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**Scott** · 12-08-06, 10:46 PM

I'm not used to seeing adenocarcinoma mentioned in these forums often. Emily posted about it recently, too.

It's not a germ cell cancer. I've read that it can arise from teratoma with malignant transformation. It's "a cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties." I'm afraid that's about all I know about it. I would definitely ask your oncologist for more explanation.

**mercyriver** · 12-11-06, 11:20 AM

Did some research this weekend

I did some research this weekend on what adenocarcinoma is.

I honestly couldn't find much in regards to testicular cancer and adenocarcinoma.

-Adeno means gland

-Carcinoma is a malignant tumor that starts in epithelial tissue

-Epithelial tissue can be either lining or glandular

-A Gland secretes things

-Adenocarcinoma is cancer of a gland OR a form of carcinoma that originates in glandular tissue cells that have secretory properties.

Most of the time when you see adenocarcinoma it is not a good case, but I think with my husbands pathology report it is in there because our hospital deals with Prostate cancer more often then not. We are in Colorado after all, where prostate cancer has a much higher incedence. So I am guessing that is just how the pathology department is used to labling things.

Still worries me that they never sent out the tumor to be checked by a testicular cancer expert center but I don't think that the adenocarcinoma ment anything other that it was a glandular cell.

Any other information would still be welcomed.

Becki

**mercyriver** · 12-28-06, 10:19 AM

Robert,

Thank you for your concern.

I'll answer questions 2-4 right now. And then post the pathology report in a post below this one, as it will take me a while to type up.

2. My husband was on surveillence until Nov 30th, he had blood work and a CT at that time. Blood work came back with an elevated Hcg at 5 and his CT showed lymph nodes that had increased in size since the September CT. The CT report states largest in the aorocaval region measuring 1.4cm x 1.8 cm and another just inferior to the first, which they said measures 7 x 8 mm and a thrid enlarging lymph node at the level of the aortic bifurcation at 1.9 x 1.4 cm. The Dr's report says there are enlargments in the retrocaval abdominal lymph nodes as wel as at the aortic bifurcation. I've looked up all of those terms trying to determine where in the body they all are and haven't found anything to helpful. Also, he went for a PET scan last Wed, he went ahead and went in this Tues for his monthly blood work and he has his regular surviellence follow-up appointment this Friday. In case you missed in a previous post, we had insurance and Dr's fighting and it took from seeing the Dr. Dec 3 till last Wed to get the PET scan done, but it was finally done. And we have a big snow storm coming in tonight that is supposed to dump 18-36 inches of snow. So the chances of us seeing our Dr on Friday.....very very low.

3. I covered the follow ups.....he has had some other pains and such, started off with abdominal pains for about 3 weeks, he also had some breast tenderness for about 1 1/2 weeks, both which did go away, it was strange. There is also the constant fatuige and it can get pretty extreme. He also has had a cough for several several weeks, at least 9. His chest x-ray was clear in October, they have skipped (forgotten to do?) the last 2.
My husband also mentioned last night his was having leg and feet cramps prior to taking some cold-ez, which has now resolved. There are most likley a million other things going on with him, but he doesn't usally share most of it!

4. He is being treated by Dr. Richard McMahon at the Rocky Mountain Cancer Center. He is a medical oncologist. He was the 2nd person on the list of oncologists that our urologist referred us to. No one has ever mentioned his testicular cancer experiance. His resume lists he is an expert in prostate cancer. Though he did mention to us the first time we saw him that they just finished chemo with a man with testicular cancer. He is by no means an expert in TC though. I honestly don't think he is working. My husband trusts him 100% and thinks there is something wrong with me to not trust him just as much. At this point I don't think I trust him at all. Unfortunantly I think I am learning very quickly my husband doesn't take much of what I have to say to heart.

As a closing note to this post, last week I did take it upon myself to have his slides sent to Dr. Ulbright at IU to have a 2nd opinon on the pathology. I am hoping it was sent out last Tuesday or Wed before the blizzard hit Denver, other wise it would have been delayed, but with that said it could be delayed coming back in as well. I will post the original pathology report below.

Thank you so much for taking the time to read through all of this.

Becki

**mercyriver** · 12-28-06, 10:47 AM

Pathology Report

I just want to note a couple things before I post the pathology report. Looking at the pathology report and the oncologists notes/report (the report he has someone type up based off of his notes from each visist.), they use the word carcinoma and adenocarcinoma interchangable. It is very odd. Because the first report/summary from the oncologist states

Chief Consultation: Embryonal cell carcinoma of the right testicle.

But down in the history of present illness it states "There was no evidence of permeation through the tunica albuginea and the tumor type was felt to be embryonal adenocarcinoma."

Kind of scary in my mind. It is like they are one in the same. I never really noticed the word adenocarcinoma until I was looking back over it this month, after seeing it on the forum a couple times. I had just assumed up until that point adenocarcinoma was the same as carcinoma. And honestly that is what the pathologist and oncologist seem to be acting like it is! And I didn't see the Dr's notes/report until I had all the medical records faxed to me on Dec 12th. If it is indeed embryonal adenocarcinoma I will be furious, but I have a feeling it is more likely they are using the word adenocarcinoma the same as carcinoma....at least that is what I am hoping for.

