Testicular Cancer

1. Testicular Cancer Presentation at WHRHS Alex Hohmann February 18-19, 2014

2. Alex’s testicular cancer • First diagnosis in October 1996 (age 30): surgery, radiation therapy and surveillance • Second diagnosis in March 2008:surgery and surveillance • Excellent prognosis

3. Alex’s post-diagnosis goals • Lead healthy lifestyle and survive cancer well • Advocate, fund raise and educate • Run third half marathon and first full marathon in 2014

4. Basic facts about TC • Testicular cancer includes different cancer cell types (seminoma vs non-seminoma) that usually appear first in the testes • TC does not have any clearly identified causes • Men with TC were most likely born predisposed to it • TC rates seem to be higher in men born with an undescended testicle and are highest among Caucasian men

5. TC by the numbers* • About 8000 new cases/year in the US • Accounts for only 0.5% of all cancer cases • Most common cancer in men ages 15 to 40 • Median age at diagnosis is 33 • Lifetime risk is about 1 in 250 • Just under 400 deaths/year • Overall 5-year survival rate of 95% • Localized (confined to testes) survival of 99% * All figures from the Sean Kimerling Testicular Cancer Foundation, National Cancer Institute, and American Cancer Society

6. Anatomy of testes and pelvis http://www.urologyhealth.org/urology/index.cfm?article=36

7. Early detection of TC • Examine testicles at least once a month • Look for presence of a pea-sized mass attached to testes or for scrotal enlargement • Other symptoms may include feeling of heaviness in scrotum, severe and worsening back ache, breast tenderness • See a urologist at the first sign of any of these symptoms. Do not delay.

8. Diagnosis of TC • Urologist will examine testicle and, if indicated, order a scrotal ultrasound to be done right away • The ultrasound is quick and painless • Ultrasound images are examined by a radiologist who will report back to the urologist if there are signs of a tumor • Urologist will draw blood and order a CT scan to be done right away

9. Diagnostic and staging tools

10. Treatment of TC: first steps • Entire testicle must be removed in a short procedure called an inguinal orchiectomy, usually done on an outpatient basis • Biopsy of the testicle, CT scan, and blood tests determine type (seminoma vs non-seminoma) and staging (1, 2, 3) • Post-orchiectomy treatment and follow-up vary according to type and stage and are done under the care of an oncologist

11. TC Stages http://www.urologyhealth.org/urology/index.cfm?article=36

12. Treatment of TC: next steps • Depending on cell type, stage 1 TC may require only follow-up testing (surveillance) • Non-seminoma may require further surgery (e.g. RPLND) for biopsy or treatment • Some stage 1 patients elect adjuvant radio- or chemotherapy to reduce relapse risk • Relapse (cancer shows up again, often in lymph nodes) must be treated immediately with chemo- or radiotherapy

13. Effects of TC and treatment • Loss of one testicle does not usually impair testosterone and sperm production • Radio- or chemotherapy can impair sperm production so some men bank sperm first • A second TC is very rare but results in loss of fertility and need for hormone replacement • Properly treated and followed up by a doctor, majority of TC survivors have normal sexual performance and live a fully and healthy life

14. Alex’s lessons from cancer • There was no known way of avoiding TC • There are others facing the same thing • There can be a great life after cancer • Keep a sense of humor • Don’t take health or life for granted • Be grateful for life by giving back to others • Don’t be shy about speaking up • Embrace new challenges

15. Points to remember • Know your body • Live a healthy lifestyle • Get a complete physical regularly • See a doctor ASAP at any sign of trouble • Have someone (e.g. loved ones) with you if you have to see a urologist or oncologist • Ask questions and take good notes • Reach out for support • Don’t be shy about discussing health issues • Above all, don’t die of embarrassment!

16. Diagnosis-related definitions • Urologist: doctor specializing in genito-urinary disorders such as testicular cancer, bladder cancer, prostate cancer, incontinence, infection, etc. • Oncologist: doctor specializing in treatment of cancer, often specializing in specific cancers • CT (computed tomography) scan: x-ray “slices” of the body to produce three-dimensional image • Ultrasound: widely used sound wave technology used to produce medical images • Biopsy: examination of tissue samples under microscope for isolation and identification of abnormalities such as cancer cells

17. Treatment-related definitions • Inguinal orchiectomy: surgical removal of a testicle done through a small incision in the groin and thus not involving incision in the scrotum itself • Radiotherapy: destruction or reduction in size of masses in isolated parts of the body using radiation of specific form, intensity, duration and frequency, usually but not always in exterior beam form • Chemotherapy: destruction or reduction of solid masses or diffuse cancer cells using cell-specific chemical agents in precise combination, timing, and dosage, usually but not always intravenously

18. Other disorders of the testes • Varicocele: swelling of testicular blood vessels • Hydrocele: accumulation of fluid in scrotum • Epididymitis: inflammation of the epididymis • Orchitis: inflammation of the testicles • Primary hypogonadism: low testosterone due to failure of testes to produce it • Cryptorchidism: undescended testicle • Testicular torsion: interruption of blood supply due to twisting of spermatic chord • Testicular rupture due to blunt force