Cancer in Men
Although campaigns against cancer are more visible for female cancers such as breast and cervical cancers, men are more commonly affected by cancer than women.
This has been shown in almost all cancers except breast and female genital tract cancers. Prostate cancer and testicular cancer are usually the focus of cancer awareness campaigns in men. However, common cancers such as lung, colon, skin cancers (melanoma and non-melanoma skin cancers), lymphoma, etc. affect all genders, and with male preponderance. Men also have a higher mortality rate from cancer than women. According to the SEER database, the lifetime risk of developing cancer (at any site) is approximately 39.6% for both men and women at some point during their lifetime, based on 2010-2012 data in America. The most common cancers in men from the SEER database are: lung, prostate, colorectal, bladder, melanoma, non-Hodgkin lymphoma, thyroid, and kidney cancers. In South Africa, the National Cancer Registry reported the common histologically diagnosed cancers in men, in 2010 as: nonmelanoma skin cancers, prostate, primary site unknown, Kaposi sarcoma, lung, colorectal, oesophagus, non-Hodgkin lymphoma, bladder, stomach, melanoma, and head and neck cancers.
Colorectal cancer
Colorectal cancer is associated with obesity, sedentary lifestyle, and diet (heavy alcohol use, high-fat, low-fibre diet). Some are also related to genetic predisposition and family history of colon cancer. It is the second leading cause of cancer death and is common in all ethnicity. Symptoms include change in bowel habits, blood in the stool and unexplained weight loss. Unfortunately, advances in the treatment of colorectal cancer had been slow but development is ongoing. Fortunately screening is improving and fecal occult blood test, fecal immunochemical test and colonoscopy are the main methods of screening.
Testicular cancer
There are two types of testicular cancer: seminoma and nonseminoma. They usually affect young men (commonly age 20-35), presenting as a mass in the testicle. Once the diagnosis is confirmed, treatment (surgery, chemotherapy or radiation) will ensue according to stages. Testicular cancer is not so common and approximately 0.4% of men will be diagnosed with testicular cancer at some point during their lifetime, based on 2010-2012 SEER data. It is highly curable and most will survive with the survival rate of above 95% in five years. Treatment is intense when chemotherapy is required and may affect fertility. Sperm banking should be considered prior to treatment.
Prostate cancer
Prostate cancer typically affects older men. Presenting symptoms can be blood in urine, urinating problems such as dribbling, obstruction or difficulty passing urine. It most commonly spread (or metastasised) to bones and patients can complain of lower backache. Most early prostate cancers are treated initially with surgery, radiation or hormonal manipulation. In later stage or when prostate cancer metastasised (stage 4), suppression of testosterone may eventually fail to control the prostate cancer and patients may require systemic chemotherapy or newer novel anti-androgens. As with most cancers, early stages are often curable but stage 4 prostate cancer is not curable but controllable. The goal of controlling stage 4 prostate cancer is firstly for symptom control such as pain, but more importantly, to prevent serious complications. The most debilitating complication is vertebral compression fractures. These fractures can cause vertebral collapse, resulting in paralysis.
Lung cancer
Lung cancer occurs frequently in men. This is likely due to more men being tobacco smokers. Men are often employed in the mining industry, exposing them to asbestos, which is a known carcinogen for lung cancer and mesothelioma. Most lung cancers are diagnosed late as lung cancer symptoms are often absent in early stages of disease. Symptoms of lung cancer are increasing shortness of breath, chronic cough (sometimes associate with coughing up blood) and weight loss. Occasionally, lung cancer patients may present with hoarse voice. Some of these symptoms are very similar to TB infection and may have been treated as TB. If these symptoms do not resolve on TB treatment in two months, further investigations should be performed. Late diagnosis of lung cancer and advanced stage at diagnosis is associated with very poor prognosis. Stage 4 lung cancer carries the worst prognosis and is the number one cancer death in the world. The survival of stage 4 lung cancer is approximately six months without treatment and one year with chemotherapy. However, with the advances of checkpoint inhibitors immunotherapy, the survival is expected to improve dramatically if there is an initial response to treatment. Various clinical trials are currently in progress to compare the survival benefit between chemotherapy and immunotherapy.
Skin cancer
Melanoma and non-melanoma (basal cell carcinoma and squamous cell carcinoma) skin cancers affect both sexes. Non-melanoma skin cancers tend to affect older people, while melanoma can affect all ages. Sun and UV exposure are the main cause of skin cancer. Sun protection in the form of sunscreen and clothing protection are often suboptimal in young people. UV exposure in the form of tanning beds can precipitate melanoma formation and should be avoided. Sometimes, melanoma can occur in the foot or hands or fingers, a term called acral melanoma. Melanoma can also occur in mucosal areas such as in nose, mouth, anus and rectum, vagina and vulva and sometimes in the uvea of the eyes. It is vital to prevent and to treat melanoma early. Survival of stage 4 melanoma is often less than one year. Although advances are fast developing for the treatment of stage 4 melanoma, new treatments are often not accessible at present. Some of the promising treatments are BRAF inhibitors and anti-CTLA4 and anti-PD1 immunotherapies.
In general, men should be as vigilant as women in terms of awareness of cancer. Young men are more susceptible to lymphoma, melanoma skin cancer and testicular cancer. Older men should watch out for lung cancer, prostate cancer, colorectal cancer, lymphoma and all types of skin cancer. The strongest cancer-causing agent (carcinogen) remains cigarettes smoking, which has been linked to lung cancer, head and neck cancers, upper gastrointestinal cancers and bladder cancer.
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MEET OUR EXPERT – Dr Sze Wai Chan
Dr Sze Wai Chan is a medical oncologist at Sandton Oncology Centre. Her major interest is in the latest developments in cancer treatment. She is also involved in clinical research both locally and internationally.