Here is the pathology report and I will gladly share what I get from Dr. Ulbright when I recieve it.

Becki

Clinical Information:
Right testicular mass.
Specimen Submitted:Testicle- RT
Gross Description:

Received in formalin, labeled with the patient's name and "Right teticle and cord," is an intact testicle, 5.0 x 3.2 x 3.0 cm, with an associated intact, 6.0 cm in length x 1.5 cm in diameter segment of spermatic cord. The 64 gram specimen is encapsulated with an intact, smooth tunica vaginalis. Bivalving shows an ovoid, 3.0 x 2.0 x 2.0 cm mas lesion occupying greater then 75% of the cut surfaces. There is a scant rim of grossly normal residual testicular parenchyma-seminiferous tubules, which string to 1.2 cm. The mass grossly compresses the parenchyma and abducts but does not grossly penetrate the tunica albuginea. The mass lesion, although showing focal areas of hemorrahage, is rather pale gray-white and well-circumscribed.
Representative sections are submitted as follows:
A: Margin of spermatic cord, trimmed, en face.
B: Mid spermatic cord, complete cross-section.
C-G: Corss sections of testicle with testicular mass and epididymis.

Microscopic Description:

The tissue is studied after hematoxylin-eosin staning. The spermatic cord sections show cross-sections with no involvement by malignant cells. Tumor sections show embryonal type adenocarcinoma that shows no evidence of permeation through the tunica albuginea. Epididymis is univolved by the lesion. No other germ cell elements are definitively identified. Intratubal germ cell neoplasia is evident in surrounding tissue. Normal spermatogenesis is not observed.

Cancer Case Summary Protocol:

Testis: Radical orchiectomy

Serum Tumor Markers
AFP 21.1, Beta Hcg 23

Macroscopic
Laterality
Right.
Focality
Unifocal
Tumor Size
3.0 cm

Microscopic
Histologic Type
Embryonal carcinoma
Pathologic Staging (pTNM)
Primary Tumor (PT)
pT1:Tumor limited to testes without vascular/lyphatic invasion
Regional Lymph Nodes (pN)
pNX: Cannot be assessed
Distant Metastasis (pM)
pMX: Cannot be assessed
Margins
Spermatic Cord Margin
Univolved by tumor.
Other Margins
Uninvolved by tumor
Direct Extensions of Invasive Tumor
None.
Venous/Lymphatic (Large/Small Vessel) Invasion (V/L)
Absent
Additional Pathologic Findings
Intratubular germ cell neoplasia.
Comment(s)
None.

Final Diagnosis:
Right Testicle, Radical orchiectomy: Embryonal Carcinoma (3.0 cm), confined to testis without involvement of permatic cord sections. Apparently completely excised, as described.

**dadmo** · 12-28-06, 10:58 AM

All of the affected lymph nodes will be back by the kidneys and the aortic bifurcation is where the major vein from the heart splits and runs down into each leg. It’s a tricky area to work (my son had problems there) but the experts (Sloan and IU) will have no problem dealing with that.

The nipple sensitivity is often be related to elevated hormones and when they drop back down the pain subsides.

I hate for you to sneak behind your husbands back but you did the right thing sending the slides to IU. It’s often easier to ask for forgiveness then it is to ask for permission.

**mercyriver** · 12-28-06, 11:28 AM

That is interesting that they would be back by his kidneys. Is that still just stage II?

By the way, his first CT in Sept noted that there was an apparent adrenal adoma measuring 13 housfield units.

No one ever told us about it, I read it when I recieved the CT report this month. Then there was nothing about it on the CT from November. So who knows, I just found it interesting that it is in the same area.

Also, yeah, it tore me to go behind him to get the 2nd opinon done, but he is just very stubborn, and I really wanted to get it done, because the 1st pathology report really just doesn't make a bit of sense with the word adenocarcinoma in it. Besides, I figure if it comes back as the same he can stick his tounge out at me and say, I told you so. And if it comes back as something diffrerent, he will be thankful.

Till then I just keep on waiting....

Becki

**dadmo** · 12-28-06, 02:07 PM

Becki,
Don't panic but Robert is correct something isn't right. You should make every effort to get into contact with an expert either at Slaon or I.U. If it's Sloan we have room here and you are welcome to stay.

**mercyriver** · 12-28-06, 02:07 PM

Honestly nothing has felt right from the start with the oncologist. The urologist we used was awsome. My husband went into the ER at 7am on Sept 11 of this year, had the ultrasound done in ER, they reffered us to the urologist, saw him at 10 am, and he was in and out of surgury by 8pm that same night. He was great. I don't know how often he sees TC, but he was certain after he removed the tumor it was going to be seminoma based off of it apperance. I did not have the same feeling because the tumor seemed to appear so quickly.

