My Story - Inguinal Orchiectomy

[zobo]

Hello TC-Cancer.com community,

Orchiectomy done and already deeming myself a survivor for acting without delay. I am all the way from Cape Town. My story thus far as follow:

Wednesday, 18 May 2016 (My 28^th Birthday)
Testicle felt different/hard and sensitive. I went to my GP that suspects epididymitis and prescribed antibiotics for 5 days.

Wednesday, 25 May 2016
I went back to GP for follow-up as testicle still felt different after antibiotics, no longer sensitive. GP recommend I wait 14 days as he cannot feel anything on this cold morning, but suspect inguinal hernia causing testicle to withdraw.

Wednesday, 08 June 2016
Back to GP for follow-up as testicle still felt different and a bit sensitive. Referred for ultrasound at local private hospital.

Monday, 27 June 2016
Urologist find something on ultrasound image and recommend Radical Inguinal Orchiectomy. Referred to Tygerberg Hospital as no medical insurance for private hospital treatment.

“Tygerberg Hospital is a tertiary hospital located in Parow, Cape Town. The hospital was officially opened in 1976 and is the largest hospital in the Western Cape and the second largest hospital in South Africa. It acts as a teaching hospital in conjunction with the University of Stellenbosch's Health Science Faculty.” https://www.westerncape.gov.za/your_gov/153

Wednesday, 06 July 2016
Tygerberg Urology Clinic: Head-to-toe physical assessment done by students and three specialist doctors. Blood sample taken for tumor markers. Paper work signed for Radical Inguinal Orchiectomy on 11/07/2016 with hospital admission and more tests (including sperm-banking) for 08/07/2016.

Friday, 08 July 2016
Hospital admission. Bloodwork reveals slightly elevated AFP, another ultrasound performed as well as chest X-ray. Sperm-banking reveals good fertility. Chest X-ray clear, but ultrasound shows mass inside right testicle. Send home for “weekend leave” returning Sunday evening to see anesthesiologist. Doctor says it look like early diagnosis! :-)

Monday, 11 July 2016
Sperm-banking again in the morning and then taken to theater for Radical Inguinal Orchiectomy the afternoon. All went well during operation and doctors happy.

Thursday, 14 July 2016
Chest and abdomen CT scan then discharged with follow-up for pathology/CT scan results scheduled 28/07/2016. Doctors recommend to stay in hospital until CT scan. Outpatients wait much longer for CT appointments then inpatients.

Saturday, 23 July 2016
Small haematoma still present in scrotum with no other complications or pain.

Thank you for this wonderful forum. I gained allot of information from day one I felt something and prepared myself well. I still need to learn the acronyms... I will keep you guys updated on my progress as well post pathology results when I receive them.

Kind Regards
Rudie

[Talis]

Hi Rudie, and thanks for your story. Sorry to have to welcome you to this forum.

It sounds like all the right things are being done, and you should know more when you get the pathology report (probably by the end of the month, I'd have thought). The fact that the chest X-ray is clear and AFP only slightly elevated is good, and with any luck you'll have caught it early and have a clear CT.

Did you get any indication of tumour size from the ultrasound?

- T

[Kiwi]

Hey bud - welcome

[zobo]

Hi Rudie, and thanks for your story. Sorry to have to welcome you to this forum.

It sounds like all the right things are being done, and you should know more when you get the pathology report (probably by the end of the month, I'd have thought). The fact that the chest X-ray is clear and AFP only slightly elevated is good, and with any luck you'll have caught it early and have a clear CT.

Did you get any indication of tumour size from the ultrasound?

- T

Hi Talis, thank you very much! If I remember correctly the radiologist said it was about 1.5cm or 1.9cm. My profile picture is actually the ultrasound from 27 June 2016 if you can make out anything. I can also upload the full resolution. May I do this on the forum? Unfortunately the second ultrasound no image was given to me, but it looked similar.

[zobo]

Hey bud - welcome

Thank you!

[Talis]

Sounds like it's only a medium size, so you have a good chance of it being stage 1 - fingers crossed.

