Micrometastases - Spreading after removal of tumor

Micrometastases are the undetectable areas of cancer that can occur after the tumor has been removed. Those cancerous cells are too small to be detected with CT Scans or PET Scans (often not covered by Health Insurance). This is the gamble when deciding whether adjuvant therapy or surveillance are the right option if the CT Scan are clean after the removal of the tumor. An adjuvant therapy (Radiotherapy or a mild Chemotherapy - Paraplatin / Carboplatin) can further decrease the relapse rate.

Article about Treatment options for Seminoma: Stage I (including statistics of studies)

Treatments - Radiotherapy or Chemotherapy or Surveillance

Article about Treatment options in general as well as arguments for surveillance as well as Radiotherapy

Article about
Treatment options including the new Paraplatin (Carboplatin) option used in places in Europe and in New York.

The Surgery - Orchiectomy

The urologist can determine based on a completely painless ultrasound examination (around 800 dollars in the US) whether the mass in the testicle is most likely a tumor or a cyst.  If it is likely to be a tumor it will need to be removed together with the testicle through an incision in the groins.  They won't touch the scrotum itself.  

The operation is necessary to avoid further spreading of cancerous cells through the lymph or blood system.  The type of tumor affects the spreading behaviour and also further post surgery treatment options.

The recovery from the operation took me about 5 weeks.  I was able to walk slowly with some pain after about 3 days.  I took painkillers for about a week.  After one week I was able to walk more or less normally however needed to take breaks every 10 or 15 minutes.  The pain in the groins from the operation was accompanied by a sharp short reoccuring pain in the top of the scrotum where the leg and the scrotum join.  This was according to my urologist a normal occurence.  It disappeard after about 3 to 4 weeks.  Sitting for longer periods of time was also accompanied with little pain and discomfort until week 4 or 5.  I am currently in my 7th week and am able to walk  at normal speed with no pain whatsoever and sitting is also not problematic anymore.

<a href="http://tcrc.acor.org/orch.html" target="_new">A great detailed article about the Orchiectomy</a>

Stages

A case of testicular cancer is categorized as being in one of three stages (which have subclassifications). Stage one is that in which the cancer remains localized to the testicle. In stage two, the cancer has spread to the nearest lymph nodes, which are small, bean-shaped structures that produce and store infection-fighting cells, in the abdomen. In stage three, the cancer has spread farther, to locations that may include the kidneys, liver, bones, lungs, or brain. The majority of cases are stage 1 when first identified; stage 3 is relatively rare.

Tumor Markers in the blood

Markers for tumours include human chorionic gondaotrophin HCG, alpha-feto protein (AFP) for teratomas (more a marker of treatment progress) and placental alkaline phosphatase for seminomas.

Pathology

Testicular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm. They are not pathogenic; i.e., they are not to be confused with the "germs" (viruses, bacteria) that cause illness.) In general, the remainder of this article discusses germ-cell testicular cancer.

Germ-cell tumors are classified as either seminomas or nonseminomas (e.g. teratomas). Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be localized (i.e., only in the testicles), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more-mature germ cells and spread more quickly. (Nonseminomas are classified as one of three or four subtypes; their rate of spread varies somewhat, but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma.

Medical Test

1) Physical examination.

2) Blood Test. This test will be looking for the serum blood markers, beta HCG and alpha-fetoprotein that indicate the presence of cancer. Up to 50 per cent with early stage non-seminoma type testicular cancer do not show these markers.

3) Ultrasound can show whether or not there are abnormalities in the scrotum. High frequency waves called a sonogram can show the presence of a testicular tumor even when it is very small and undetectable by physical examination.

4) Biopsy of the tumor. Because of the high risk of contamination and spread of the cancer by doing a scrotal biopsy, the affected testicle is almost always removed through an inguinal incision and the tissue is examined. The sample will show the type of cancer. Seminoma (40%) is the most common subtype. Nonseminoma subtype account for the rest and include teratocarcinoma and embryonal cell carcinoma.

Further tests will be carried out by the doctor to check if cancer has spread.



menshealth.about.com : Test

The Self Examination

Best Performed after a warm shower or bath:

1 - In front of mirror: Check for swelling on the scrotal skin

2 - Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top.

3 - Roll the testicle gently between the thumbs and fingers -- you shouldn't feel any pain when doing the exam. Don't be alarmed if one testicle seems slightly larger than the other, that's normal.

4 - Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. If you are familiar with this structure, you won't mistake it for a suspicious lump. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front. Lumps on the epididymis are not cancerous.

5 - If you find a lump on your testicle, see a doctor, preferably a urologist, right away. The abnormality may not be cancer, it may just be an infection. But if it is testicular cancer, it will spread if it is not stopped by treatment. Waiting and hoping will not fix anything. Please note that free floating lumps in the scrotum that are not attached in any way to a testicle are not testicular cancer. When in doubt, get it checked out - if only for peace of mind!


Links:

How to do the self examination

www.aafp.org

www.tc-cancer.com/selfexam.html

Symptoms of Testicular Cancer

- a pulling sensation or feeling of unusual heaviness in the scrotum
- a dull ache in the groin or lower abdomen
- pain or discomfort (which may come and go) in the testicle or scrotum
- tenderness or enlargement of tissue in the breast area
- a sudden collection of fluid in the scrotum (called a hydrocele).

In my case the pain started almost not noticeably. It just felt like a mild, short stinging pain starting in the testicle and reaching out into the groins.



Links:

Cancerhelp.org.uk

What is Cancer

Links:

Cancer.org - What is Cancer

Statistics

- 2006: 8250 new cases of TC predicted by American Cancer Society.
- 2006: 370 men will die of TC.
- Rate increasing. Reasons still unkown.
- Increase mostly seminomas.

- Survival Rate: 96%.
- Survival Rate if cancer has not spread: 99%!
- 5 Year survival Rate if cancer has spread beyond Lymph Nodes: 72%.


Links:

Cancer.org

Cancer.gov

Basic Testicular Cancer Facts

- Testicular cancer is the most common cancer in young men between the ages of 15 and 35 years old, but it can strike any male, any time.
- Testicular cancer is almost always curable if it is found early.
- Most testicular cancers are found by men themselves, either as a painless lump, a hardening or change in size of the testicle, or pain in the testicle.
- Children born with an undescended testicle have an increased risk of getting testicular cancer regardless of whether surgery is done to correct the problem. However, the surgery should still be done to preserve fertility.
- Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, surveillance, or a combination of these treatments.


Links:

Testicular Cancer Resource Center - TCPRIMER

Introduction

Hello.

I have been diagnosed with Testicular Cancer (Seminome) a few weeks ago and have successfully undergone surgery, after switching doctors 3 times! I have a couple of days of radiation ahead of me. TC has a high recovery rate even when discovered at a late stage I have read online. The internet has served as a great resource to prepare myself to talking to doctors and be able to judge their competence a little better.

You can read up on my personal experience on this blog (Testicular Cancer on Easter). On this blog I will assemble information I am finding on the internet for myself, but I hope that it will be helpful for other people as well.

Thank you.

--ER