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Hi everyone. I have just been diagnosed with TC and I am looking for some advice on treatment options.
I started having some pain in my right testicle about 6 months ago. It lasted for about 2 days and then went away. The end of March I went to have my annual physical for work and the pain had returned. I also had elevated white blood cell count. I went to my GP and he started treating me with antibiotics for epiditymitis. I noticed a small knot on my testicle about 2 weeks later. It was kind of soft and the GP thought it was just a hydrocele and continued to treat me with antibiotics. After 3 weeks of antibiotics the knot had grown to cover most of the inside of the testicle. My GP referred me to the Urologist who ordered an ultrasound and confirmed that there was a mass. My tumor markers and chest X-ray were normal (I don't know the numbers). He said the only way he could tell for sure was to do the I/O and take a look at it. I had the surgery on 5/18/07 and the Urologist told me after the surgery that it looked like cancer to him. I saw the doctor on 5/29/07 and the pathology confirmed that it was cancer.
[I]Histopathologic Diagnosis:
Right Testicle, Radical Orchiectomy: Non-Seminomatous Germ Cell Tumor Consistent with Embryonal Carcinoma.
Focality: Unifocal
Pathological Stage: pT2, pN0, pMX
Tumor Size: 2.8 cm (Gross Dimension)
Spermatic Cord Margin: Univolved
Lymphovascular Invasion: Present
Extra testicular spread: Absent (Tumor confined to testis).
Comment:
Sections show a tumor which is largely subcapsular in location. The tumor cells are fairly large with very large pleomorphic nuclei having frequent prominent nucleoli. A few poorly formed gland like structures are noted. Mitotic figures are fairly frequent and there is hemorrage and necrosis within the tumor. There are several foci where there are nest of tumor cells in thin walled apparent vessels which most likely represent lymphatics. In one focus there is a cluster of tumor cells within a muscular vessel. It is felt that this represents true lymphovascular invasion. A PAS stain shows strong cytoplasmic staining which is eradicated by diastase indication significant glycogen in the tumor cells. An immunostain for human chorionic gonadotropin is performed and shows virtual absence of staining in tumor cells. An immunostain for alpha fetoprotein is performed and shows only rare positive cells. The histologic appearance and immunostain characteristics of this tumor are most consistent with a choriocarcinoma (choriocarcinoma is marked out and initialed, the Urologist sais that he discussed it with the Pathologist and he said it was a typo).
I got an infection after the I/O and I still have my staples. The Urologist is going to remove the staples on Monday and then schedule the CT. I live in East Tennessee and I am thinking about going to Vanderbilt-Ingram Cancer Center at Vanderbilt University to get a second opinion. The Urologist is handling everything on his own and has not even mentioned reffering me to an Oncologist. The Urologist said that my options were to watch it, RPLND, or Chemo. He is recommending the RPLND because he says that the 10 year recurrance with chemo is very high and there is a 20-25% chance that the cancer will come back if we just watch it. Could someone help me to understand the staging? I thought I understood the Urologist to say that it was stage I but I am beginning to wonder if its not stage II due to the lymphovascular invasion. Any advice that you can give me will be appreciated. Sorry for such a long post.
I started having some pain in my right testicle about 6 months ago. It lasted for about 2 days and then went away. The end of March I went to have my annual physical for work and the pain had returned. I also had elevated white blood cell count. I went to my GP and he started treating me with antibiotics for epiditymitis. I noticed a small knot on my testicle about 2 weeks later. It was kind of soft and the GP thought it was just a hydrocele and continued to treat me with antibiotics. After 3 weeks of antibiotics the knot had grown to cover most of the inside of the testicle. My GP referred me to the Urologist who ordered an ultrasound and confirmed that there was a mass. My tumor markers and chest X-ray were normal (I don't know the numbers). He said the only way he could tell for sure was to do the I/O and take a look at it. I had the surgery on 5/18/07 and the Urologist told me after the surgery that it looked like cancer to him. I saw the doctor on 5/29/07 and the pathology confirmed that it was cancer.
[I]Histopathologic Diagnosis:
Right Testicle, Radical Orchiectomy: Non-Seminomatous Germ Cell Tumor Consistent with Embryonal Carcinoma.
Focality: Unifocal
Pathological Stage: pT2, pN0, pMX
Tumor Size: 2.8 cm (Gross Dimension)
Spermatic Cord Margin: Univolved
Lymphovascular Invasion: Present
Extra testicular spread: Absent (Tumor confined to testis).
Comment:
Sections show a tumor which is largely subcapsular in location. The tumor cells are fairly large with very large pleomorphic nuclei having frequent prominent nucleoli. A few poorly formed gland like structures are noted. Mitotic figures are fairly frequent and there is hemorrage and necrosis within the tumor. There are several foci where there are nest of tumor cells in thin walled apparent vessels which most likely represent lymphatics. In one focus there is a cluster of tumor cells within a muscular vessel. It is felt that this represents true lymphovascular invasion. A PAS stain shows strong cytoplasmic staining which is eradicated by diastase indication significant glycogen in the tumor cells. An immunostain for human chorionic gonadotropin is performed and shows virtual absence of staining in tumor cells. An immunostain for alpha fetoprotein is performed and shows only rare positive cells. The histologic appearance and immunostain characteristics of this tumor are most consistent with a choriocarcinoma (choriocarcinoma is marked out and initialed, the Urologist sais that he discussed it with the Pathologist and he said it was a typo).
I got an infection after the I/O and I still have my staples. The Urologist is going to remove the staples on Monday and then schedule the CT. I live in East Tennessee and I am thinking about going to Vanderbilt-Ingram Cancer Center at Vanderbilt University to get a second opinion. The Urologist is handling everything on his own and has not even mentioned reffering me to an Oncologist. The Urologist said that my options were to watch it, RPLND, or Chemo. He is recommending the RPLND because he says that the 10 year recurrance with chemo is very high and there is a 20-25% chance that the cancer will come back if we just watch it. Could someone help me to understand the staging? I thought I understood the Urologist to say that it was stage I but I am beginning to wonder if its not stage II due to the lymphovascular invasion. Any advice that you can give me will be appreciated. Sorry for such a long post.
), and the only important things now are: to not get crazy, to keep you mind – you are as normal as everybody, this is not a disease.
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