second opinion?

[Alex_G]

Hello all,

I was diagnosed with TC. Based on ultrasound and blood work my doctor said that it’s seminoma.
I still cannot believe it. Is it only the ultrasound that they base diagnose on?
4 week ago I woke up and felt pain in my left. It was larger than usual and very painful to touch. I scheduled an appointment with my doctor but it took me 2 weeks to get there. By that time pain was almost gone and testicle size back to usual.
They made me go to ultrasound and my doctor called me told me that they found multiple
swellings and I need a surgery.
Is that a procedure? Do I need to go to another doctor for second opinion? If doctors make their decisions based on ultrasound only then it doesn’t make any sense to go to another doctor?

What next?
Sorry for my English – it’s not my native language.

[Kman99]

The way you say multiple swellings is a bit unclear. Did the ultrasound reveal a solid mass? Do you know what your blood work says (your tumor marker levels)?

An ultrasound is used to detect tumors, not to specifically diagnose TC, certainly not seminoma vs non seminoma. To make that determination, a sample of the tissue must be removed and sent to a pathologist. If there is a tumor, the normal procedure for this is an inguinal orchiectomy, which is the removal of the testicle - http://tcrc.acor.org/orch.html

My initial impression is that you need to see another doctor or at least ask your current doc some specific questions.

Let us know if you have more questions.

[Alex_G]

I’m sorry for being unclear.
Actually my doctor didn’t show me ultrasound results –I assume that it was probably multiple tumors.
I have my blood result however.
Alpha-1-feto-marker 2.1
HCG marker low lever <2

[Kman99]

I think you should get more specifics from the ultrasound first, but if you really do have multiple solid masses, you should have the surgery as soon as possible to remove that testicle.

Your tumor markers appear to be in normal ranges to me, but that doesn't mean you don't have TC, so do the best you can to see someone (preferrably a doc with TC experience) soon.

[Alex_G]

May be someone knows answer to this question
In age of 7-8 I had surgery for undescended testicle. It was brought down and it much smaller in size. Is it still functional? Will it produce hormones etc?
My doctor told me that he is not sure but he checked and told me that there is a good blood flow there.

Any idea?

[dadmo]

An undescended testicle is more likely to have cancer then one that descended on it's own. Is the one that was undescended the one you have a problem with? Kman is right about a biopsy being needed to determine what form of tc you have. If your markers are normal and you are older you may have seminoma but you can't tell from just blood work. Your doctor needs to get this right otherwise he may prescribe the wrong treatment.

[Alex_G]

Unfortunately for me I’m having problem with normal one. Undescended is fine.
I’m just curious is undescended still functional? I had surgery to bring it down in age of 7.

[dadmo]

I can't answer that one but you should certainly consider banking sperm.

[Alex_G]

What about testosterone? Is it also testical job?

[Kman99]

I too don't know whether your undescended testicle is functioning normally. You really need to ask a qualified doc these questions. Have your doc test sperm count and testosterone levels to make sure it is working normally.

More importantly, you need to get better answers on your other testicle too and find out about the tumors/swelling. You will want to have that one removed, regardless of the undescended one, if there are really solid masses.

[Alex_G]

I have the surgery scheduled for next Wednesday.
What the next steps are going to be? CT scan after that? I thought they should do CT scan before surgery. I’m kind of confused here.

[Kman99]

Alex,

Here's an excellent website that gets into details on what to expect - http://tcrc.acor.org/index.html

[Karen]

Alex,
Can you tell us what part of the world you live in? There may be others here from the same area that can guide you to more expert doctors for you to be treated by. You do need the surgery as soon as possible, but your diagnosis and treatment are very important so you want to go to an oncologist that is very experienced in this area.

[Kman99]

Good idea Karen. I'm concerned about Alex's doc already diagnosing TC, a seminoma no less, by the use of an ultrasound.

[Alex_G]

I live in USA Chicago area.
Here is my short story.
4 weeks ago I felt a pain in testical area. In 2 weeks I visited my urologist. He sent me to ultrasound and blood work. Ultrasound results – multiple tumors (I’m not sure about exact wording I can get copy from a doctor). Blood work comes up clean.
My doctor told me that it looks like seminoma and I need surgery asap. I’m in higher risk zone because in my childhood I had undescended testical surgery.

Please let me know if that’s the procedure.

