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3 Masses Discovered on Ultrasound - 2 on Left and 1 on Right

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  • 3 Masses Discovered on Ultrasound - 2 on Left and 1 on Right

    Let me start by saying that I am 44 years old, married with two nearly grown sons and completely done with having children.

    The past week has been... life changing. On Monday (10/2) I saw my primary care physician to discuss the fact that I have very low testosterone (<250 ng/dL) and my high blood sugar. Initially she just wanted me to start TRT, but I didn't feel right about it and said that I wanted to understand why my testosterone was so low. I told her that I was concerned that it may be related to the fact that 6 years ago a different primary mentioned detecting a cyst but said it was nothing to worry about. Based off of this, she referred me to urologist.

    Amazingly, I was able to see a urologist the very next day (10/3). He palpated the cyst, which was just a spermatocele and told me it was nothing to worry about and started talking about TRT, just like my primary. I pushed back, explaining that things just didn't feel right and that I really wanted to figure out what was wrong before starting TRT. He offered to order an ultrasound to rule out any other problems.

    Thursday (10/5) I went in for the ultrasound. The tech put the image up on the screen as she was doing the scan so that I could see what she was doing. This is where it got VERY surreal. As I watched she viewed my left testis and immediately noticed a mass with another mass next to/connected to it. She then went onto my right testis and discovered one mass there. She performed additional sonography and confirmed that each of them were not just on the exterior of the testes. It was past 5:00 p.m., so the tech sent the images to the on-call radiologist to have them read ASAP.

    The next day (10/6) I didnít hear anything from my urologist by 11:00 a.m. so I called them. It seems my urologist was out of the office. I told the receptionist that I had an ultrasound the previous day and they found a mass. She said she would pass the message to the doctorís nurse. At about 3:00 p.m. I received a call from another urologist from the practice who read the radiologist report since my urologist was out. She apologized, saying that she didnít want to tell me over the phone and going into the weekend, but that the radiologist indicated masses that were likely cancer. She then told me that she was putting in an order for a blood draw and chest x-ray. She wanted the blood work done immediately and told me to get the x-ray first thing Monday.

    We set up an appointment with my original urologist on Tuesday.

    So, I spent all weekend discussing this with my wife and thinking about what is to come. I have also been readingÖ a lot! From what I have read, it seems that I am most likely looking at a bilateral I/O, and I am actually OK with that. After all, I was already looking at lifetime TRT. Add in that, like I told my wife this morning, now that I know that I have those masses inside me, I WANT THEM OUT!

    My concern is that the urologist will want to be as conservative (organ sparing) as possible and only remove the testis with 2 masses and perform a frozen biopsy on the one with a single mass. Is that likely? Like I said, I really just want those things out of me before they spread and endanger my health.

    Wow, that was long...

  • #2
    So sorry to welcome you hear but.....welcome. First things first: get an appointment with a TC specialist immediately! You're beginning a journey and you need the best possible team in your corner. Clearly, your PC AND your urologist are not up to speed on TC. Here is a link http://tcrc.acor.org/experts.html. Right now, you are gathering facts and then you'll form a game plan. Your bloodwork and imaging will reveal what you're dealing with. You want the best possible people on your case, even if you need to travel for treatment. Don't waste any more time or money with the urologist who told you it was nothing to worry about!!!! Be thankful you took charge of your health and be your own best advocate. Keep us posted on your BW results. Tumor markers (AFP, HCG, LDH) will be able to tell you what the masses are made of and dictate treatment plans. You've got a lot of good things in your corner!!

    Comment


    • #3
      So sorry to hear about the results of your ultrasound. Do you have any idea how big the tumors appear to be on ultrasound? The impression of the ultrasound and the size of the tumor may help in some of the decision making as would the tumor markers. Do you have the results of your blood work back, specifically your tumor markers?

      If it were me, I would be sure to get copies of the ultrasound results, X-rays, CT scans and tumor markers when I had them done and that way they can be referenced as time passes.

      Mike
      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Surveillance...
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

      Comment


      • #4
        Good suggestions so far- get copies of the u/s. the x-ray, the blood work. You need a CT scan done as well. You are in the waiting mode, and it can be stressfull, but until you have blood work, scans, you are in limbo. Glad you were persistent though with the doctors- both of them.
        17 year old son Grant dx 12/21/16
        pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
        pre/o CT Scan 12/22/16 normal
        r/o 12/22/16
        Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
        PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

        -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
        2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
        BEP x 3 1/27/17
        Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
        2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
        Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

        Comment


        • #5
          First, thank you all for the helpful and supportive responses. It is good to have a community like this to turn to in such a difficult time.

          So, I went in for my chest x-ray today and requested that they provide me with copies of the U/S report and the x-ray report. The stated that they would mail them to me, which doesn't do me any good in the short term. I am trying to remember the size of the masses from the ultrasound, but it was all so surreal that it is hard to remember. I believe that the right one 1.4 cm x .9 cm. I can't remember the sizes of the left ones, but I know they were larger than the right one.

