Testicular CancerTesticular CancerPresentation at WHRHSAlex HohmannFebruary 18-19, 2014

Alex’s testicular cancerAlex’s testicular cancerFirst diagnosis in October 1996 (age 30):

surgery, radiation therapy and surveillanceSecond diagnosis in March 2008:

surgery and surveillanceExcellent prognosis

Alex’s post-diagnosis Alex’s post-diagnosis goalsgoalsLead healthy lifestyle and survive cancer

wellAdvocate, fund raise and educateRun third half marathon and first full

marathon in 2014

Basic facts about TCBasic facts about TCTesticular 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*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 Anatomy of testes and pelvispelvis

http://www.urologyhealth.org/urology/index.cfm?article=36

Early detection of TCEarly detection of TCExamine testicles at least once a monthLook 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 TCDiagnosis of TCUrologist will examine testicle and, if

indicated, order a scrotal ultrasound to be done right away

The ultrasound is quick and painlessUltrasound 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 Diagnostic and staging toolstools

Treatment of TC: first Treatment of TC: first stepsstepsEntire 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 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 StagesTC Stages

http://www.urologyhealth.org/urology/index.cfm?article=36

Treatment of TC: next Treatment of TC: next stepsstepsDepending 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 Effects of TC and treatmenttreatmentLoss 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

Alex’s lessons from cancerAlex’s 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 humorDon’t take health or life for grantedBe grateful for life by giving back to

othersDon’t be shy about speaking upEmbrace new challenges

Points to rememberPoints 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 oncologist

Ask questions and take good notesReach out for supportDon’t be shy about discussing health

issuesAbove all, don’t die of embarrassment!

Diagnosis-related Diagnosis-related definitionsdefinitionsUrologist: 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 Treatment-related definitionsdefinitionsInguinal 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 Other disorders of the testestestesVaricocele: 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