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  • Diagnosis is uncertain but surgery is scheduled

    Hello,

    First, thanks for making this forum, I'm glad theres a place to share experiences and info.

    I am 45. I started getting some pain in my lower scrotum area a couple of months ago. I waited it out for a few weeks to see if it would go away or get worse. It didn't really go away so I made an appointment with my GP. Before that visit, I went into an emergency clinic and had tests for STI's just in case. They came back negative.

    I've had a small cyst on left testicle for almost 20 years, I informed everyone of this ahead of imaging.

    GP made an ultrasound appointment for me, which came back 'suspicious'. GP tells me I have Seminoma but everything is OK because it's highly survivable.
    GP gave blood tests for markers, all came back negative.

    Urologist shows me the mass, as far as I can tell it's different than the cyst which is also visible, but it shows blood flow to it form the doppler reading.

    Urologist gives marker tests again, came back negative again.

    Chest X-Ray came back fine.

    CT Scan came back normal. Radiologist says this about lymphodes:

    LYMPH NODES: Small left periaortic retroperitoneal lymph nodes are within normal limits for size and morphology, for example node measuring 1.4 x 0.8 cm (series 601, image 45). There is no evidence of abdominal or pelvic lymphadenopathy.

    Urologist tells me theres an enlarged lymph node that is suspicious. Also tells me I need to remove the left testicle. So right away I have a discrepancy between the radiologist and the urologist as far as I can tell.

    I'm going through all of this and to the best of my understanding, no one really knows what's wrong but that I need to remove the testicle just to be safe and they will find out if its cancer when they inspect it. I'm scheduled for surgery in two weeks. Aside from the obvious emotional strain on a man having to lose a testicle, there is the burden on me having to take time out from recovery, and then the possibility of chemo/radiation therapy cutting in to my ability to work (self employed). All of this of course has me second guessing the doctors, which I would imagine is fairly normal.

    The urologist ordered a second ultra sound for me as a second opinion type thing.

    The thing is, as far as symptoms go, I don't think I feel a mass on my testicle besides the cyst. I might, but not 100% sure, so it's not large if its there. But what I do feel is a crazy swollen epididymis. This is obviously enlarged to me and the discomfort is generally in that area, but also on both sides of my scrotum. I've read that this should accompany an infection but I don't have any other symptoms of an infection. My concern is that the doctors are overlooking something because maybe they are just resigned to remove and observe as normal?

    I do have some slight abdominal pain from time to time, but I can tell it is connected almost directly to that tender area, like theres a nerve shooting up from my scrotum.

    Is there some other condition that would result in these symptoms? Can the epididymis be infected without external excretions or bacteria in the urine?
    What about on the second ultra sound I am about undergo? Can I ask the tech to take some extra imaging of the epididymis area? Will that even show up?

    Could it be a coincidence that I maybe DO have some kind of infection but they happen to also find a new mass and the two are unrelated? Some extra info that I did tell the doctors but they didn't seem to care much about. I do lift weights...squats with barbells. I have not had any noticeable injuries though or any event that I thought might cause an injury. In the past 3-4 months, I have gained some extra weight, but I have not change my wardrobe, so my cloths are kind of tight right now, including my underwear. I am stubbornly telling myself that I'll kick up on some cardio again and loose the extra pounds, but I haven't yet throttled it up. Could the constant pressure against my scrotum and decreased blood flow cause this swelling?

    How do you reconcile the differences between the three doctors? The GP first said 'oh maybe the first radiologist over read the ultrasound'. This was after the markers came back negative. Then the Urologist said the markers can come back negative and it still be cancer, so remove it. Then the GP said this was all highly unusual, but the urologist still insists that surgery is the answer and now the GP 'tends to agree with him'.

    Thank you for taking the time to read.

  • #2
    Hello, feel sorry for you to be here. You story is incredibly similar to mine, allmost to every detail. Ok, I'll skip comparions and try to help you.

    First, no one can say that you have seminoma without pathology report, it is just pure guessing and showing off. If it is cancer it is most likely seminoma as markers are negative, but it is not up to GP or ultrasound guy to tell that.

    If there is a mass in the testicle, and if there is a blod flow through the mass, it is most likely a TC, and removing the testicle is golden standard. You didn't say how large mass is.

