| The Testicular Cancer Resource Center |
So, you've been diagnosed with testicular cancer...and if that's not bad enough, they want to cut your testicle off, and they want to do it NOW! Hopefully, this article will explain what they are going to do -- and why they are going to do it. (Please note: This article is about testicular cancer. While they may do an orchiectomy for other reasons, including prostate cancer, it is not the same operation!)
First of all, if you've got a testicular tumor, you need this operation. We're sure you are thinking things like:
Well, these are all very good questions, and we'll try to answer them as best as we can.
Can't they do more tests? - Most Urologists are going to suspect cancer simply by feeling the afflicted testicle; however, there are other tests they will do to verify the diagnosis. They may try things like transillumination (shine a very bright light through the testicle) in order to rule out a benign cyst, but it is more likely, though, that they will order an ultrasound. The ultrasound is very good at detecting testicular tumors. In time, other tests will be necessary, but if the ultrasound indicates a tumor, then it is most likely that the testicle has to come out.
Why does it have to come out? How do they know it's cancer and why can't they do a biopsy? Well, they don't necessarily know it's cancer, but statistics indicate that it is very likely that it is -- then add in the fact that more than 95% of testicular tumors are malignant. The only way to tell if it is malignant is by looking at the dissected testicle under a microscope. They cannot do a biopsy because if it is cancer, they do not want to risk disturbing or spreading the cancer while it is still in the body.
Can't they just remove the tumor and leave the testicle? Well, yes
and no. While some doctors claim to be able to do this, there are many
more reasons to steer clear unless the cancer is caught very early
and there are special circumstances -- like you only have one testicle to
begin with! Few doctors perform this operation, and the experts do not believe
it is a good idea. Remember, testicular cancer is still cancer. The purpose
of the operation is to remove the cancer. Even if the surgery got all the cancer, leaving part of the testicle
behind will almost certainly leave precancerous cells behind that will eventually become cancerous again.
OK, so they have to take out my testicle. What does that mean? Well,
psychologically and/or socially this may cause you some issues, but in
most physical instances, it should not affect you in any way other than
minor post operative recovery. One testicle is all that is needed to do
all the things you like doing: growing hair, being manly, having erections, intercourse,
and babies -- all should still be possible with only one testicle. (Be
aware, though, that many men with testicular cancer have had fertility
problems before the testicle is removed. This problem may or may not go
away after the orchiectomy.)
Things to know before the operation
The doctor should have some blood work (tests) done. They need to check
your blood for the presence of certain tumor
markers and their levels while the tumor is still in your body. These
tumor markers can later be used to determine if the cancer has spread outside
of the testicle, but it is very important that they begin testing and establish
some baselines before the surgery. Similarly, we strongly encourage newly
diagnosed men to ask their doctors to check their serum testosterone
level before the orchiectomy. There is no therapeutic reason to
do this, but we have found that it may be useful to know this number at
some point in the future.
The doctors may also give you the option of an epidural or general anesthesia
for the surgery. General anesthesia is clearly the more traditional choice.
However, an epidural (lower back) block may be beneficial if you do not
react well to general anesthetics -- such as if you are not young or in
particularly good health. With the epidural anesthetic it is possible (though
maybe not desirable!) to remain awake and talkative during the whole
operation! Both anesthetics have possible problems and side effects,
so be sure to discuss your anesthetic options with your docs...
We have created a list of questions that you might want to print out
and take with you when you talk to the doctor about the operation. You
can find these questions here.
The Orchiectomy
The actual removal is done by making about a 4 inch incision along the "bikini line"
through the lower abdomen on the side in question--they will NOT
cut through the scrotal sack whatsoever. Once the incision has been made,
the surgeon pushes the testicle up through the pelvic region and out it
comes. A snip here, a stitch there, and you're done before you know it.
If you want to see what I'm talking about, Medscape has a picture
of the orchiectomy showing how the testicle is removed from the body and clamped before the cord is
actually cut. You might want to skip this one if you are squeamish...
Average time on the table is about 45 minutes to an hour, but you should
probably expect to stay in the hospital at least overnight. This operation is very simple and should not require any special
expertise on the part of the surgeon. Note that while some men do
stay overnight, most guys go home the same day (particularly in the USA). There is no
problem with this, just make sure you get some pain killers before you leave the
hospital, just in case...
They will probably wake you up pretty soon afterwards and encourage you
to get up and try to walk. It will hurt, but it will also get your insides
working faster and get you out of the hospital sooner. You'll probably have
a reasonable amount of pain at the incision, and you might want to consider
wearing sweatpants for a week or two. There may also be numbness of the
skin around the incision, but that should eventually go away.
Different people will react differently to the operation. Some will
be up and about the next day; others will lay around in bed for a while.
We recommend that you try to get up and do something because otherwise
you may just end up sitting around feeling sorry for yourself. Your attitude
will make a huge difference in your recovery time; the better it
is the better you will do. We suggest you learn about the cancer (the TCRC is
a great source!), so that you know what to expect from the pathology report
and from the doctor and the future ahead -- but don't let it overwhelm
you. The doctor probably wont let you drive or do any heavy lifting for
a couple of weeks, so be prepared to ask for help getting around.
Developing a hernia because you tried to do too much too soon is no
fun...
Following the operation, you get to experience what is arguably the
most frustrating side of cancer -- waiting for lab results! They
can take from 3-10 working days, during which time you think a LOT
about "what if, what if"...we used this time to do a lot of our research
so we knew all the possible paths we were going to take--all the way from
"Oops, we were wrong, you're fine" to "Uh-oh, now you've got a long row
to hoe." BUT by knowing what all the possibilities are, you
won't be surprised by the ensuing courses of action and will be more confident
in their results, too.
When you DO get the lab and pathology results, be sure to get a copy
of them. Use a source of information like the Pathology Report page and the TCRC glossary to understand it. This report is one of the most important pieces of information you will receive . It will determine what type
of cancer you have, and it will help to determine what type of treatment
you will need. Be sure that the report explains what type(s) of cancer
were in the tumor (if the tumor was mixed,
the pathologist
should have attempted to estimate the percentage of each type of cancer
present in the tumor). The report should also indicate if they saw any
vascular
or lymphatic invasion. This information is essential to making an informed
treatment decision in the near future.
So far it is likely that you have been treated only by a urologist
and the urologist is the one who will give you the results. Of course,
he will then offer an opinion as to what you should do next. Keep in
mind that urologists are surgeons, and they are thus more likely to recommend
surgery if there is more than one option. We recommend that if you are offered this option, you say "Thank
you very much!" and take the pathology report to a medical
oncologist for a second opinion. In fact, depending on the results,
you might even want to get a second opinion on the pathology report. This
is particularly important for people who have been diagnosed with "clinical
stage I nonseminomatous germ cell cancer" as you may be eligible for
surveillance depending on the specifics (and accuracy) of the report.
In any event, the orchiectomy is a fairly simple but necessary operation
in your initial stage of the TC experience. You will be "back to normal"
fairly soon afterwards, although it has been said once you have had cancer,
you're life will never be the same again. Listen to your docs post-op instructions,
and read up on as much as you can so you're involved in the management
of your disease, and not just an unwilling subject.