Advice PLEASE

[Lucky Luke]

On 9th January I found a very small bump on the top of my right testicle (near the epididymis). I was experiencing minor discomfort in my groin and this concerned me. I saw a doctor (not my usual doctor, who was away on holidays) and she said probably nothing but best to get an ultrasound.

The ultrasound report (I had the ultrasound on 11th January) said:
Right side: The right testis measures 4.7 x 2.3 x 2.6 and has a normal vascularity and echogenicity. The area that the patient is palpating corresponds to the epididymis which is normal in size. There is a 3.7mm cyst within the epididymis head.

Left side: The left testis measures 4.7 x 2.1 x 3.1cm. There is a 2mm hypoechoic area within the superior aspect of the testis. It does not have any internal vascularity. The testis otherwise has normal vascularity and echogenicity. The epididymis appears normal.

Conclusion: Non-specific 2mm hypoechoic area in the left testis, a tumour is not excluded and a repeat ultrasound in three months’ time is recommended to ensure that this is not increasing in size.

Obviously this was a mixed result.. .Good that the lump i had been concerned about was a epididymal cyst, but bad because there was a new lump which was suspected/seen inside the left testicle. This was obviously concerning to me, even though my doctor said it is nothing to worry about. I freaked out and went to another doctor to order another ultrasound, along with a CT of the abdomen and pelvis, as well as tumour marker blood tests.
The tumour marker blood tests came back normal apart from the AFP which was 6.4 (normal is 0 – 6.0), so it was only marginally above normal.

The CT scan came back normal,The CT scan was an over-reaction on my behalf and i probably shouldnt have had it (the doctor probably shouldnt have ordered it for me)... But it is good to know that if it is TC, the cancer hasnt spread yet (or at least at the time of the CT).

The secondary ultrasound came back with the following report:

Today’s study was performed with reference to the recent scan at …. On 11th January 2006. Both testes were scanned and appeared normal and in spite of very close attention to the anterior surface of the left testis at the site indicated as containing a hypoechoic area on the previous scans, this could not be reproduced. It seems likely that the initial appearance is artefactual but a repeat ultrasound in 3 months time with particular reference to this area is indicated as a minimum follow up. Both sets of films should be brought with him at that time.
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This has left me utterly confused! I definitely have a palpable lump on the right side of the left testicle which I don’t believe I could feel 2 weeks ago, but now I can, albeit very small. My doctor (who has now returned from holidays) believes there is nothing abnormal and I have been on antibiotics for the past 10 days. The pain in my groin / lower abdomen has become more of a pain rather than discomfort, however it comes and goes. When pressure is placed on the lump, it causes some degree of discomfort/minor pain. I also have been experiencing lower back pain, however this could be to do with a minor injury I sustained about a month ago lifting weights.

I insisted on being referred to a urologist despite the fact that my doctor believed it was probably not necessary. I could not get an appointment to see the urologist until 10th February, 2006.

Obviously I am concerned, I am 26 years old, a university student and keen athlete.

I would be keen to hear any opinions on any part of my experiences so far... Either in regards to the appropriateness of my actions so far, or advice on how i should handle things in the future.

Thanks.

[Scott]

This may all turn out to be nothing, but I've got a nagging suspicion about that slightly raised AFP result. It's not high enough to prove anything right now, but have you asked about a repeat blood test?

I wouldn't panic. You're clearly paying careful attention, and if it does turn out to be cancer, you will be cured.

[Don]

Kudo's Luke on pushing the Dr into having those tests done ... When your talking about the posibility of having Cancer I think having all the tested that were performed is almost a must--especially seeing the notation of a possible problem from the first Ultrasound.. Given the circumstances I would do the same thing if in your shoes. I'm wondering if some of the discomfort and mild pain might be from frequent examination or over examination of the spot in question( just a thought). If there is any problem the Urologist is going to find it. I would also wonder if the problem area found in the first scan could be nothing more than an error generated by the technician or a flaw in the equipment(which would not be the first time). I can't see how it would be there one day and be gone the next. I have a feeling that from the information given your persistance will yeild a clean bill of health!!!!!!!! Best of luck to you and please give us an update when you get your results!!!!!! DON

[Lucky Luke]

Thanks for your responses and I will let you know what happens.