          My blood work was taken Friday, so I won't have the results until tomorrow at the earliest. The good news is that my lab will automatically put them on the patient portal when they are finalized. As for seeing a specialist, the closest one is 2 hours away and not covered under my insurance plan. The second urologist I spoke to (the one that gave me the "news") seemed to be more knowledgeable than my original, so dependent on how the appointment goes tomorrow, I may ask to see her for a second opinion. If I still don't feel comfortable with the plan of action, I will contact the specialist. I work for a hospital system that has a cancer center near me, so I know that I will have good oncology resources available to me once I get through the initial diagnosis phase.

          On a side note, one thing that made me laugh about the blood work is that the person drawing it commented on the fact that one of the test, HCG, is part of a pregnancy panel. I explained to her that it was also a marker for a certain type of cancer in men. She was surprised... I guess that is why she is a phlebotomist and not a physician.

          Comment


          • #6
            HI Brian,

            Typically, I see partial orchiectomies done when tumor sizes are 2 cm or less and in guys with a solitary testicle. Not sure if that will help with your discussion. As far as having both removed, I would want to see what the US actually said but I would use your same logic in that if I was hypogonadal anyway and had no desire for more children then the benefit of keeping a partial testicle just wouldn't make that much sense to me. However, to be honest, I am not sure if it is routine to remove one testicle and confirm the cancer before suddenly removing both. Perhaps they could do a frozen biopsy intra-operatively just to make sure it is cancerous before removing it/them? The thing to think about too, if they do a partial, is that I have heard it isn't like a normal testicle. It is a testicle with a chunk taken out if it and feeling that may be worse than just having it totally removed. I do not speak from personal experience on that though.

            Mike
            Oct. 2005 felt lump but waited over 7 months.
            06.15.06 "You have Cancer"
            06.26.06 Left I/O
            06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
            06.30.06 It's Official - Stage I Seminoma
            Surveillance...
            Founded the Testicular Cancer Society
            6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

            Comment


            • #7
              Seems like you need the rest of the picture to really know how to proceed.However,assuming things proceed as it appears theyt will at the moment, no harm in allowing the frozen section in the hopes of saving part of a testicle, but I have seen very few cases where that technique actually saved a full I/O.

              If you do end up joining the double "club" rest assured that life goes on much the same as before for most of us. Other than the minor hassle of dealingwith testosterone replacement, nothing else really changes for most.

              Dave
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #8
                Again, thanks for such great support! I spoke with my urologist today and we discussed the options. To start of the conversation, he made it clear that the left testicle had to go, so the conversation really revolved around what to do with the right one. The options presented to me were to A) Leave the right testicle, see what the pathology report on my left testicle says, monitor it closely for growth/change, and if necessary go back in for it; B) Conduct a frozen biopsy of the tumor and decide from there; C) Conduct an organ saving partial removal to get just the tumor; D) Remove the right testicle. After some brief discussion, we ruled out the partial, as the risk vs. reward didn't seem to make sense. Included in the discussion was the fact that I already have significantly low testosterone, so the benefit vs risk of just monitoring the testicle was questionable, as I will still need to go on TRT.

                This left me with the idea of having a frozen biopsy and possible removal (if it showed to be cancerous) or just removal. I told him that I needed to think about it and wanted to see the results of the blood work and chest X-ray first. He added on that he wanted a CT done ASAP to determine if there was any signs of spread to the lymph nodes, so I want to see those results as well, although I don't really know what I am looking for to help me make up my mind.

                Right now I still just want it out of me since my testicle doesn't really work and the risk of cancer is too great.

                Comment


                • #9
                  I personally agree with your feeling of wanting it out. If there is truly no medical benefit of keeping it, why risk it? You'll need hormones either way. I know lots of women who had both breasts removed for the reasons. When's the CT scheduled?

                  Comment


                  • #10
                    My CT was today. I should have the results tomorrow, then we can schedule the I/O. Last night I received two of the labs back, HCG and LDH, and they are normal. Still waiting on the AFP . I also got the chest x-ray results and all was clear. I like having tests come back negative!

                    Hopefully the CT is clear and this surgery will be the end of having cancer in me.

                    Comment


                    • #11
                      Well, just to add another $.02, Clear blood work is good, but does not help decide what to do it is common to have TC and have negative markers. The CT scan is also not useful in deciding what to do with righty. As I said before, no harm in the frozen biopsy, but the odds are good that the test results will indicate that it will need to come out. Still, it's worth a try, just in case. They did that with my second I/O & it was positive, so out it came.

                      Dave
                      Jan, 1975: Right I/O, followed by RPLND
                      Dec, 2009: Left I/O, followed by 3xBEP

                      Comment


                      • #12
                        I received my CT and the last of the labs back, everything is clear. As I was discussing the results with my urologist, he stated that he would like to do the frozen biopsy and would schedule the surgery to take 3 hours so they can do the second I/O if needed. We talked at length about the relatively small advantages of keeping my right testicle if it was a benign tumor and my feelings of not wanting any tumor left in me. Honestly, I am not sure where we ended it... But I received a call the next day from the scheduler telling me that my surgery is scheduled for 10/25/17.

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