Transcript Cancer of the Testes

Testicular Cancer
Presentation at WHRHS
Alex Hohmann
February 18-19, 2014
Alex’s testicular cancer
First diagnosis in October 1996 (age 30):
surgery, radiation therapy and surveillance
 Second diagnosis in March 2008:
surgery and surveillance
 Excellent prognosis

Alex’s post-diagnosis goals
Lead healthy lifestyle and survive cancer well
 Advocate, fund raise and educate
 Run third half marathon and first full
marathon in 2014
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Basic facts about TC
 Testicular
cancer includes different cancer
cell types (seminoma vs non-seminoma) that
usually appear first in the testes
 TC
does not have any clearly identified causes
 Men
with TC were most likely born
predisposed to it
 TC
rates seem to be higher in men born with
an undescended testicle and are highest
among Caucasian men
TC by the numbers*
 About
8000 new cases/year in the US
 Accounts
 Most
common cancer in men ages 15 to 40
 Median
age at diagnosis is 33
 Lifetime
 Just
for only 0.5% of all cancer cases
risk is about 1 in 250
under 400 deaths/year
 Overall
5-year survival rate of 95%
 Localized
(confined to testes) survival of 99%
* All figures from the Sean Kimerling Testicular Cancer Foundation, National Cancer Institute, and American Cancer Society
Anatomy of testes and pelvis
http://www.urologyhealth.org/urology/index.cfm?article=36
Early detection of TC

Examine testicles at least once a month

Look for presence of a pea-sized mass
attached to testes or for scrotal enlargement

Other symptoms may include feeling of
heaviness in scrotum, severe and worsening
back ache, breast tenderness

See a urologist at the first sign of any of
these symptoms. Do not delay.
Diagnosis of TC

Urologist will examine testicle and, if
indicated, order a scrotal ultrasound to be
done right away

The ultrasound is quick and painless

Ultrasound images are examined by a
radiologist who will report back to the
urologist if there are signs of a tumor

Urologist will draw blood and order a CT
scan to be done right away
Diagnostic and staging tools
Treatment of TC: first steps

Entire testicle must be removed in a short
procedure called an inguinal orchiectomy,
usually done on an outpatient basis

Biopsy of the testicle, CT scan, and blood
tests determine type (seminoma vs nonseminoma) and staging (1, 2, 3)

Post-orchiectomy treatment and follow-up
vary according to type and stage and are
done under the care of an oncologist
TC Stages
http://www.urologyhealth.org/urology/index.cfm?article=36
Treatment of TC: next steps

Depending on cell type, stage 1 TC may
require only follow-up testing (surveillance)

Non-seminoma may require further surgery
(e.g. RPLND) for biopsy or treatment

Some stage 1 patients elect adjuvant radio- or
chemotherapy to reduce relapse risk

Relapse (cancer shows up again, often in
lymph nodes) must be treated immediately
with chemo- or radiotherapy
Effects of TC and treatment

Loss of one testicle does not usually impair
testosterone and sperm production

Radio- or chemotherapy can impair sperm
production so some men bank sperm first

A second TC is very rare but results in loss of
fertility and need for hormone replacement

Properly treated and followed up by a doctor,
majority of TC survivors have normal sexual
performance and live a fully and healthy life
Alex’s lessons from cancer

There was no known way of avoiding TC

There are others facing the same thing

There can be a great life after cancer

Keep a sense of humor

Don’t take health or life for granted

Be grateful for life by giving back to others

Don’t be shy about speaking up

Embrace new challenges
Points to remember
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Know your body
Live a healthy lifestyle
Get a complete physical regularly
See a doctor ASAP at any sign of trouble
Have someone (e.g. loved ones) with you if
you have to see a urologist or oncologist
Ask questions and take good notes
Reach out for support
Don’t be shy about discussing health issues
Above all, don’t die of embarrassment!
Diagnosis-related definitions

Urologist: doctor specializing in genito-urinary
disorders such as testicular cancer, bladder cancer,
prostate cancer, incontinence, infection, etc.

Oncologist: doctor specializing in treatment of cancer,
often specializing in specific cancers

CT (computed tomography) scan: x-ray “slices” of the
body to produce three-dimensional image

Ultrasound: widely used sound wave technology used
to produce medical images

Biopsy: examination of tissue samples under
microscope for isolation and identification of
abnormalities such as cancer cells
Treatment-related definitions

Inguinal orchiectomy: surgical removal of a testicle
done through a small incision in the groin and thus not
involving incision in the scrotum itself

Radiotherapy: destruction or reduction in size of
masses in isolated parts of the body using radiation of
specific form, intensity, duration and frequency,
usually but not always in exterior beam form

Chemotherapy: destruction or reduction of solid
masses or diffuse cancer cells using cell-specific
chemical agents in precise combination, timing, and
dosage, usually but not always intravenously
Other disorders of the testes

Varicocele: swelling of testicular blood vessels

Hydrocele: accumulation of fluid in scrotum

Epididymitis: inflammation of the epididymis

Orchitis: inflammation of the testicles

Primary hypogonadism: low testosterone due to failure
of testes to produce it

Cryptorchidism: undescended testicle

Testicular torsion: interruption of blood supply due to
twisting of spermatic chord

Testicular rupture due to blunt force