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Normal Tumor Markers But Diagnosed with Testicular Cancer?!

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  • Normal Tumor Markers But Diagnosed with Testicular Cancer?!

    Greeting warriors,

    To begin my story, I've recently (about two months ago) started to feel a lump in my right atrophy testicule with a discomfort in it.
    I went to a urology doctor where I did an ultrasound, blood test for tumor markers, and two MRI sessions.

    The ultrasound result as following:
    - Right intra testicular solid mass lesion for more work-up.
    - Left varicocele grade 1.

    The blood test (tumor markers) as following:
    - AFP 2.06 ng/mL
    - B-HCG Titer 1 mIU/ml
    - LDH 170 U/L
    All markers are falling under the normal values range.

    The MRI results as following:
    - MRI on Abdomen: Testicular neoplasm to rule out metastasis.
    - MRI on Pelvis: History of right testicular malignancy to rule out metastasis.

    As for my diagnosis, my doctor told me that it is most likely I have a TC stage 1. I also visited other two urology consultants where they also came to the same conclusion.

    Both consultants advised me that I should do orchiectomy in order for them to take a sample of this mass and send it to the lab for analysis, if the lab result returns a TC they will remove the testicle, else testicule will be intact.


    I don't know if I'm the only one with this case, so I'm interested to hear your opinions regarding my condition.
    And why do you think all of my three doctors insisted that it is most likely a TC even though my tumor markers came normal?

    If assuming I have a TC, what's the probability of having a seminoma in my case?

    Also I'd like to know your experience after you went through with orchiectomy, how is the feeling and pain after the operation?
    The idea itself of cutting my testicule terrifies me, and currently feeling deeply depressed about it.



    - May all humans be cured of all cancers and other diseases.

  • #2
    Sorry to welcome you. So you have been dx with TC? If you need an Orchietcomy they remove the testis via an incision above the groin area. Wishing you the best.
    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: 3.5cm Periaortic Teratoma, 2.5cm & 3.5cm Intraaorticaval Teratoma, and a 2.8cm Paracaval Teratoma.

    Comment


    • #3
      Hi Silver, sorry to have to welcome you here. I had 3 intratesticular lesions in my lefty. All intratesticular lesions are like over 90% being TC unfortunately. When I had all of my tumor markers drawn everything came back normal as well. I was diagnosed with 100% classical seminoma. If I were you I wouldn't delay getting it taken out. Surgery isn't as bad as it sounds. A couple hours after my surgery I went to my daughter's graduation. My wife did help me walk around and I was out of it but it wasn't horrible. My advice is to take a stool softener after surgery. It really sucks trying to push something out hard with the incision there.

      I had my surgery in June and I'm like pretty much all healed up. If I push down on where my incision was it is still kind of sore but I think it will take like a good 6-months or more to heal completely. Having one testicle isn't as bad as I thought it was going to be either. It feels like I don't need to adjust my nuts as often. Oh, and one more thing, don't freak out if your sack and base of your penis get bruised. This is normal and will go away within a few weeks.
      April 2017 - Scheduled physical with DR for testicular pain / ultrasound scheduled
      May 2017 - US shows 3 solid masses 1.2 x 0.7 x 0.7 cm/0.8 x 0.5 x 0.8 cm/ 0.4 x 0.3 x 0.4 cm
      June 2017 - Left inguinal exploration and left radical orchiectomy. Pathology - Seminoma, classic type and intratubular germ no neoplasia - seminomatous. CT scan shows 2 long nodules (most likely granulomas) and Borderline prominent but non specific mesenteric nodes within the right lower quadrant.
      July 2017 - 2nd CT scan all clear! Lung nodules stable. Active surveillance 5 years.

      Comment


      • #4
        You cannot biopsy a testicular mass without removing the testicle. The entire testicle has to be removed. There is a saying in the medical field about testicular masses: "all solid testicular masses are cancer until proven otherwise". You must get this testicle removed as soon as possible. Non-seminomas actually are very fast spreading. Right now, you almost certainly have testis cancer, just we don't know which type until the biopsy is completed.
        Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

        7/1/2015: felt tiny lump on side of R testicle
        7/30/2015: Ultrasound shows 2 intra-testicular masses.
        7/31/2015: tumor markers normal, CXR clear
        8/5/2015: R orchiectomy
        8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
        8/14/2015: CT abdomen/pelvis clear, Stage 1b
        8/24/2015: started 1 x BEP

        Comment


        • #5
          If you don't get it out now, you will regret it later when it turns into stage 2 or 3. Get it out of there. Not really even a choice, its just something you have to do. You don't need two anyway!
          6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
          6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
          7/7/15: bHCG 56, AFP 42, LDH 322
          7/13/15 - 9/18/15: 4xEP
          10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
          10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
          4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
          4/20/16: RPLND @ IU - teratoma only!
          9/18/2017 all clears up to this date!

