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Blood tests and ultra-sounds pointing in different directions...any thoughts?

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  • Blood tests and ultra-sounds pointing in different directions...any thoughts?

    Greetings folks,

    Over the last few days, as I’ve been trying to give myself a crash course on testicular cancer, I’ve found this site to be an enormous help…both as a source of information but also as a way of de-fusing anxiety. So, my thanks to the participants and the excellent administrators.

    My case currently has my GP, the urologist and an oncologist a bit stumped. Thoughts and insights from the collective wisdom here would be appreciated.

    I’m a 34 year old with two little kids and no particularly bad habits except for the abuse that two toddlers and a demanding desk job throw at you. About 3 months ago, and during a very random accident, I’d got my testis caught on the crotch of a pair of trousers that were hiked up too high and a bit too tight. Embarrassingly, I somehow gave myself a reverse wedgie that resulted in a lot of swearing and an uncomfortable couple of days. The pain went away and I didn’t think much of the event until about three weeks later when I identified a lump on the affected testis and sought immediate attention.

    The GP thought the bump felt like the swelling from a bruise and that it had only become noticeable a few weeks after the accident due to a bit of blood clotting that was trapped under the outer layer of the testis. To be sure, however, he sent me along for an ultra sound and over the last two months, three ultra sounds have shown the lump shrinking from 20mm*15mm to its current size of 9mm*5mm. Good news.

    In the last month, I’ve also met with a urologist who did some blood work. The first blood test (from about 2 weeks ago) was normal in AFP but the beta HCG levels came in at 12 (I understand 3 is normal). This created some cause for concern. The blood work was redone a few days ago and the beta HCG have come down to 9… which is still quite high but at least moving in the right direction.

    The urologist has now called an oncologist with – so I’ve been led to believe – experience in testicular cancer (I missed the name but was something like “Dr. Tester” from Leeds in the North of the UK where I live). They are confused as to why the ultra-sounds and blood tests would be pointing in different directions but will re-do the blood tests in 2 weeks. If the betaHCG levels still remain above normal, then I’ll be in for immediate surgery to remove the affected testis.

    My questions for the forum are (1) does this approach sound sensible or should I advocate for more immediate surgery – clearly not an attractive option if the testis turns out to be healthy…; (2) are there any thoughts as to why the ultra-sound and the blood test suggest different things and (3) does any of this sound likely to be associated with the injury? Might there be a tumour lurking under the bruise? In which case, that reverse wedgie might have been extremely lucky…?

    Cheers folks,
    Evan

  • #2
    Welcome to the forums, Evan. It's good that your doctors are keeping a close watch.

    Regarding your second question, one possibility to evaluate is that there are other causes for elevated hCG, as other forum members have experienced. The TCRC dictionary notes that "the HCG level can become elevated (falsely positive) due to abnormally low levels of testosterone or because of marijuana use." Also, this article says, "Some examples of non-hCG substances that can cause false-positive results include human LH, antianimal immunoglobulin antibodies, rheumatoid factor, heterophile antibodies, and binding proteins."
    Last edited by Scott; 07-25-07, 09:20 AM.
    Scott, [email protected]
    right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


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    • #3
      Evan:
      Boy this is a tough call. In the US they don't assume cancer until the HCG is around 25, but being 34 years old ,if you were to have tc it would most likely be seminoma which may not elevate your markers. Even though tc is quite curable cancer is nothing to take lightly. I would assume that the solid mass is cancer and that the HCG is elevated because of the cancer. I would need absolute proof that it isn't tc before I would let that testicle remain.
      Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

      Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.

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      • #4
        Gentlemen, thanks very much for your words of wisdom: your generosity with your time is much appreciated.

        Especially as I’m not a pot-smoker, I agree with erring on the side of caution and would rather go through life without a testis than risk any spread. When I have my next blood test I’ll ask my urologist about testosterone and the other issues you raise that might cause a high BHCG. If there’s no change, however, surgery will follow quite quickly.

        If there is a tumour, at least it is not behaving aggressively – or at least that’s how the change from 12 to 9 on the BHCG and the smaller ultra-sounds are being interpreted. This suggests that there is time for another round of blood work. (I sure hope this is the right approach…)

        I’m sure I will post again when I get my next batch of results in a couple weeks.

        Regards,

        Evan

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        • #5
          A CT scan will better define the testicle, nodes, etc. and give you a better idea of what, if anything, is going on. If there is a tumor lurking you want to be sure it's in that testicle before they remove. It sounds like you doc is a good one...repeating tests and calling in a consult for an oncologist indicates to me they are watching out for you.
          Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

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          • #6
            Have you gotten a tattoo lately? It's not a common association but we had a member have his HCG go wild for a few weeks right after a new large tattoo.
            Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

            Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.

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            • #7
              Hey Evan,
              From what I understand, the lump by U/S has shrunk, but the HCG level is hovering a tad above normal, right? You should (and probably will) get another reading on your HCG within 7 days of your last exam. There is also the small possibility that your HCG baseline could just be high because of other hormonal imbalances just like the ones Scott delineated in his earlier post. I wonder whether a hormonal panel would come in handy to see if that solves the mystery of the high HCG.
              "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
              11.22.06 -Dx the day before Thanksgiving
              12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

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              • #8
                Nope, no tatoo...distressingly square life in fact. I'll ask about the CT scan when I see the urologist in 12 days.

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                • #9
                  I really hate to see that testicle come out if nothing is going on. Let's hope your markers keep going down and the mass go's away. If they need to they may be able to biopsy the mass and save the testicle.
                  Last edited by dadmo; 07-25-07, 12:39 PM.
                  Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

                  Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.

                  Comment


                  • #10
                    Good point Fed. A hormone panel including FSH and LH fills in some additional info. You may want to give the doc a call with these questions so if he/she orders more tests you will not have wait.
                    Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

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                    • #11
                      Hi

                      Hi Evan,

                      I read your thread.
                      What to tell you … hm.
                      Your doctors should give you the medical aspect of all this stuff.
                      Could you go somewhere else and redo the ultrasound?
                      I don’t think CT-scan will help you for detection of tumor in testicle, but for sure it will check the “retroperitoneal lymph nodes” – this is the other thing that TC specialists usually check. A Chest X-Ray could be done too.
                      All this is a nightmare for you, I know.
                      Listen …
                      Don’t worry! With one testicle you could live normally, that’s no problem.
                      If they suggest to do nothing at this moment, you are OK too.
                      As long as you follow your appointments, technically you have all chances to be saved if needed.
                      Keep your results here. We are with you!

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