Our first meeting with the oncologist wasn't as pleasing. I do believe he thinks he is doing the best for us, but I don't think he has consoulted with any TC experts. And he has missed now 2 Chest x-rays and not questions anything on the orginal pathology and has not shared everything found on the CT's with us. I am sure he is a great oncologist for prostate cancer, but I don't like that he thinks he is the same for TC. And it has bothered me since the start. His parents wanted him to get a 2nd opinion, I did as well, but didn't say a word after he told me his parents don't understand doctors today and that there is no need for a 2nd opinion. As things went on and the oncologist started missing things I did start raising my concern about the Dr to my husband, but his response was always along the lines of , Dr's make mistakes and that he trusts the oncologist 100%. And that he is the oncologist and he clearly knows more about it then we do.

Like I have said, my husband is stubborn. I couldn't even come close to explaining HOW stubborn he can be. But once he has it set in his mind that he is right, it doesn't change.

His first CT in September did show enlarged lymph nodes, but not at the 2cm mark to consider them cancer. But he did not have elevated tumor markers at that time. So they continued with surviellence. They did a chest x-ray at the end of Oct, it came back as normal, we haven't had a chest x-ray since. The CT at the end of November came back with enlarging lymph nodes, still none up to the 2cm mark, but the Dr who reviewed the CT stated it was "Worriesome for metastatic disease". His blood work showed his Hcg at 5. So his oncolgist decided it could all still be just a fluke and he didn't want to give him Chemo if he didn't really need it. And the oncologist wanted to have a PET/CT done to confirm active cancer cells. My husband agreed, but we did both walk out of there knowing it was cancer and started prepping ourselves for chemo. Well then the insuance company and the Dr's office started arguing about the PET/CT scan. Insurance company only wanted a PET scan done and the Dr's office swore no one in Colorado did just PET scans anymore. Well after fighting over it for 3 weeks the finally found a PET scan in Boulder, and that was done last Wed.

So, you can see why I don't like the oncolgist, I still don't know why my husband does.

I am just hoping at the end of all this we can look back and laugh, because I am hoping none of these delays and mistakes will ever make a difference. I can't say that is my gut feeling, but it is my hope.

By the way, the only "TC Expert" in Denver (where we are), isn't covered by our insurance, of course.

So that is about it.....hope I filled in some of the blanks.

Becki

**mercyriver** · 12-28-06, 02:18 PM

Honestly guys, I know. I do know he should be seeing someone else. But short of drugging him and dragging him off somewhere else, I have to do it all myself.

I never got past Dr. Einhorn's secretary who informed me that I would have to either make and appointment to see Dr. E or get my oncologist to consult with him.

We have a Dr appointment set up with the oncologist tomorrow at 2pm. We have major snow storm moving in right now, it is supposed to dump up to 18 inches of snow tonight. But there is supposed to be a break in the weather tomorrow before it starts back up tomorrow night. So I am really hoping we will still get to both go to the Dr's appointment so I can actually ask about and adenocarcinoma, because if I can get my husband to see the Dr. waiver and be unkowledgable about something, then I have my in. If he all of a sudden sees that the Dr isn't the expert he thinks he is, we can move to someone else.

I am also hoping I hear back from Dr. Ulbright's patholgist's before they do anything else. From what I have read if there is adenocarcinoma in there it won't respond to chemo.

I really do wish my husband would listen to what I say as real knowledge, but without a medical degree behind me I am just a talking head to him...actually more like a over worried wife who reads WAY to much and reads way to much into everything. In fact he likes to tell me sometime that because I am throwing all this negative information at him, it is because I want something worse to be wrong with him than what the Dr.'s have said.

It is always an uphill battle with him, he can be quite unreasonable at times.

Thank you for all your support and information, I will do what I can with all of it!

Becki

**mercyriver** · 12-28-06, 03:04 PM

AFP in Nov was 5.2, it was 5.8 in Oct

LHD was 152 in Nov, 136 in Oct

Hcg was 5 in Nov, 3 in Oct

**mercyriver** · 12-28-06, 06:28 PM

What other kind of respitory distress? Like wheezing? Or heavy breathing?

None that I know of. All I know is he is at a point where he thinks he is getting a cold, though we have no colds going around.

Becki

**mercyriver** · 12-28-06, 06:40 PM

Also Robert, I don't know who you are or where you came from, but Thank you for all the help and assistance you are providing. I had no idea you were contacting IU.

I will most likely not be able to check the forum till later this evening.

I will do what I can to work on my stubborn husband! Unfortunantly with the current snow storm we will not be able to going anywhere till early next week.

Thank you again

Becki

**dadmo** · 12-28-06, 07:01 PM

Robert:
Thank you for what you are doing, please ,please, please, let me know if I can be of any assistance. I can't help with IU but I can be into Sloan in 45 min. if that should be needed.

Becki:
Please use all the help Robert is offering but remember if needed you can stay at my place and go to Sloan. As for you husband just tell him that for this you are in control and that if something should happen and you didn't see experts you couldn't live with yourself.
Those marker numbers are a concern and need to be taken very seriously.

**Scott** · 12-28-06, 07:41 PM

Originally posted by mercyriver

Also Robert, I don't know who you are or where you came from...

By the way, Robert, welcome to the forums -- and thanks for jumping right in! Please do let us know some more about yourself in The Ballroom when you have a few minutes. We're glad you're here.