          Comment


          • #6
            Hi Silver, in addition to what advised above (take it out asap), take into consideration that markers are indicative only when elevated, normal markers do not mean you do not have cancer. I have never had any elevated markers although I had a non-seminoma. all the best with the surgery

            Comment


            • #7
              I had testicular cancer/ non seminoma, with normal tumour markers
              Take care of you

              Comment


              • #8
                You should definitely get the orchiectomy procedure asap! I had a similar experience as you are having right now. All my tumor markers were within normal range and my CT showed no metastasis. My doctors definitely agreed I had TC so I had no choice but to have my testicle removed. After the orchiectomy you will have some pain but it's very manageable. I was able to walk slowly the next day. Have you considered a prosthetic testicle? I opted for one and I am quite satisfied with it. A pathology needs to be performed in order for a 100% diagnosis.

                Comment


                • #9
                  Well you guys scared the sh*t out of me, just how fast this cancer spread?!

                  I'm aware of the danger situation I'm in, and I will have to do the orchiectomy in a month if I have to. But currently I'm thinking of following an option that my doctor gave me, which is to do an ultrasound next month to see if the tumor decrease in size or not. If it decreases then it's most likely an inflammation and it'll go away by time, otherwise it's a cancer and he did frankly told me that 80% will be a cancer. I'm psychologically prepared myself to do the operation.

                  Not to mention, my doctor is taking a two weeks vacation, I have no choice but to wait for him.



                  Originally posted by juvn View Post
                  You should definitely get the orchiectomy procedure asap! I had a similar experience as you are having right now. All my tumor markers were within normal range and my CT showed no metastasis. My doctors definitely agreed I had TC so I had no choice but to have my testicle removed. After the orchiectomy you will have some pain but it's very manageable. I was able to walk slowly the next day. Have you considered a prosthetic testicle? I opted for one and I am quite satisfied with it. A pathology needs to be performed in order for a 100% diagnosis.
                  What was your cancer type? Seminoma or non-seminoma?

                  As for prosthetic testicle, two of the doctors that I visited were aggressively against it and told me to wait 1-2 years to do it. Even thought the third doctor told me it's ok if I want to.

                  Comment


                  • #10
                    Waiting a month isn't likely to change your long term survival given a clear CT scan, but it could potentially be the difference between needing chemo and/or RPLND afterward if it spreads to your lymph nodes between now and then.
                    6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
                    6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
                    7/7/15: bHCG 56, AFP 42, LDH 322
                    7/13/15 - 9/18/15: 4xEP
                    10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
                    10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
                    4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
                    4/20/16: RPLND @ IU - teratoma only!
                    9/18/2017 all clears up to this date!

                    Comment


                    • #11
                      Your U/S indicates a solid mass. I have no idea why your doc is stalling, he should not be. He is not doing you any favors.

                      While there is no way to predict how fast this may spread, waiting a month could mean the difference between an I/O & surveillance and an I/O plus 9 weeks of chemo. Losing a nut is no big deal in the greater scheme of things, honestly.The traitor is trying to kill you, get him first.

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

                      Comment


                      • #12
                        Originally posted by Silver View Post
                        Well you guys scared the sh*t out of me, just how fast this cancer spread?!

                        I'm aware of the danger situation I'm in, and I will have to do the orchiectomy in a month if I have to. But currently I'm thinking of following an option that my doctor gave me, which is to do an ultrasound next month to see if the tumor decrease in size or not. If it decreases then it's most likely an inflammation and it'll go away by time, otherwise it's a cancer and he did frankly told me that 80% will be a cancer. I'm psychologically prepared myself to do the operation.

                        Not to mention, my doctor is taking a two weeks vacation, I have no choice but to wait for him.




                        What was your cancer type? Seminoma or non-seminoma?

                        As for prosthetic testicle, two of the doctors that I visited were aggressively against it and told me to wait 1-2 years to do it. Even thought the third doctor told me it's ok if I want to.

                        If you have a solid mass, it's not inflammation. How large is your mass? You have to get it out asap. Waiting a month is a complete waste of time and can mean that you may undergo extremely hard treatment that you may be able to forgo if you remove the testicle now. Seminomas tend to be slow-growing, non-seminomas are fast growing with a doubling rate of 10-30 days depending on the type.

