Testicular cancer

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What's next?

whatllhappen
Posted by

Hi Everyone,

Thank you in advance for reading this post and for your comments.

March 2018: During a business trip, I had middle-back "muscle" pain. I thought It was from the A/C and the awkward sleeping position during flight. The type of pain was consisent on the middle back muscles. When I am back, I had 3-4 sessions of "trigger point massage" which relieved the pain eventually. The pain did not come back.

30th of May: I had stomach pain and I started having high fever so I went to emergency care. They found WBC (leucocyte) and NEU (neutrophils) are 50% above their respective normal ranges. I couldn't give a sample for a stool test so the doctor could only suspect of a potential intestinal infection and we started antibiotics. In addition to the stomach pain, I also had short-sharp middle-back pain (mostly on my lats) at that day. The doctor saw intestinal gas and stomach gas on my X-ray so he concluded that the pain is due to the presence of "gas" on my stomach and intestines.

4th of June: I felt my left testicle "heavier than usual" on last Monday. The next day, I went to see an urologist who told me that I am right with my suspicion. We did ultrasound and blood tests and the results are below:

Ultrasound report: The left testicle dimensions are 40x18mm. In the bottom part of the left testicle, 16x15mm sized peripherial heterogeneous hypoechoic solid massive lesion was observed. A significant vascularity increase like a peripherial hale surrounding the lesion was noticed. The 16x15 mm sized peripherial heterogeneous hypoechoic solid massive lesion (which shows a dense vascularity increase) is corresponding/conforming to a primer testicle tumor.

Blood Tests: (We might be using different units in this part of the world, so I specified the normal ranges)
-

Marker Result Unit Normal Range
LDH 134 U/L 135-225
AFP 3,1 ng/mL 0,00-7,00
Beta-HCG 0,1 mIU/mL 0,00-2,00

-

8th of June: Orchiectomy done, left testicle removed. Pathology report will be available within 3-4 days.

My question is: what do you think are the odds that the cancer has spread to other areas? Considering the types of middle-back pain that I had: In March 2018 the "consistent" middle-back pain was gone when I had 2-3 sessions of deep tissue massage. And two weeks ago I had short attacks of sharp pain when I had stomach and intestinal gas.

While waiting for the pathology report and before the CT-scan, I am trying to figure out If the cancer has spread to other areas based on the symptoms that I had in the past.

UPDATE:

11th of June: Pathology report is as below:

- Seminoma (WHO/IARC ICD-O: 9061/3)
- p T1aNx / AJCC-2016 , Prognostic group: IA
- Tumor size: 1.7x1.5x1.5 cm
- Tumor spread status: Tumor contained within the testicle
- Lymphovascular invasion is not present.

UPDATE 2:

13th of June: CT-Scan oberservation report says that on the bottom part of the right lung, 7 mm diameter nodule which shows ground-glass density appearance was observed.

The Board of Ocology at the hospital concluded: Surveillance, next CT-scan is in 2 months to check whether or not the 7 mm diameter ground-glass nodule (in the right lung) is increasing in diameter or not.

Final Question: Have you had ground-glass nodules related with the testicular cancer?

winter_knight
Posted by

Hello whatllhappen,

First of all, well done for being so proactive when recognising any symptoms.


Have you read through my own post from yesterday?

It seems that I presented with a similar sequence of symptoms. Back pain followed by a renewed pain in the groin / lump.


However, my pain was predominantly in the lower back, which I later found out was in part because of tumours in the lymph nodes pressing on the nerves. The fact that yours is higher up, your normal tumour marker levels and the size of the removed tumour hopefully means that things haven't progressed.


Of course, this is all guesswork and results will be the only true indicator. It's easy to say "don't worry about it until you find out" but I know it's never that simple - just know you've done everything you can so far - the rest is just a waiting game!


I wish you the best of luck - let us know how you get on with the results.


x


whatllhappen
Posted by

Hi winter_knight,

thank you for your reply. I did read your post and I felt sorry what has happened in your case (the delay in diagnosis). My urologist would't have let you go away without removing the testicle.

Like in your case and the information online describes that the pain is usually in the lower-back because that's the closest place the testicular cancer can spread. However there are also cases of "long distance methastasis" to lungs and liver and I was wondering where the pain would be in such cases. Middle-back and lats like in my case? What would be the type of pain? Would it go away with a few sessions of deep tissue massage?

Whatever I read online, there are always exceptions. There are TNMS classifications for people with normal marker levels but long-distance spreads. According to a study, the chances of tumors less than 2 cm to do metasthasis is higher than tumors greater than 2 cm (strange, right?).

So, I thought If I can make a prediction based on the type of pain that I had comparing to the other people's experience.

gregm
Posted by

Hi Whatlhappen,

Back pain is such a common complaint for thousands of reasons other than TC, and is not very definitive for those with TC, that its not much use in diagnosing spread. That's what a CT Scan is for, and you'll be getting one shortly. Any guesses we make now on staging isn't going to change the outcome of that scan or where it is or isn't. What we can do is help you prepare mentally for whatever the full diagnosis is.

I had upper middle backpain, between my shoulder blades, and I had Stage 2c. Its incredibly unlikely that yours will be any further than that and not in any other organs (Stage 3). M tumour was pretty big, yet all it took was 12 days treatment spread over 9 weeks - mostly a very dull experience and much drudgery, I've had worse colds.

So, given that many people with a TC diagnosis do require some chemo to mop up any escaped cells, I would mentally prepare for the full 9 week treatment, and anything else less than that is a bonus.

The good news is you've spotted it, the primary is out, and all that's left now is some clean up treatment.