I am in a frustrating and scary place right now... At the moment there are a couple of little indicators suggesting it COULD be cancer, however no one can tell me catergorically yes or no... It is frustrating because I know you have better prognosis the earlier you find the TC... but at the moment there seems very little i can do about it!

Scott, no i havent had my bloods rechecked... I intend to do this over the next one or two weeks (making it three - four weeks after the initial test). My doctor (my regular doctor) did not seem to concerned with a marginally high AFP result. He told me that there are many factors that influence this. He said that for example if I was Asian and I had even a marginally high AFP result, I would almost certainly have cancer. He said the same cannot be said for caucasian patients, who generally have a higher AFP than their Asian counterparts. Also, as I am a fairly keen athlete, athletes apparently generally have blood results come back mid-high range of many different tests, this may also be a factor. All this being said, i think it would be silly of me not to have it rechecked once a month until we have an answer to my concerns. My other results such as White Blood Cells, LDH and HCG were all clearly within the normal range.

Don, I agree totally in regards to the pain/discomfort partially being attributed to the over examination (both self examination and medical examination of the lump)... Once you have something of concern down there it is very difficult to forget about it and I quite often find myself self examining on a daily basis (sometimes on multiple occassions).... I have to try and stop this, as whilst it probably is not doing too much harm, it definitely would not be doing any good!

Its a little frustrating as my doctor could not feel the lump that I am talking about. It is definitely different to the right testicle and whilst small, i believe it is definitely palpable. I too dont understand why one ultrasound venue found it and the other could not... It begs the question which ultrasound venue do I go to for my next ultrasound?? The one that found the hypoechoic area? Or the one that did not?

My doctor does believe that I am going over the top and expressing unwarranted anxiety over the issue, however I think it is best to get to the bottom of this as quick as possible so I can either be given a clean bill of health or fight the TC and get better as soon as possible (before it spreads).

I think the CT scan may have been unwarranted, however it is good to know that if it is TC it hasnt spread yet! BUT I acknowledge I have not being diagnosed yet, so I should keep a positive outlook until it happens (if it happens at all!)

Thanks for your comments and support, I will keep the board updated with my progress and would encourage others to leave comments.

Thanks again.

[burgdob]

Luke, I admire your diligence. Please don't be fearful, it can eat you up. You are doing the right things, and never apologize for pushing doctors to check things out. They make mistakes too.

Your description isn't like my story (diagnosed in December). If it is TC, you've obviously caught it very, very early. My tumor was 5 cm.

[Lucky Luke]

UPDATE....

Saw the urologist today (he was able to fit me in a week early), he seemed to think there was nothing to worry about. He did a quick examination and told me that the pain i am experiencing may be to do with a back injury i sustained several weeks ago(i have had some minor back issues in the past). I dont think he could even feel the lump.. I suppose that is my biggest concern.. what if he missed it or didnt understand what i was talking about!

He advised not to even bother getting another ultrasound as he was pretty sure there was nothing to worry about.

He also said that it is probably wise to check the AFP in 3 months but he doesnt believe it will be any more elevated than it already is. But worth checking again.

Should I trust this advice? I suppose he is the urologist and the specialist.... My concern is that no one I see seems to be able to feel this lump that i have. It is practically the size of a enlarged pimple or maybe a hardened, raised mole. Should I try to forget about it for a month or two and re-evaluate then with another ultrasound and my blood markers tested again?

[burgdob]

It sound like good advice to me. Doesn't sound like TC.

[Scott]

I agree, I'd relax for now and get that repeat blood test in three months.

[Lucky Luke]

UPDATE!

Pain has got worse in my groin, lower abdomen and testicle, lump seems to be same size. Not sure what I should do.. Urologist didnt seem concerned at all, neither did my usual GP. I saw another GP today he could feel the lump, albeit he said it was very small. He did blood tests (tumour markers), as well as scheduled ANOTHER ultrasound for Thursday. This will be my third ultrasound (after first said lump was seen and second said lump wasnt seen). I am having the ultrasound done at Peter MacCallum Institute in Melbourne, which is the only cancer institute we have in Melbourne. I booked in there because they will probably be more familiar with lumps, etc (maybe wishful thinking).