                        I had non-seminoma, normal markers. As soon as the mass was found on ultrasound, I wanted it out ASAP! I had to wait about 5-6 days after the ultrasound to schedule the orchiectomy. In my urologists words "this is not something that can wait, we have to take this out as fast as possible". I knew he was right as I work as a doctor.
                        Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

                        7/1/2015: felt tiny lump on side of R testicle
                        7/30/2015: Ultrasound shows 2 intra-testicular masses.
                        7/31/2015: tumor markers normal, CXR clear
                        8/5/2015: R orchiectomy
                        8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
                        8/14/2015: CT abdomen/pelvis clear, Stage 1b
                        8/24/2015: started 1 x BEP

                        Comment


                        • #13
                          Originally posted by RJKD View Post


                          If you have a solid mass, it's not inflammation. How large is your mass? You have to get it out asap. Waiting a month is a complete waste of time and can mean that you may undergo extremely hard treatment that you may be able to forgo if you remove the testicle now. Seminomas tend to be slow-growing, non-seminomas are fast growing with a doubling rate of 10-30 days depending on the type.

                          I had non-seminoma, normal markers. As soon as the mass was found on ultrasound, I wanted it out ASAP! I had to wait about 5-6 days after the ultrasound to schedule the orchiectomy. In my urologists words "this is not something that can wait, we have to take this out as fast as possible". I knew he was right as I work as a doctor.

                          Based on the ultrasound, the mass size is 1.5 x 1.0 cm, and it's there for a two months now.


                          In any case, I'm honestly freaked out by all of the feedback here, I just called my hospital to get an appointment with my doctor ASAP in order to get this surgery done, the earliest date is 19 Sep since he is on vacation and will return on 16 Sep. I don't want to change my doctor since he is the only one I feel comfortable with, and he is also considered the best in my city.
                          Most likely I will do the operation before the end of this month. Hopefully the cancer will not spread by that time!

                          Comment


                          • #14
                            Originally posted by Silver View Post


                            Based on the ultrasound, the mass size is 1.5 x 1.0 cm, and it's there for a two months now.


                            In any case, I'm honestly freaked out by all of the feedback here, I just called my hospital to get an appointment with my doctor ASAP in order to get this surgery done, the earliest date is 19 Sep since he is on vacation and will return on 16 Sep. I don't want to change my doctor since he is the only one I feel comfortable with, and he is also considered the best in my city.
                            Most likely I will do the operation before the end of this month. Hopefully the cancer will not spread by that time!

                            That's larger than what I had, but still relatively small. If that is indeed a SOLID mass, then it has to come out. There's a >95% chance it's cancer. There are some super rare solid benign masses.

                            It should come out within the next week. Any longer is just being ridiculous in my opinion.
                            Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

                            7/1/2015: felt tiny lump on side of R testicle
                            7/30/2015: Ultrasound shows 2 intra-testicular masses.
                            7/31/2015: tumor markers normal, CXR clear
                            8/5/2015: R orchiectomy
                            8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
                            8/14/2015: CT abdomen/pelvis clear, Stage 1b
                            8/24/2015: started 1 x BEP

                            Comment


                            • #15
                              Hi Silver.

                              If I understand you correctly, the ultrasound did show a solid mass in the testicle? If that's the case, then I agree that you should get an inguinal orchiectomy done as soon as possible. It's likely to be a tumor (I was told the ultrasound is a very accurate predictor).

                              Have you noticed any change in size over the last 2 months?

                              In my case, I saw the urologist on a Friday. He was apprehensive about waiting until the following Wednesday for the surgery, but with a holiday on Tuesday there wasn't much of a choice. He considered trying to get it done on Monday but I needed to get a pre-surgery exam first. That may give you an idea of the timeline involved.

                              There is a small chance that it's something else, but if it is T/C then the sooner it's out the better. It'll make later treatment decisions easier. Considering that you've already waited 2 months, I guess I'm not sure how much of a difference 2 more weeks might make. But the less chance it has to spread, the better off you'll be. My understanding is that it's inadvisable to try to do a biopsy of the testicle while it's still in your body; they have to cut the tissue which gives it a path to spread inside the testicle itself - that just makes things worse. It's much safer to just remove the whole testicle and some of the cord.

                              A Radical Inguinal Orchiectomy surgery is not as bad as it seems. I was really scared beforehand (never had surgery before) and hated the idea of losing a testicle. My surgery was outpatient and the surgeon was done in around half an hour. I got to the hospital around 12:30 PM and left just before 5:30 PM that day. The incision is just above the groin (pelvic bone) so they don't cut the scrotum. They pull it up and out, then cut off a few inches of the cord. It hurt for a few days and I had some trouble sleeping as a result. The pain meds helped. It basically felt like I had very low abdominal muscle strength (even though he didn't cut the muscle), so I moved slowly for a couple weeks. I had some pain, sensitivity, and numbness around the incision area for a few weeks. Some people have different extent of swelling & pain; my swelling was pretty much limited to the incision area. I developed numbness from the incision down toward the scrotum, which I didn't expect, but it went away after a few weeks.

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