Testicular CancerPresentation at WHRHSAlex HohmannFebruary 18-19, 2014

Alexs testicular cancerFirst diagnosis in October 1996 (age 30): surgery, radiation therapy and surveillanceSecond diagnosis in March 2008: surgery and surveillanceExcellent prognosis

Alexs post-diagnosis goalsLead healthy lifestyle and survive cancer wellAdvocate, fund raise and educateRun third half marathon and first full marathon in 2014

Basic facts about TCTesticular cancer includes different cancer cell types (seminoma vs non-seminoma) that usually appear first in the testesTC does not have any clearly identified causesMen with TC were most likely born predisposed to itTC 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 USAccounts for only 0.5% of all cancer casesMost common cancer in men ages 15 to 40Median age at diagnosis is 33Lifetime risk is about 1 in 250Just under 400 deaths/yearOverall 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 pelvishttp://www.urologyhealth.org/urology/index.cfm?article=36

Early detection of TCExamine testicles at least once a monthLook for presence of a pea-sized mass attached to testes or for scrotal enlargementOther symptoms may include feeling of heaviness in scrotum, severe and worsening back ache, breast tendernessSee a urologist at the first sign of any of these symptoms. Do not delay.

Diagnosis of TCUrologist will examine testicle and, if indicated, order a scrotal ultrasound to be done right awayThe ultrasound is quick and painlessUltrasound images are examined by a radiologist who will report back to the urologist if there are signs of a tumorUrologist will draw blood and order a CT scan to be done right away

Diagnostic and staging tools

Treatment of TC: first stepsEntire testicle must be removed in a short procedure called an inguinal orchiectomy, usually done on an outpatient basisBiopsy of the testicle, CT scan, and blood tests determine type (seminoma vs non-seminoma) 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 Stageshttp://www.urologyhealth.org/urology/index.cfm?article=36

Treatment of TC: next stepsDepending 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 treatmentSome stage 1 patients elect adjuvant radio- or chemotherapy to reduce relapse riskRelapse (cancer shows up again, often in lymph nodes) must be treated immediately with chemo- or radiotherapy

Effects of TC and treatmentLoss of one testicle does not usually impair testosterone and sperm productionRadio- or chemotherapy can impair sperm production so some men bank sperm firstA second TC is very rare but results in loss of fertility and need for hormone replacementProperly treated and followed up by a doctor, majority of TC survivors have normal sexual performance and live a fully and healthy life

Alexs lessons from cancerThere was no known way of avoiding TCThere are others facing the same thingThere can be a great life after cancerKeep a sense of humorDont take health or life for grantedBe grateful for life by giving back to othersDont be shy about speaking upEmbrace new challenges

Points to rememberKnow your bodyLive a healthy lifestyleGet a complete physical regularlySee a doctor ASAP at any sign of troubleHave someone (e.g. loved ones) with you if you have to see a urologist or oncologistAsk questions and take good notesReach out for supportDont be shy about discussing health issuesAbove all, dont die of embarrassment!

Diagnosis-related definitionsUrologist: 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 cancersCT (computed tomography) scan: x-ray slices of the body to produce three-dimensional imageUltrasound: widely used sound wave technology used to produce medical imagesBiopsy: examination of tissue samples under microscope for isolation and identification of abnormalities such as cancer cells

Treatment-related definitionsInguinal orchiectomy: surgical removal of a testicle done through a small incision in the groin and thus not involving incision in the scrotum itselfRadiotherapy: 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 formChemotherapy: 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 testesVaricocele: swelling of testicular blood vesselsHydrocele: accumulation of fluid in scrotumEpididymitis: inflammation of the epididymisOrchitis: inflammation of the testiclesPrimary hypogonadism: low testosterone due to failure of testes to produce itCryptorchidism: undescended testicleTesticular torsion: interruption of blood supply due to twisting of spermatic chordTesticular rupture due to blunt force