What's the damage, doc?

The source of the cancer was removed and on a jet plane to Arizona to be analyzed. The surgery was on a Friday and my urologist told us to call the following Wednesday to hear the pathology report. This is basically the biopsy report. It helps to identity the type of TC and help stage it. Having done plenty of research I was hoping for what is called a classic seminoma. This is a type of TC that spreads very slowly and is very responsive to radiation treatment. It is the type of TC that is more likely to be treated with the removal of the testicle and nothing else. The other common type of TC is nonseminoma, and there are several sub types within nonseminoma. This is the more aggressive of the two types and tends to spread much quicker. It is generally treated with more surgery and or chemotherapy. So you can see why I was hoping that the pathology report would come back telling me it was a classic seminoma.

I called the urologist on Wednesday and disappointingly the pathology report was not complete. Such was the case on Thursday and Friday. In fact, it was still not completed through the next week. Finally the following Thursday arrived and I was scheduled for a post-op appointment with my urologist. The pathology report was finally complete and I would hear the news from Dr Stout at her office. I received 95% of what I was hoping for. The tumor was 95% classic seminoma. Unfortunately the tumor also contained 5% nonseminoma which contained two sub types, Embryonal carcinoma and yolk sac. Even though the tumor was 95% seminoma, it would have to be treated as a nonseminoma.

Up to this point I had remained extremely positive. I felt good about everything and was prepared to put up a strong fight. This was the first time since finding out I had a tumor that I really felt scared. The survival rate for those with seminoma is and outstanding 98%. For nonseminoma it is a little closer to around 90 or 92%. Still outstanding but if someone told you there was a 10% chance you would die in a car accident on the way home from work today it would probably make you a little nervous. Nevertheless, I am extremely optimistic and excited to face this head on. Another element of the pathology report that wasn't in my favor was the presence of vascular invasion. This means that the cancer had leaked into the veins. This is the launching pad for the cancer to spread to the lymph nodes in the stomach. Part of what makes testicular cancer so treatable is its predictability. The first place that TC spreads to is the lymph nodes in the stomach. This being the case the next step is to have a C/T scan looking for tumors in the lymph nodes. However, statically speaking, whether or not tumors show up on the scan, there is better than a 50% chance the cancer has spread. Micro metastasis is too small to be picked up on the scans but will develop into cancer sooner or later. This can cause false negatives on a C/T scan.

Dr. Stout explained the pathology report and then we discussed what the potential treatment plan would be depending on the results of the C/T scan. This is the part that is causing the majority of my stress at the moment. It gets confusing so pay attention :) If the C/T scan comes back positive, in other words it comes back showing enlarged lymph nodes, then the cancer has more than likely spread. This would put it at Stage II, nonseminoma testicular cancer. The treatment would call for chemotherapy and likely surgery to remove some lymph nodes. This type of cancer is highly responsive to chemo. If the C/T scan comes back negative, showing no evidence of enlarged lymph nodes, then the cancer would be stage a late Stage I nonseminoma. Meaning the cancer is isolated to the testicle but has signs that it may have spread. Interestingly enough, the standard protocol for this is surgery. It is called Retroperitoneal Lymph Node Dissection. Yes, it is as bad as it sounds. Basically they go in, push all your 'insides' to the side, go all the way behind your stomach, and remove a bunch of lymph nodes. Usually you are in the hospital for five days before you are released. There are also some pretty important nerves that run through that area that if nicked could do some damage. You are probably asking the same question I am right now.... why go through such an intrusive surgery when there isn't any identified cancer? It is partially to diagnose if there is cancer there, remember, there is a 50% it is there even if it doesn't show up on the scan. And two, if there is cancer then it can possibly be completely removed without the need of future chemotherapy. Chemotherapy isn't exactly the equivalent of eating your fruits and vegetables and its fairly likely it will leave you sterile. So if you can avoid it all the better. However, there is still a 50% chance that the cancer has not spread and you are performing needless surgery. If you do not have the surgery though, you will spend the next several years having monthly C/T scans, x-rays, and blood work. If the cancer does show up down the road, early detection along with chemotherapy almost always kills the cancer completely.

I had the C/T scan on Saturday. It wasn't bad but I could definitely do without the barium. I dealt with its after affects half of the day. It should only take a couple of days to get the results back. Once the results are in I am guessing I will meet again with my urologist and probably an oncologist as well to determine a course of treatment. I will also need another blood test to see if there has been a change in the tumor markers. There are many components that go into consideration when deciding on a course of treatment. At this point I have to be prepared for surgery and chemo, although I am hoping I only have to deal with one of the two.