TC after a vasectomy? Yep

[freudhawk]

Hi everyone my journey to this forum and diagnosis seems rather odd, so bear with me.

I'm a 36 year old married male with 2 young kids. I had a right I/O done yesterday to remove a testicle which was almost the size of a lemon. It had been rather large since after having a vasectomy in October 2012. During the exam for the vasectomy the doctor was concerned about the vas on the right side being so tight it might make the procedure difficult. Indeed, when he snipped that right side I was hurting.

Anyway, recovery from the vasectomy was slow. I was black and blue and very swollen for a few days. Soon, my left testicle returned to it's normal size and the small hematoma around the stitches resolved itself soon afterwards. My right testicle, shrunk somewhat but didn't return to normal. I chalked it up to my 7 month old and 4 year old accidentally kicking Dad down there when they come sit by me or wrestle with me and that the doc said that side was going to be tricky, etc. So, I didn't get it check out until 6/21.

I went back to the PCP who did the vasectomy and he was very concerned. He ordered a US and I went straight over and got it done. They said that there was a mass but couldn't determine if it was clotting (my guess was a hematocele) or a tumor. I had to wait until Monday to see the urologist and he upon hearing the course of things and examining me he guessed it would be a hematocele as well.

Well, as you can guess the mass was indeed found to be a tumor yesterday when I had the I/O. I have a follow-up with the urologist on Friday where I hope to get the pathology results and the results of the CT of my abdomen and chest they performed after the I/O.

I assume any tumor is cancerous but the course of this seems different from what I have read. So, I'm scrambling a bit right now. Any thoughts on this would be appreciated.

One thing I am sure of. I appreciate that this forum exists to give people a place to experience support and educate themselves on this scary journey. God Bless.

freudhawk

[Davepet]

I assume any tumor is cancerous but the course of this seems different from what I have read. So, I'm scrambling a bit right now. Any thoughts on this would be appreciated.

While every once in a while an U/S is wrong, they tend to be *very* accurate at detecting TC, so if it found a solid mass, chances are overwhelming that it is TC.

My first TC was found because I'd had an injury that caused my testicle to swell & it never went back to normal two years later, so I asked my doc about it during a routine physical.However it gets found, it's always good that it *was* discovered, & hopefully early enough to allow surveillance as the only ongoing treatment.

Dave

[freudhawk]

While every once in a while an U/S is wrong, they tend to be *very* accurate at detecting TC, so if it found a solid mass, chances are overwhelming that it is TC.

My first TC was found because I'd had an injury that caused my testicle to swell & it never went back to normal two years later, so I asked my doc about it during a routine physical.However it gets found, it's always good that it *was* discovered, & hopefully early enough to allow surveillance as the only ongoing treatment.

Dave

Thanks Dave. That really helps to hear that. I have basically accepted it as TC, just the manner it occurred seemed odd. Looking forward to follow-up with urologist tomorrow and getting the pathology report. Any advice for this meeting?

[Davepet]

Any advice for this meeting?

Write down your questions now & take a notepad in with you. If you have someone who can accompany you, it helps. It is easy to forget to ask questions & easy to not recall the answers, anything that helps avoid that is a plus.

Dave

[freudhawk]

Write down your questions now & take a notepad in with you. If you have someone who can accompany you, it helps. It is easy to forget to ask questions & easy to not recall the answers, anything that helps avoid that is a plus.

Dave

Yep, I plan on doing that. And my wife is going with me.

What's a good question (and doctor's answer) to determine if he is good to do follow-up surgeries or if I should look at a place of excellence?

[Davepet]

Assuming the path report indicates TC, I'd expect to be referred to an oncologist for further treatment decisions.

Dave

[freudhawk]

A little further down the road

*Moved to Surveillance, 2x Carbo, or other?


post I/O and going over pathology report.