[Kman99]

Yes, you are in higher risk, but I am a bit concerned your doc is diagnosing a seminoma through the use of an ultrasound. Do you know whether the tumors were solid or liquid? Try to get the ultrasound report. In the mean time, there is a TC expert facility in Chicago. I highly recommend seeing the doctor below...


Chicago, Illinois

Dr. Chris Coogan - Urology
Rush Presbyterian St. Lukes Medical Center
1725 West Harrison, Suite 758
Chicago, IL 60612
Phone: (312) 666-2410

[Alex_G]

Actually he didn’t diagnose me with anything yet.
He told me that even if my blood test is fine I still need surgery to do biopsy.
He explained me that low markers are usually means seminoma.
Let me get copy of ultrasound so you guys can take a look at it.

[Kman99]

Originally Posted by Alex_G

I was diagnosed with TC. Based on ultrasound and blood work my doctor said that it’s seminoma

Sorry, I was basing my prior comments off of your first post. I have always had normal markers with a nonseminoma primary tumor. Is it possible for you to see that doctor in Chicago? Keep in mind TC is very rare in relation to other cancers. This means very few doctors see many cases. If it's possible, I highly recommend you try your best to see the doc I mentioned previously.

[Alex_G]

I will call this doctor right now.

Here is ultrasoundresult

Findings: The left testicle is enlarged and is measuring 4X7X3 cm
The testicle is very heterogeneouse and there are multiple mixed echogenic nodules. Findings are worrisome for testicular neoplasm.

[huckchef]

i had three opinions done before i made the decision myself to go ahead with surgery. so don't hesitate to get it right!
if problems are occuring with both testicals, i would highly recommend a sperm count BEFORE surgery and bank sperm. if you only bank a little i believe you will be satisfied in the long run. it will not cost that much to do it. but because of the atrophy to the other testical you MAY have problems down the road with sprem production. so please take this seriuosly and check into it. you do have time to get the sperm banked, even if it requires a change in surgery date to allow you a couple of days to bank quality amounts. i hope this isn't the case!!!! but speaking on my experience i wish i would have waited a few more days to allow me more chances to bank more!
i hope it all goes well.
my thoughts and prayers
brian

[Alex_G]

Thanks for a good advice. Actually I got same advice from my doctor. I’m already in process with sperm bank.
I’m actually curious. I just contacted the doctor advised by KMan99 and fax him blood result and ultrasound result. Is there any different approach? I was under impression that if any masses found next step is surgery and biopsy.
Is this correct?

Alex

[huckchef]

i would assume if tumors are present the next step, yes, would be surgery! from there biopsy and classification and staging.

[dadmo]

Yes the next step should be to remove the testicle so the doctors can see exactly what's wrong and develop a plan to cure you.

[Kman99]

Alex-

As the others have said, if there are solid tumors, the normal and routine process is to remove the testicle. The website I posted previously will give you a great idea of what to expect from the surgery.

[Alex_G]

Thanks guys for your help!
I will keep you posted. I just wanted to understand the process.
I hope everything will be fine.

[Michael112]

I was in the same boat as you acouple days ago, ultrasound showed up 2 lesions(lumps) 1 heterogenous(meaning it contains 2 or more types of mass) another normal, both showed vascularity(blood flowing to them meaning there not cysts) they measured at something like 2x1.8x2 and 1x0.8x0.9, The effected testical was smaller then my right, cant remember the measurements but it was significant but not extreme. The mass was noted as seminoma. I had the lump there for about 3 years, with slight occasional pain for 1 year wich worsened 1 week before diagnosis, when checking it out I agitated it more a day before the ultrasound. The ultrasound report also had "possible lymphoma". Then 2 urologists suspected non-seminoma, a physical examination did not find any swollen lymph nodes, although I have them swollen all over my body as of past few weeks, they schedualed a I/O within 6 days. Next day I went sperm bank then got my blood test results, they came back all normal.
Day after The CT scan came back clean, they scanned abdomen, chest and "helun"(head?). I am going to schedual a 2nd ultrasound and push the surgery date forward a bit only because it spread and that there is conflicting reports on what sort of tumor it is, this will also give me the opotunity to bank more sperm.
I am going to look up risks of frozen biopsy and put it into consideration.
If I do go through with I/O the doctor is going to put a prosthetic one in after surgery using local anesthesia, because he says that when doing it with the I/O it doesnt sit right.

[Scott]

Originally Posted by Alex_G

I thought they should do CT scan before surgery.

It's typical to have the CT scan after the orchiectomy.