    As I said, your story is exactly like mine. I also had 1,4 cm node on the same spot, radiologist wrote similar thing, that the node is "reactive", that is euphemism for "not cancerous". My urologist also said that this node is somehow suspicious, but he was young and too ambitious and he rushed with conclusions. About the discrepancy, it is common in this situation, as radiologists and urologists ussually have different point of view. I can tell you through my experience and articles I red that this node is suspicious as it is too large to be normal, and yet it is to small to be called cancerous for sure, and if pathology report of the testicle shows that it is seminoma then there is about 25% of chance that this node is cancerous. This chance is too small for chemo or radiation, so if it is TC, you will be put on surveillance after the operation.

    You really don't have to worry about the recovery, you'll be out in 3-4 days after the surgery, back in full normal condition in max. 2 weeks, and now it is too soon to think about the chemo or radiation.

    Second ultra sound seems very sane in this situation, but this should be another utrasound radiologist with different perspective, perhaps some with comprehensive experience.

    About your simptoms, TC ussually has no simptoms, coincidence is actually most common thing in TC diagnostics.

    About three doctors...all of them are right from their point of view, just wait for another one, oncologist, with his perspective. This is kind of disease that has to be managed multidisciplinary but at the end of the day you are one that will be making decisions so stay positive and focused.

    We'll be smarter after another ultrasound.
    45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
    Waiting...

    Comment


    • #3
      Thanks for the info Harxxony. It's really difficult to get answers from anyone in the immediate sphere of my world. I'm very grateful to you for your story and this forum for putting us together. I hope I can contribute in the future to anyone looking for help or reassurance.

      To add to my story, here is the report from the ultrasound. The mass sounds small. I'll be curious to see after the next ultrasound if the mass has increased in size at all.

      The left testis measures 4.4 x 1.8 x 2.3 cm. The left testis is normal in echotexture and demonstrate no focal mass lesion. Normal blood flow seen with color Doppler. Hypoechoic solid lesion in the lower aspect of the left testicle measures up to 0.5 x 0.6 cm. There is evidence of internal vascularity. The borders are smooth. There is an adjacent small hypoechoic solid focus measuring up to 0.2 cm. Cystic nodules seen in the upper aspect of the left testicle measures up to 0.5 cm. There is an additional adjacent area of focal heterogeneity which does not appear to represent a discrete mass.

      Comment


      • #4
        The left testis measures 4.4 x 1.8 x 2.3 cm. The left testis is normal in echotexture and demonstrate no focal mass lesion. Normal blood flow seen with color Doppler. Hypoechoic solid lesion in the lower aspect of the left testicle measures up to 0.5 x 0.6 cm. There is evidence of internal vascularity. The borders are smooth. There is an adjacent small hypoechoic solid focus measuring up to 0.2 cm. Cystic nodules seen in the upper aspect of the left testicle measures up to 0.5 cm. There is an additional adjacent area of focal heterogeneity which does not appear to represent a discrete mass.
        Uhm, I don't get this report, first it says that testis is normal and without focal mass, and then that there is a solid lesion (two of them) in the lower aspect? Did you make a typo right/left? Another ultrasound by another US radiologist is the best thing right now. Good luck.
        45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
        Waiting...

        Comment


        • #5
          I noticed that too. I assume it's referring to something else besides the 'hypoechoic solid lesion'. The last line of the report says
          IMPRESSION:
          Subcentimeter hypoechoic vascular masses in the left testicle highly suspicious for malignancy.

          I'll find out Monday or Tuesday about the second ultrasound results. Thnx.

          Comment


          • #6
            If there is any uncertainty you can order an open biopsy. In this case, the testicle is exposed through an inguinal incision, the cord is clamped then they take some tissue and send it for histology. If it turns to be benign they place it back in the scrotum. Ask to the doctor for more information

            Comment


            • #7
              The testis mass is small but concerning. At that size a partial orchiectomy is possible but a periaortic node at 1.4 cm is of borderline concern (usually start to get concerned when they are at 1 cm) and asking about a repeat CT in like 6 weeks may shed some more light on if it is an issue or not.

              I suppose I would wait to see what the second ultrasound has to say. Not sure why they are ordering one but so be it. If there is an inter-testicular solid mass like this then they kind of have to assume it is cancerous until the pathology would prove otherwise. You markers can be negative and the disease can still lead to death so while negative markers are good, they don't rule out it being cancer.

              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

              For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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