Greg

whatllhappen
Posted by

Hi Greg,

I have been reading your comments here since the last few days and I am glad you gave me a reply.

Coming back to the back pain symptoms, mine was between my shoulder blades too. Can you please tell me If your back-pain was similar to a muscle pain? Because mine felt like a muscle pain so I took a few sessions of massage therapy which solved the problem in a week time and It did not come back again. This pain was "constant" in the muscles until we relieved it with massage. I read your earlier posts where you described that the pain was gone when you stood up but it started again when you lied back in the bed for a few more hours of sleep.

Until two weeks ago, when I had a completely different type of back pain (short but sharp, needle type of middle back pain in the middle back between shoulder blades), associated with fever and infection, initially concluded by the emergency doctor as a result of stomach gas.

Can you please try to describe your type of back-pain?

Moreover, I know from your earlier posts that you tell it will reveal in the pathology report whether or not the cancerous cells contained within the testicle. My ultrasound report says that the tumor was at the bottom part of my left testicle (using past tense for my left testicle feels strange) which means that the tumor was not inside the left testicle, but the tumor was on the outer sole of the testicle (please refer to my original post for the details of the ultrasound report). So do you think that there is bigger chance that it was spread due to tumor being on the outer shell of the testicle?

Thank you in advance for your comment.

gregm
Posted by

Hi,

I had two back pain symptoms, one felt sharp like someone pressing the knuckle of a finger hard between my shoulder blades, and the other was less acute but more persistent and achy lower back pain that was bad when sleeping. It was the latter that drove me to the docttor (after trying physio). The other significant symptom was occassional drenching night sweats.

I don't think the tumours themselves are painful, the lymph nodes probably don't have nerves(?), but its the effect they have on the neighbouring body parts. i don't know what caused the shoulder blade pain, but the lower back pain was my kidneys complaining that they couldn't drain when the tumour was resting on the outlet.

Many people have backache during a TC diagnosis, and it turns out to be unrelated.

WIth regards to the tumour placement, I don't think that gives much clue as to spread or not.

I remember when I had my diagnosis, and asking the doctor how long he thought I'd had it for it to be the size it was. He just shrugged and said doesn't matter, and not of interest, we know how to treat it. We all try to ask why, or how, or if, during the diagnosis stage, but it will have no effect on what's to come - that's fixed now and you'll know soon enough.

Take care,

Greg

whatllhappen
Posted by

Hey Greg,

Here is the latest update:

11th of June: Pathology report is as below:

- Seminoma (WHO/IARC ICD-O: 9061/3)
- p T1aNx / AJCC-2016 , Prognostic group: IA
- Tumor size: 1.7x1.5x1.5 cm
- Tumor spread status: Tumor contained within the testicle
- Lymphovascular invasion is not present.

I assume that this is not a bad thing and we will still need the CT-Scan to come out.

Can I have your comments on the pathology report?

gregm
Posted by

Hi,

That's a good report, a Stage 1A seminoma diagnosis - the only stage less than that is 'false alarm'.

The tumour is pretty small, still contained within the testicle and zero evidence that it has spread towards any of the exits. The chances of it having spread (and being any cause of backache) would be pretty slim indeed.

So, Stage 1A diagnosis unless the CT scan disagrees, likelihood of full cure, 101%.

Most likely treatment option is surveillance - nothing more needs doing. They might give the choice of a single shot of carboplatin, but I don't think they will.

Greg

whatllhappen
Posted by

Hey Greg,

Here is the latest update in my case:

13th of June: CT-Scan of bottom and upper abdomen are all good. But the chest CT oberservation report says that on the bottom part of the right lung, 7 mm diameter nodule which shows ground-glass density appearance was observed.

The Board of Oncology decided to put me on survelliance, the next CT-scan is in 2 months to see whether or not the 7 mm diameter ground-glass nodule is increasing in diameter or not.

Final Question: Have you had ground-glass looking nodules related with the testicular cancer? What is the type of "appearance" nodules make related with a spread from seminoma or testicular cancer in general?

Thank you for your support all the way to here,

Sincere regards.

gregm
Posted by

They told me my prosthesis was made of silicone, it seems it might be a crystal ball... they've put you on surveillance only.

TC nodules are organic, and with veins (vascular), rather than ground glass. Perhaps you inhaled a ball-bearing as a child? Not sure what it is, but they'll be keeping an eye on it.

Congratulations on the surveillance only diagnosis!

Greg

whatllhappen
Posted by

Thanks Greg, I will keep you posted on regular CT-scan surveillance progress.

whatllhappen
Posted by

Hi Greg,

It has been 3 weeks since the orchiectomy and I have a pain on my left side bottom rib-cage (on the side of my elbow). There is still 6 weeks until the follow up (second) CT.

I don't know If this can be related with TC or Am I just worrying and causing myself a psychological-unconscious pain? It can also be due to aircondition, I must add.

I don't know If I should go and see a doctor before the next CT and appointment. Any advise?

gregm
Posted by

Hi,

It is extremely, extremely unlikely to be anything sinister. We've had others with pulled muscles and twinges, often because they move awkwardly or sleep in a new position to alleviate discomfort from the operation. If the last CT didn't show anything in that area, then nothing new could have occurred there in such a short time. It may be manageable just with pain killers and some rest, but if not, then DO go and see your doctor, just to check it is isn't something else, unrelated to TC.

Not something to worry about with regards to TC, and you have a follow-up CT booked already. If it doesn't get better in a few days then pop along to see your doctor.

G.

PS: here is a recent example of someone else with aches after the operation, that went away with rest