Diagnosis elusive

[Fed]

My understanding is that the pathology report discusses the physical spread of the tumor itself (invasion) but the CT scans are also needed to check for distant tumors due to cancer cells that may have spread through some other avenue? Are the odds of spread lower with the early stage and it being seminoma?

For the most part, you are correct. The pathology serves as a description of your primary tumor from which any potential metastases arise. The CT scan will look for the mets themselves. Your assessment about seminoma is also accurate. The odds of seminoma having spread when caught early are low, primarily because seminoma divides and grows very slowly. The only drawback is that because of its slow growth and spread, the window for a relapse is larger (5 years). With stage I seminoma, your chances of having been cured by the orchiectomy alone are 80-85%.

I'm sorry to hear about your struggles with the medical system. I am glad to hear, though, that you are being persistent with this, particularly since you will need to be under the care of an oncologist for your surveillance.

[dadmo]

Gary:
From the path report it seems unlikely that they will find any spread but that needs to be confirmed with the scans and xrays. If you are indeed stage I surveillance is a great option.

[The Prospector]

Hey thanks again everyone,
Just thought I would post an update with a few more questions.
Well since my last post I have been struggling with our health care system here again.
Before and after the surgery with urologist #2 I was pushing to get a CT scan but no luck, they want to wait for the pathology first. Well by the time the pathology was back, urologist #2 had left for holidays. Although he promised that he had set up an appointment for a CT before he left, I was not able to confirm any appointment with any hospital he was associated with. In the mean time I was contacted by our BC cancer agency and told that they could not accept me as a patient without a CT scan! So I managed to convince the urologist on call at the hospital to take over my care (#3), he was quite upset with what had happened and had me a CT booking in 15 minutes. So I think things are back on track now, thats a big relief.

My understanding is that the pathology report discusses the physical spread of the tumor itself (invasion) but the CT scans are also needed to check for distant tumors due to cancer cells that may have spread through some other avenue? Are the odds of spread lower with the early stage and it being seminoma?

Personally I think I will take the surveilance route if at all possible as I am very sensitive about the damaging effects of radiation. I am even concerned with getting CT scans, I have read that each one is about 3 years of background radiation. I suppose that even 10-20 of these is still far less than RT?

Much thanks,
Gary

[slimjim]

Hey Gary....good news! I had not seen your post until after I replied to your post to me......good stuff.....the obvious participation of others sure helps the waiting game...your diagnosis and subsequent pathology sounds like it was/is being caught early....keep us informed as to your next steps so we can all keep learning and praying.

[Sans rt1]

Prospector - -

Congratulations on the good report! As Fed explained, you caught it very early and you may well be cured already. You have some decisions to make, but you can rest assured that all should lead to an ultimate cure for you.

[Fed]

Hey Gary,
This is indeed quite a decent (and well-redacted) report. The diagnosis of seminoma is in your favor, since you have the form of TC that is the easiest to treat. The "intratubular germ cell neoplasia" means that the progenitor cells of the cancer (the precursors to actual seminoma, the cancer itself) are present and found inside the tubules. This is, in a sense, the "pre-cancerous" state. By the NCCN guidelines, you are staged at pT1, which translates to stage I-A.
Based on the report, you will have a choice of close surveillance, adjuvant radiation, and possibly adjuvant chemo. My take (and take this with a grain of salt, since I'm not an M.D.) is that although you are an excellent candidate for surveillance, it is likely that your docs might recommend adjuvant radiation on the basis of the rete testis invasion because it has been documented that rete testis invasion likely correlates with an increase in the chances of a recurrence.
Irrespective of the above, you really have no bad choices here. Surveillance already gives you an 80-85% of having been cured by the I/O alone, and RT only increases those odds to 98% with the only drawback being a greater risk (albeit still small) of developing in the long run (20 years or so) a secondary cancer as a product of having received radiation.
Discuss all of your options with your oncologist. It will boil down to a personal decision. Best of luck, and keep the questions coming. At the very least, the wait is over.

