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Testicular Cancer - Case Summary

1. Biker Max Schuller detected a small mass in his right testicle when swelling occurred after a century bike ride. He had a history of orchiopexy at 12 months of age for an undescended testicle.

2. Common symptoms of testicular cancer include swelling and a mass or lump in the testis. There may be a heavy feeling in the scrotum, discomfort or pain.

3. Diagnosis is based on several factors. A physical exam confirms the mass and swelling. The physical exam is usually followed by an ultrasound to rule out other conditions that may cause swelling such as a hydrocele or varicocele. If the ultrasound confirms a mass, blood samples are drawn for tumor markers. Tumor markers for testicular cancer include alpha-fetoprotein (AFP), HCG, and LDH. These markers are used for diagnosis, cancer staging, and to monitor the course of the disease.

The stage of testicular cancer is determined using the TMN Staging system. T (tumor) assesses if the tumor is still confined or has spread. N (node) assesses if cancer has spread to regional lymph nodes. M (metastases) assesses if cancer has spread to distant lymph nodes or organs of the body. If there are serum tumor markers those are also assessed (S). Max’s cancer was staged as T2, N2, M0, S1 giving him an overall stage of IIB. This basically means that Max’s cancer has spread to nearby lymph nodes in the abdomen or pelvis, and serum tumor markers are slightly raised.

4. Max underwent an orchiectomy to remove the cancerous testicle. This does not affect fertility as the remaining testicle will continue to produce sperm. This was followed by two cycles of chemotherapy for a total of six weeks. Common chemotherapy agents for testicular cancer are BEP (Bleomycin, Etoposide, Platinum (also called Cisplatin)). Chemotherapy may lead to infertility. Because of this, Max was advised to freeze semen samples through a sperm bank. This increases his chance of fathering a child in the future. Max’s cancer responded well to the treatment. Tumor markers after the chemotherapy were within normal range and pelvic lymph nodes appeared normal in size. Retroperitoneal lymph node dissection (RPLND), removing the pelvic lymph nodes, is an option if the lymph nodes are still enlarged. There is a risk from this surgery of nerve damage which could cause permanent sexual dysfunction and retrograde ejaculation where the semen flows from the prostate to the bladder instead of out of the urethra.

5. The risk for developing testicular cancer for a male is about 1 in 270 which is quite low. This rate has been increasing in the United States and other countries without explanation. The risk of dying of testicular cancer is only 1 in 5,000. There is a 95% survival rate if the cancer is detected in early stages. Even if cancer has metastasized, there is still a 74% survival rate. This is typically a disease of younger men affecting men between the ages of 15-35.

6. While testicular cancer cannot be prevented, it can be detected early by performing monthly testicular self-exams; checking for lumps while rolling the testicle between the thumb and fingers. Lumps may be as small as a pea or larger. Testicles should also be checked as part of a yearly physical exam with a physician.

7. Max was first seen by his family physician that performed a testicular exam and referred Max to an Oncologist. The oncologist confirmed the diagnosis of testicular cancer based on imaging and serum tumor markers. The oncologist coordinated all steps of the treatment for Max and monitored his cancer through imaging and tumor serum marker levels. A surgeon with the assistance of surgical nurses and technicians removed the cancerous testicle. The tumor was sent to a pathologist who analyzed the tissue and from this analysis assisted in the staging of cancer. Surgeons operating on cancer patients may have received a specialty in surgical oncology. Radiology technicians with specialties in ultrasound and Computed Tomography (CT) performed the imaging. Medical Laboratory Scientists performed the tumor marker studies and other blood work.