I have several symptoms of TC but cannot get anyone to tell me what is wrong with me !! Even if it isnt TC, all i want to know is what is it... I have several common symptoms of TC including a palpable lump, generalised and specific pain in groin/lower abdomen. I realise there are lots of things that could be wrong, however in my reading, my syptoms very much correlate with TC symptoms with a couple of small exceptions.

I know pain isnt a usual symptom of TC thats what has me totally confused, I have quiet specific pain on the testicle when the lump is pressed. Cant be an infection I was on a strong antibiotic for 15 days (3 courses of Augmentin Duo Forte).

Going a little crazy here!

[Lucky Luke]

I wake up this morning and pain has definitely subsided. To be honest whilst there is still some discomfort in the testicle and groin... Most of the pain has gone! After the extreme of last night, I do not know what to think... Also, the lump is much less noticable today... Have i fiddled with it too much?

This is crazy!

One question I do have.... Sometimes the "lump" is much more noticable than other times... does anyone have an explanation for this? Sometimes I have to work really hard to find the lump, and sometimes it is there as a clear as a bell. This would seem to me to be not a symptom of TC.. Would I be correct?

Also, TC is solid is it not? Therefore, would it be impossible for me to massage, fiddle with it so much that it either disappears temporarily or pushes it outside the testicle (eg. through the epididymis or spermatic cord) or to another place in the testicle? I ask this because I am unable to work out an answer to why sometimes it is easier to feel than other times.

[burgdob]

No doubt your "fiddeling" will make you sore. When I first noticed mine, I checked about every 10 mniutes to see it it had gone away. After several days it felt like someone had hit me hard. Yes, a tumor would be solid.

[Lucky Luke]

Well i got my bloods and another ultrasound back today.

AFP levels were 6 on one test by one doctor and 7 by another doctor. When you also add to it the 6.4 I had last month, you would assume that MY level of AFP is around the 6 - 7 mark... Worth keeping an eye on but not stressing about i would suggest??

Ultrasound showed the 2mm hypoechoic area is still present (the 2nd ultrasound missed it)... It hasnt changed in the last 4 weeks, although they did find a solitary focal area of microcalcification... I dont really know what that means!

Ultrasound report says:
"Left Testis: Once again, a 2mm hypoechoic area was identified. Approximately 2cm from this area a solitary focal area of microcalcification is seen. Overall appearances are stable when compared with the ultrasound scan from 11th January, 2006.

No focal abnormality identified at the site of clinic abnormality as indicated by the patient.

A repeat ultrasound in three months time is recommended to monitor this area."

Basically i think this means the lump that i think is a lump, is actually not a lump (or not one they can see), but I do have a very small lump at another location in the testicle. Also there is a calcified area about 2cm from the lump.. Not sure what that means. On the right testicle it showed 2 small epididymal cysts the largest being 3.4mm.

Any ideas... Advice?

I suppose my options are:
1. Wait 2-3 months and test again
2. Get a 2nd urologist opinion
3. Get an oncologist opinion

By the way, thanks for everyones advice and support over the past month... I really appreciate it!

[Scott]

I wouldn't worry about the blood test results; they're reading normal and staying consistent. I'd just keep an eye on things and relax for three months unless the situation changes.

[Jens]

Hi Luke.
If I were you I would probably worry, but since I'm me, I will clearly state that you are thoroughly checked out and seems to be all clear.

But don't miss the appointment in 3 month! (I don't stress this to make you worry... )

Jokes aside, you have done all you can for now, the waiting game is unfortunately a part of this. It's tough but it passes due time (there I go again...)

Best wishes
Jens

[dadmo]

Luke:
Surveillance is tough but it's a fact of life for all cancer patients. Just don't miss any appointments. "Surveillance", how come this isn't a four letter word?