[The Prospector]

Well I saw my GP today to get the staples removed. I thought they were infected as the skin had become bright red around each staple leg, but he said that was just the body's natural reaction to a foreign object.
But more importantly he happened to have my pathology report. It appears to be relatively good news, I am copying it below for your much appreciated opinions:

GROSS DESCRIPTION:
....On sectioning the testicle measures 3 cm in greatest dimension. Contained within the testicle is a tan, 0.8 cm tumor nodule. This is separate from the tunica albuginea an epididymis. The uninvolved testis is tan and homogenous. Representative sections are submitted as "A" spermatic cord margin, "B" to "D" testicular tumor, "E" uninvolved testis, "F" and "G" additional sections through spermatic cord submitted proximal to distal.

MICROSCOPIC DESCRIPTION:
Sections show the tumor nodule to be a seminoma. Although this nodule was grossly 0.8 cm, seminoma is seen to infiltrate the testis. Overall I would estimate that this measures 1.4 cm in greatest dimension. Lymphatic/vascular or perineural invasion are not identified. The seminoma does involve the rete testis but does not extend into the epididymis. It abuts but does not invade the tunica albuginea. There is focal intratubular germ cell neoplasia. The adjacent testis shows marked atrophic change.

***DIAGNOSIS***
Excision left testis showing:
A) Seminoma of testis measuring approximately 1.4 cm in greatest dimension.
B) Extension into rete testis.
C) Intratubular germ cell neoplasia present.
d) Epididymis, spermatic cord and soft tissue margins negative for seminoma.
E) Marked atrophic change in adjacent testis.
....


So... judging from what I have read elsewhere on this site, this seems relatively good? The 'Intratubular germ cell neoplasia' has me puzzled though, anyone know what this is about?

Thanks,
Gary

[The Prospector]

Hey thanks for the info,
What I am feeling is like a thread (ie. too small to be felt between the thumb and finger). It can only be felt with a 'plucking' action, and it it definitely attached at both ends. Well I'm not too worried as long as it dissolves like the urologist expects.

Thanks,
Gary

[Pete]

I had the same thing also, and it had a little ball on the end of it, the doc said there were stitches there that would dissolve in time.
it was very sensitive to being touched, bumped and heavy acitivity. Just work around it, it goes away.

[fuse929]

Hey Gary. I have the same single cord, and a few weeks ago my urologist said it was exactly what Fed said, the spermatic cord. As you describe, there is a stinging pain when you mess with it.....that lasted a good month after surgery, but has now faded to almost nothing. Give it a few weeks and hopefully it will turn into an afterthought.

Bobby

[Fed]

Gary,
Nowadays, soluble sutures are the standard. General discomfort could last up to six months, particularly in places where nerve growth is taking place. The "short thread" you felt is likely the remnant of the spermatic cord which will still be connected to the abdomen. The entire thing is not taken out, and a piece will be left hanging.

[The Prospector]

Thanks Jaybird,
I finally got to talk to my urologist this afternoon and he said it was normal.
His explanation was that there are internal areas that need to be stitched up after the surgery to keep them from bleeding and adhering to adjacent areas. He said it is a good idea to manipulate the scrotum to help prevent these areas from adhering and this would help pull any stitching free that was preventing the scrotum from hanging loose. He said the stitches are chromic and would dissolve in a week or two anyway. Sounds kinda strange to me but I am glad to hear they will dissolve.

Thanks,
Gary

[jaybird]

Gary, that does not sound right to me. Hopefully you are getting it checked out today.

[The Prospector]

Thanks to Bobby for the Slimfast shake suggestion (awesome idea). I have been eating fresh cherries since the surgery for the same reason.
My urologist said the chest x-rays taken at the time of the surgery looked fine and has requested an appointment for a CT scan. He will be on holiday when the pathology comes back so the report will go to my GP.
OK, now I have a really wierd question: Last night I decided to investigate why my scrotum is kinda inverted on the left like a large dimple. At first I just assumed that it was because there is no longer a testicle in there to round it out, but when I tried to flatten out the dimple I got a sharp pain in my abdomen! So I have discovered that there is a short thread connected from the inside left bottom of my scrotum to something up inside my abdomen! Pretty creepy. I was hoping someone here might know what this is. I was thinking it might be for some temporary purpose and just dissolve or maybe to facilitate a prothesis in the future? Nothing like this was discussed with my urologist and he won't be back in the office until tomorrow.

Thanks
Gary

[Fed]

Glad to hear that you are in recovery mode. The waiting does suck, but have some patience and focus on your recovery. Other than the coughing and the laughing, the biggest fear was having my kid trying to jump on me while I was lying down .

Looking foward to hearing from you again,