- T

[zobo]

Update: The provisional Pathology report shows Embryonal Carcinoma (EC) with a clear abdominal and chest CT scan. No spread found outside testicle so it was confined. Just waiting for the meeting with doctor and oncologists in a few minutes...

I did ask pure or mixed EC, but they cannot say at this time due to more pathology stents being looked at to compile full complete report.

[JeskiM69]

With clear scans and margins. Sounds like you will have the following options:

1: Surveillance
2: Adjuvant Chemo (1xBEP or 2xBEP)

Ask about your % chance of a relapse. It will help you make a decision about which option to go with.

- Matt

[Mike]

Hi Rudie,

I sent you a private message with some contact information on a fellow TC survivor friend of mine in Cape Town, in case you would like to reach out to him.

As far as your pathology, with the CT being clear and the tumor markers hopefully returning to normal after the orchiectomy, then you would end up being stage I. In that case, knowing if the pathology report shows any lymphovascular invasion may help in estimating your risk for relapse so I would ask about this and get a copy of the full pathology report, as well as another reports, if you can so that you have them if needed.

With nonseminoma, lymphovascular invasion and embryonal content may point to a higher rate of relapse than not having lymphovascular invasion or a high percentage of embryonal content n the tumor so this information may help in deciding on next steps.

The AFP does need to return to normal though. Any ideas on how elevated it is?

Mike

[zobo]

Hi Mike,

Thank you. I will make contact with your friend.

Unfortunately, the oncologist could not be reached by the doctor and I will have to wait until tomorrow for a new date to set up a meeting to discuss treatment. Government Hospital...

As far as I understand, the tumor was confined with only the provisional histological report available. No percentages yet. The doctor gave me a letter I required and I quote him: "...no infiltration tunica..." "...no infiltration of cord..." if that means anything.

CT scans showed all clear.

A fresh blood sample was taken so I will wait for the results on markers.

In the meantime, I'm staying positive.

Rudie

[Mike]

Hi Rudie,

Getting the full pathology and the actual AFP levels will help along the way so be sure to grab them when you can. The infiltration that the doctor mentioned is good news as it shows the extent of reach of the tumor, but that data is separate than the lymphovascular invasion information, which should be in the full pathology report.

Keep us posted.

Mike

[zobo]

Hi Rudie,

Getting the full pathology and the actual AFP levels will help along the way so be sure to grab them when you can. The infiltration that the doctor mentioned is good news as it shows the extent of reach of the tumor, but that data is separate than the lymphovascular invasion information, which should be in the full pathology report.

Keep us posted.

Mike

Thanks Mike!

Seeing the oncologist on Friday morning with hopefully the full report available by then.

[zobo]

With clear scans and margins. Sounds like you will have the following options:

1: Surveillance
2: Adjuvant Chemo (1xBEP or 2xBEP)

Ask about your % chance of a relapse. It will help you make a decision about which option to go with.

- Matt

Hi Matt.

Stage 1 mix germ cell. Oncologist recommended for the best reslult 1 X BEP.

He has been with Tygerberg 30 years and have treated many TC case's successfully.

Starting Monday, 15 August due to all the public holidays.

Still waiting om full pathology but all is looking great on provisional reports. I will know my most recent markers on Monday.

Will keep all informed.

Rudie

[RJKD]

Hey Rudie, I would see if you have LVI on the path report. If no LVI, then surveillance is usually recommended. If you have no LVI but you have a very high percentage of Embryonal component then you can consider 1 x BEP in such a scenario, but still surveillance is usually recommended without LVI. If you are LVI positive, then 1 x BEP is a much more appropriate step.

[zobo]

Hey Rudie, I would see if you have LVI on the path report. If no LVI, then surveillance is usually recommended. If you have no LVI but you have a very high percentage of Embryonal component then you can consider 1 x BEP in such a scenario, but still surveillance is usually recommended without LVI. If you are LVI positive, then 1 x BEP is a much more appropriate step.

Hi RJKD.

Thanks for the reply. I should know all those details soon. My luck the IT department did upgrades today so doctor couldn't pull pathology. Hopefully Monday they will have more details. How is the 1 x BEP experience? It seems I will receive treatment as it has the best results to lower relapse in the 1st two years as per my doctor.