disease two or three times a year. The cause, he says, is largely unknown, but the risk for men with undescended testes is 3-14 times higher than the 5-10 percent risk to men without this condition. Corrective surgery can be performed and is recommended prior to puberty. Also at risk are men with a family history of this disease.
“The primary symptom is a firm, painless mass in the testicle,” says Dr. Benton. “It can grow slowly or rapidly. In the more rare and aggressive types, secondary symptoms can include the growth of abnormal amounts of hair on the face and body.”
Blake did not have a family history of the disease, but he did have the secondary symptom of abnormal hair growth. His parents assumed it was a natural part of puberty.
The best way to prevent the disease is early detection. According to Dr. Benton, pediatricians should conduct examinations, and boys should also do a self-exam. Blake’s mom Christie Roberts heartily agrees.
“Early detection is the only prevention,” she says. “Boys should be taught to self examine and not be afraid to speak up.” Blake had a slightly enlarged testicle, but didn’t think anything about it and didn’t divulge it.
“Don’t just settle for a sports physical after junior high immunizations,” she adds. “Continue annual physicals with blood work at the pediatrician.” Blake had a sports physical as recently as October 2008. When given the option, Blake declined the required male genitourinary exam. When he was diagnosed two months later, the doctors said the cancer had been present for six months to a year.
The biggest problem, according to Dr. Benton, is patient denial. The most famous case is bicyclist Lance Armstrong.“ He had a firm, hard testicle for a year, only seeking medical advice in response to secondary symptoms due to the spread of his cancer to other parts of his body.” Tumors in the testes, says Dr. Benton, are virtually always malignant. “We don’t biopsy testicles. If we find a solid mass in the testicle, it is removed and that is the end of it. Usually we do a CT scan, chest X-ray and other studies to be sure it hasn’t spread.”
“On the optimistic side,” Dr. Benton adds, “in the last 20 years testicular cancer has become one of the most curable solid cancers, because the chemotherapy has turned around the survival rate. Across the board the cure rate with appropriate treatment is in the 90-95 percent range.”
Chattanooga Radiation Oncologist Dr. Stephen Golder agrees.“Radiation, surveillance or the chemo option all seem to work about the same with seminoma patients. In the nonseminoma germ cell tumors, during surgery they will often remove all the lymph nodes that we would usually irradiate because NSGCTs are a lot more resistant to radiation. That’s where they’ve made a lot of strides with chemotherapy. Even patients with advanced testicular cancer have a high cure rate with chemotherapy.”
Dr. Golder, medical director for the Sarah Cannon Cancer Center at Parkridge Medical Center also advocates early screening to detect abnormalities as soon as possible. “It’s a rare tumor, but it’s so treatable that you are better off to find it early. Young men should be taught to do their own testicular exam like a woman is taught to do a breast self-exam for breast cancer. It’s an unlikely thing to happen, but if they feel something abnormal there, they need to get into a doctor and have it checked out.”
“Parents need to be educated as well and encouraged to ask questions from their pediatricians,” says Christie Roberts. “Too many times we assume because we have taken our children to have a routine physical that this covers everything … but it doesn’t.”
The American Academy of Pediatrics recommends routine well-child examinations annually for children 10-18 years of age. Currently 78 percent of teens get their only physical examinations through school sports exams.
Marcia Swearingen has lived in Chattanooga for 30 years. She has a Bachelor of Science degree in Journalism from the University of Tennessee at Knoxville and is currently a board member of the Chattanooga Writers Guild. Marcia and her husband, Jim, have one daughter and live in Hixson.
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