new member .some questions .

[boram]

Hi all,
Two weeks ago I felt uncomfortable with a lump on my left testicle ,that I am not sure to remember when was the first time I felt her.
Last monday I went to urologist and he sent me directly to hospital to get check .

I had passed blood,ultrasound ,CT scan(stomach,pelvis,chest) tests and released home with scheduling for orchiectomy for next Monday .

Ultrasound - show a tumor size 15 mm diameter in the bottom left testicle.

CT scan -point Mesenteric Lymph Nodes little bit enlarged (the DR told me that it might be normal)and the testis tumor.

Blood test marker show AFP 42.71 NG/ML,
hCG 115 MIU/ML.
LDH Normal level.

When touching the tumor it seems to be something between on to in the testis.

I am 31 years old and healthy man with no medical history all this situation is new for me.

i got some questions

* I understand its possible to removed only the tumor and that approach is new ...If some one have any information regarding half orchiectomy?

* I want to ask if it possible statistically to evaluated, TC treatment stage based on the blood markers level ?(is there any connection between the markers level to the type of treatment? )

Tnx Boram

[Fed]

Hey Boram,

Welcome to the Forum (and I'm sorry you have to join the club). To answer your first question, the partial I/O is feasible, but it is difficult and almost never done. Usually it is considered when there is a contralateral presentation (i.e. if you have had testis removed, and you get a new primary in the remaining one). Moreover, it is more difficult to obtain surgical margins that are free of tumor, so there's always the possibility of spread within the partially resected testicle. One can function perfectly well with only one testicle (the vast majority of us do ). Besides, in cases where TC is caught early, sometimes people can be cured with an orchiectomy alone.

As far as your second question is concerned, the markers serve as a guide, but are never used alone to determine a course of treatment. Since you have elevated AFP, though, it is a certainty that any treatment you will receive will follow the protocol for non-seminoma, because seminomas never produce AFP. That being the case, they will probably keep watching your markers and the enlarged nodes, and depending on the pathology and cell type composition, you would get either chemo or surgery (RPLND).

You should go ahead with the I/O on Monday, though. It's the right path to a complete cure. Hang in there, and keep asking questions if you have them.

[Scott]

* I understand its possible to removed only the tumor and that approach is new ...If some one have any information regarding half orchiectomy?

A recent answer posted to the TC-NET mailing list quoted the European consensus on this question.

"Organ preserving surgery might be an alternative to orchiectomy in small primary tumours, but this approach is highly experimental and must be limited to clinical trials. However, in patients with synchronous bilateral tumours, metachronous contralateral tumours or solitary testicles with normal preoperative testosterone levels, organ-preserving surgery is an alternative procedure to orchiectomy and should be discussed with the patient. If organ preserving surgery is considered, the patient should always be treated at a centre with experience in the management of this rare clinical situation [EBM IIB: 37-39]. If organ preserving surgery is performed and TIN histologically documented, adjuvant radiotherapy of the remaining testicular tissue is strongly recommended according to the management strategy for TIN in unilateral tumours [EBM IIB: 14, 37-40]."