Good news/bad news: Tumor was 100% seminoma but was 8cm. Pathology report said it was fully encapsulated and didn't make it into the spermatic cord, etc. However, the CT scan showed one lymph node that was 9.3mm (not cm). My LDH numbers have been going down but are still elevated:

6/25 (I/O date)= 1056
6/28= 378
7/8= 217

I met with oncologist yesterday and he (and urologist) are leaning more toward chemo than surveillance; probably because of the tumor size, LDH still above normal, and CT finding. Oncologist is going to take the results to the tumor board at the health center next week and will meet with me afterwards. Right now, he's thinking 2x Carbo regimen but that could change. He's willing to talk to Dr. Einhorn as well.

My questions are:

1.) Do my LDH levels show lymph node invasion or is it usually take that long to come down? (I'm getting them run again on Friday and next Wednesday)

2.) Is the 2x Carbo treatment a good idea or should I go more of the 3xEP or 3xBEP? (I saw Dr. Nichols state** that he wasn't totally convinced about the whole 2x Carbo treatment)

Any input would be appreciated.



** http://tcrc.acor.org/chemo.html In recent years, particularly in Europe, one or two cycles of adjuvant Carboplatin are being recommended to treat Stage I seminoma. Studies do exist implying that this treatment is just as effective as radiation in reducing short term recurrences, but there is less evidence that it is as effective in reducing long term recurrences. Nevertheless, most men with Stage I Seminoma are cured by the orchiectomy alone, and while this Carboplatin treatment is very quick and relatively painless, it still is chemotherapy and can lead to other side effects. Surveillance should always be considered as a viable option for men with Stage I disease.

Some countries in Europe (particularly the UK and Germany) plus a few sites in the US are now recommending 2 cycles of adjuvant chemo for patients with high risk stage I nonseminoma. Their thought is that if they can't see the spread of cancer on CT scan, but the pathology report indicates that it is likely to have spread, then they can save the patient from surgery or excessive chemo by giving them just two cycles of BEP chemo right away. Unfortunately, neither I nor most of the experts I have talked with agree with this thinking.

- First of all, the success rate of the standard chemotherapy and surgical procedures is so high (~98%) that it would take a very large sample of people to ever prove that the 2 cycle regimen is equivalent to the existing protocol. It would take many years to get enough people to run the study, and even then, you would have to watch for many years to ensure that no one is suffering from recurrences years later.

- Secondly, the argument for using two cycles of chemo is based on the fact that only microscopic clumps of cancer have spread so far. This is a very poor assumption. Unfortunately, the CT scan that we often rely on is only accurate 80% of the time. In other words, 20% of the time it may be falsely negative - 20% of the time it says there are no enlarged nodes when, in fact, there are enlarged nodes. I know of one person who was told that he was stage I, and was thinking about the two cycle approach. He decided to choose surgery instead. When they opened him up, they found LOTS of cancer. If he had been treated with just two cycles of chemo, it would not have been enough to cure him, but it probably would have been enough to make the cancer resistant to cisplatin based chemo.

- Finally, a substantial number of men with high risk stage I nonseminoma were actually cured of their disease during the orchiectomy. The two cycle approach is not a lot of chemo, but it is two cycles more than many guys need.

[Aegean]

I actually went in for a vasectomy consult and came out having found TC. Got the I/O five days later. I only had the vasectomy last January, a bit more than 4 years later.

You have 6-8 weeks post I/O to administer adjuvant chemo. They may want to wait till closer to the limit date to do another ct to see what happens to that node and determine course of action based on result. Either way, whatever treatment you move forward with, it will more than likely be the end of the seminoma.

[freudhawk]

I actually went in for a vasectomy consult and came out having found TC. Got the I/O five days later. I only had the vasectomy last January, a bit more than 4 years later.

You have 6-8 weeks post I/O to administer adjuvant chemo. They may want to wait till closer to the limit date to do another ct to see what happens to that node and determine course of action based on result. Either way, whatever treatment you move forward with, it will more than likely be the end of the seminoma.

Yep, that is true. We might still do another CT scan if the tumor board thinks so. Or, I might just ask about doing it anyway.

Also, I love C.S. Lewis!