Another new dx from a 41 Year Old..

[Concerned Sis]

Hi. Glad to find this forum. My brother was dx over the weekend with testicular cancer. His friend is a urologist and gave him an after hours exam at his house. His friend new immediately that it was cancer. Blood work was drawn Monday to check marker levels. They came back normal. He had surgery (Thursday) yesterday to remove the testicle and received his pathology report today. The tumor was 1.5CM. The pathology report reads: "pure seminoma with microscopic lymphovasular invasion". His friend the urologist is referring him to an oncologist/radiologist. They will do a full body scan, draw blood to make sure his markers remain normal, and if all comes back clean they will radiate the left side (cancer side). I have several questions - Is it likely that this has invaided his lymph nodes? Is it a good sign that he has unelevated tumor markers? Is it possible they can rise post surgery if they weren't present prior to? And also, I have to inquire about this as it's been heavily on my mind.... - My brother is the epitome of good health. He eats well and works out five times a week. He's all about limited body fat and all of that stuff. Approx 8 months ago he ordered some steroids (injectible) over the internet. Some synthetic form of testosterone from what I gather. I do realize that this is given to some men post TC and I am sure there are times when it can be a good thing - But, for a healthy male who didn't have a need (other than to feed his vantiy), for steroids - I can't help but wonder if his cancer is directly related to his steroid injections. The information is very limited about cancer (specifically testicular and prostate) being linked to steroid use. Does anyone have any feelings on this matter or perhaps know of a study? Has anyone on this forum taken steroids prior to their dx? Can I do a poll here? I hope I am not in any violation of forum policy by asking about this. I am anxious to hear your stories and some educated opinions regarding the "probable" prognosis of my brother's situation given the info I provided. Thank you and thanks very much for this site!

[dadmo]

Concerned Sis:
I'm sorry about your brother, but welcome to the forum. No questions here are off limits. Your a good sister for asking, just keep asking. Knowledge in this battle is everything. In your post you mentioned microscopic lymphovasular invasion, that indicates to me that the lymph nodes may be involved but that isn't as bad as it sounds. You're really going to have to wait for all the results to be in. From the sound of it your brother will get the radiation and then be put on surveillance. I can't answer the question about steroids, I just don't know. What I do know is that continued steroid use will cause the testicles to atrophy but I don't know that there is a conection to testicular cancer, other cancers yes but not tc that I know of.
Check back often other who know more about radiation will certainly jump in. The weekends here can be quiet so don't get frustrated if you don't get a lot of responses in the next two days. What you can do is follow this link to a great tc web site that will answer many of your questions and give you some additional ones to ask. http://tcrc.acor.org/

[Concerned Sis]

Thank you...

Thank you for the reply - I will check out the website and perhaps pass that one on to my brother. He would roast me if he knew I posted about the steroid use - mainly because he doesn't think I know about it. But getting back to the TC - do the "tumor markers" not tell us anything? I was so hoping that it was a really encouraging sign. The though of him having to have his lymph nodes tested is rather upsetting. I've seen many horrible stories about post op issues. I did get excited about "mircoscopic" lymphovasualr invasion as opposed to a larger invasion? But invasion is invasion, correct? It could go either way for him?

[dadmo]

Sis:
The markers being normal is great even better then great but. The microscopic invasion may have been taken care of but the removal of the testicle. The scans will tell the whole story. Seminoma is very slow growing so if the scans are clean he may go directly into surviellance.
My sons used to push a lot of weight and when he was diagnosed I asked him about the use of steroids and I told him to be honest because we needed to work with the best information available. If he finds out he may be upset but he will love you all the more for caring.

[Concerned Sis]

Steroid use...

I do find it odd that so many athletes have been dx with TC, especially since TC is one of the rarer cancers. Notwithstanding athletes, the age where this cancer is most likely is in the "prime" of a guys life. The time where, if they did try steroids, it would be within that time frame for the most part. I know usage is on the rise. I wonder how many athletes who had TC used steroids at some point but refused to admit it. I wonder home many regular "Joes" do the same thing. My brother isn't planning on telling his oncologist - but I will. Did your son admit to it? I am surprised more men in great shape don't have it - aside from steroids, it seems that dairy, working out, etc (seemingly good things) can contribute to this cancer.

[dadmo]

No my son said he didn't use any steroids and I believe him. He understood the seriousness of the situation and wanted the doctor to have evcery bit of information available, and our oncologist did ask that question.
I read an article one time that was trying to make a connection between warm testicles, which and tc. They indicated that the use of athletic supporters kept the testicles to close to the body which caused them to overheat, the same way they felt undecended testicles were prone to tc because of overheating. I'm not sure what to make of that idea since I bring my tresticles with me everywhere I go and never had a problem. Believe me I keep them close by my side (well not really my side but you get the idea).

[Scott]

Sis, tumor markers often aren't elevated at all with pure seminoma. Radiation therapy is a very effective treatment for seminoma.

[Concerned Sis]

Thanks, Scott

Do we know why markers aren't elevated with this type of tumor? Could his scans go either way at this point? What is "microscopic" invasion? Are there other types of invasion or is it all the same? What's your opinion on what you know about my brother at this point?

[Scott]

Seminoma tumors just don't release chemical markers into the blood the way non-seminoma tumors do. "Microscopic" invasion, as you said, is still invasion. That does increase the likelihood, but does not guarantee, that the cancer has spread. Seminoma is always treatable even in advanced cases, and I fully expect your brother to be cured.

[Concerned Sis]

One more question

I thought so. I couldn't find a term for "microscopic" invasion. Do you think radiation alone should do it or do you think a round of chemo could be more effective w/ radiation?

I, too, fully expect his scans to come back completely clean.

[Jens]

Hi Sis.

Radiation is the treatment of choise for seminoma. It will take care of any spreading. In case of a later recurrence (very rare!), chemotherapy is generally considered feasible. The overall cure rate for seminoma stage I is close to 100% (actually meaning more than 99%!)

It is generally accepted that TC is something you are born with. It araises in the early fetal stages and if it's there (carcinoma in situ), it will show it's ugly face sooner or later.

- I know the logical argument: if it's there but dosen't grow into full blown cancer, you will never know, right? But as said, it's generally accepted that it will manifest itself at some point in life.

There is no evidence (as far as I know) that links anything (apart from undescended testicles but including steroids) to TC.

So, even though I find steroid mis-use totally $¤£&#@-up, I wouldn't give him a hard time about it now. It can wait....

Best wishes
Jens

[Rainman]

Seminoma

Sis,

The good news is that he has a seminoma...even if there is the possibility of lymphovascular invasion it will be treated the same, e.g., radiation, as if there were no evidence of spread. Likely 15 days of RT to the periaortic nodes should do the trick. Chance of recurrence is very rare.

Ray