His diagnosis came as a shock to many, who could not believe that someone so young and fit could be afflicted.

In reality, testicular cancer is the most common form of cancer diagnosed in men aged between 20 and 40. As Armstrong's example shows, however, it is not a death sentence, and is treatable.

Dr Yau Tsz-kok, clinical oncologist at the Pamela Youde Nethersole Eastern Hospital, says the cure rate is almost 100 per cent if the cancer is caught early.

Hong Kong statistics

There are about 11/2 to two cases of testicular cancer per 100,000 men a year in Hong Kong, according to data from the Hong Kong Cancer Registry. Dr Yau says the incidence rate is several times lower here than it is among Caucasians.

In Norway there are about 11 cases a year per 100,000 men, while in the United States there are six cases in the same sample.

A recent study by the US National Cancer Institute has found that, while incidences of testicular cancer increased 60 per cent worldwide between 1973 and 1997, most of the increase was seen in populations with existing high rates.

While Hong Kong's 21 per cent increase is one of the lowest, it is important to be informed about the disease.

Signs and symptoms

Unlike some forms of cancer, testicular cancer manifests signs and symptoms that should prompt a trip to the doctor for examination.

Dr Yau says a mass or lump in the testicle is usually the first sign of the disease. The mass may or may not be painful. Other symptoms include testicular swelling, hardness and a feeling of heaviness or aching in the scrotum or lower abdomen. The cancer generally occurs only in one testicle, although in some cases it can progress to the other one.

Some subtypes of testicular cancer may produce high levels of hormones, leading to breast tenderness and abnormal growth of breast tissue or premature growth of facial and body hair in young boys.

Testicular cancer that has spread to other organs, or metastasized, may cause lower back pain, shortness of breath, chest pain and coughing.

Risk factors

Scientists have identified a few risk factors that increase the chances of getting testicular cancer.

'There is evidence that the risk of testicular cancer is higher in men whose testicles did not descend normally [cryptorchidism] - that is, move down from the lower abdomen into the scrotum,' Dr Yau says.

For this reason, surgery is often performed to correct the problem. A study of children who had this operation found that their rate of testicular cancer was not increased as long as the operation was done before they were 11.

'This means that doctors and parents should be checking male children to make sure the testes are descended,' Dr Yau says.

He says men who know they have the risk factor cryptorchidism are likely to be more watchful and to practise testicular self-examination to allow for an earlier diagnosis of the disease.

Other risk factors include a family or personal history of testicular cancer, and Klinefelter syndrome, a congenital disorder caused by an extra X chromosome that results in underdeveloped testicles and is usually diagnosed after puberty.

Recent studies have identified other risk factors that are more relevant to the expatriate than the local population in Hong Kong.

One set of studies demonstrated that an unusual condition called multiple atypical nevi, in which pigmented spots or moles appear on the back, chest, abdomen and face, is associated with an increased risk of developing testicular cancer.

A Swedish study also found that tall, slender men were more likely to develop the disease than their shorter counterparts.

'It is important to note that the exact cause of testicular cancer is not known,' Dr Yau cautions.

'Many men get the disease without having any of the associated risk factors.'

Prevention

According to Dr Yau, research conducted to date has not shown a connection between testicular cancer and any habits, activities or lifestyles.

Many medical bodies advise men to conduct monthly self-examinations.

Treatment

Testicular cancer is a highly treatable and often curable disease, Dr Yau says. Treatment depends on the kind of cancer and the stage at which it is found. It generally involves surgery known as inguinal orchidectomy to remove the affected testicle or testicles.

Post-operative adjuvant treatment to prevent a relapse includes radiotherapy for some types of early-stage cancer, although surveillance is a viable option in some cases. Combination chemotherapy is used to treat cancers that have progressed to a higher stage.

'All the international standard treatment options [radiotherapy and chemotherapy] are available in public and private hospitals of Hong Kong,' Dr Yau says.

Recovery

Many men diagnosed with testicular cancer worry about the impact that it will have on their sex lives.

Because many men who have testicular cancer are young and have not yet had children and the removal of a testicle and chemotherapy may affect sperm production, some doctors recommend that they store their sperm for future use before surgery and treatment.

Post-surgery testicular implants are available that have the look and feel of the real thing.

In most cases, treatment does not have an impact on a man's ability to achieve an erection and ejaculation. In cases where it does, various surgical and pharmacological remedies are available.

Warning signs

A lump or enlargement in either testicle

A sudden collection of fluid in the scrotum

Pain or discomfort in the testicle or scrotum

A feeling of heaviness in the scrotum

A dull ache in the abdomen or groin

An enlargement of, or tenderness, in the breasts

Testicular cancer is relatively rare, especially among Hong Kong-born men, and the above symptoms can have a variety of underlying causes other than cancer. These may also require treatment.

MODEL: Philippe Sung from Dreamodels