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Testicular Cancer. Presentation at WHRHS Alex Hohmann February 18-19, 2014. Alex’s testicular cancer. First diagnosis in October 1996 (age 30): surgery, radiation therapy and surveillance Second diagnosis in March 2008: surgery and surveillance Excellent prognosis.

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Testicular cancer

Testicular Cancer

Presentation at WHRHS

Alex Hohmann

February 18-19, 2014

Alex s testicular cancer
Alex’s testicular cancer

  • First diagnosis in October 1996 (age 30): surgery, radiation therapy and surveillance

  • Second diagnosis in March 2008:surgery and surveillance

  • Excellent prognosis

Alex s post diagnosis goals
Alex’s post-diagnosis goals

  • Lead healthy lifestyle and survive cancer well

  • Advocate, fund raise and educate

  • Run third half marathon and first full marathon in 2014

Basic facts about tc
Basic facts about TC

  • Testicular 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 US

  • Accounts for only 0.5% of all cancer cases

  • Most common cancer in men ages 15 to 40

  • Median age at diagnosis is 33

  • Lifetime risk is about 1 in 250

  • Just under 400 deaths/year

  • Overall 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 pelvis
Anatomy of testes and pelvis


Early detection of tc
Early detection of TC

  • Examine testicles at least once a month

  • Look 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 tc
Diagnosis of TC

  • Urologist will examine testicle and, if indicated, order a scrotal ultrasound to be done right away

  • The ultrasound is quick and painless

  • Ultrasound 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

Treatment of tc first steps
Treatment of TC: first steps

  • Entire 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 stages
TC Stages


Treatment of tc next steps
Treatment of TC: next steps

  • Depending 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 treatment

  • Some stage 1 patients elect adjuvant radio- or chemotherapy to reduce relapse risk

  • Relapse (cancer shows up again, often in lymph nodes) must be treated immediately with chemo- or radiotherapy

Effects of tc and treatment
Effects of TC and treatment

  • Loss of one testicle does not usually impair testosterone and sperm production

  • Radio- or chemotherapy can impair sperm production so some men bank sperm first

  • A second TC is very rare but results in loss of fertility and need for hormone replacement

  • Properly 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 cancer
Alex’s lessons from cancer

  • There was no known way of avoiding TC

  • There are others facing the same thing

  • There can be a great life after cancer

  • Keep a sense of humor

  • Don’t take health or life for granted

  • Be grateful for life by giving back to others

  • Don’t be shy about speaking up

  • Embrace new challenges

Points to remember
Points to remember

  • Know your body

  • Live a healthy lifestyle

  • Get a complete physical regularly

  • See a doctor ASAP at any sign of trouble

  • Have someone (e.g. loved ones) with you if you have to see a urologist or oncologist

  • Ask questions and take good notes

  • Reach out for support

  • Don’t be shy about discussing health issues

  • Above all, don’t die of embarrassment!

Diagnosis related definitions
Diagnosis-related definitions

  • Urologist: 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 definitions
Treatment-related definitions

  • Inguinal 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 testes
Other disorders of the testes

  • Varicocele: swelling of testicular blood vessels

  • Hydrocele: accumulation of fluid in scrotum

  • Epididymitis: inflammation of the epididymis

  • Orchitis: inflammation of the testicles

  • Primary hypogonadism: low testosterone due to failure of testes to produce it

  • Cryptorchidism: undescended testicle

  • Testicular torsion: interruption of blood supply due to twisting of spermatic chord

  • Testicular rupture due to blunt force