October 21, 2005
In late July 2005, I was reading an article about Lance Armstrong?s seventh Tour de France win. As I read the paragraph about his cancer, it made me think about early detection. I knew at age 35 I was still at higher risk for testicular cancer, and it had been a long time since I did a self-check. That day I did a self-exam and detected a palpable lump on the right side. I thought I was imagining it. I was in denial for a few days, and then my wife encouraged me to see my primary care doctor who said ?you?d probably sleep better if we sent you for an ultrasound.? I had no other symptoms of being ill, and so I was still in denial about it possibly being cancer. I kept thinking it had to be a cyst, an infection, or something else.
Ultrasound
I showed up for the ultrasound and, of course, a woman had to do the procedure, which was awkward and kind of embarrassing. During the procedure I watched the computer monitor at first, but I had no idea what I was looking at. The ultrasound technician was very professional and serious with no changes in her expression. I left knowing nothing. The next day a call came from my primary care doctor. He said that they detected a mass in the right testicle, and he would set up an appointment with a urologist. Well, the urologist quickly brought me out of my denial when he said ?you have a testis tumor and we need to remove it.? I sat silent for what seemed like two minutes, although it was probably only a few seconds. I immediately thought about my family, my wife and our two children. For the first time in my life, I seriously pondered on the scenario of dying young. The urologist went on to explain that testis tumors are almost always malignant and are either seminoma or non-seminoma type. He also said ?If you only remember one thing from our appointment today, remember that testicular cancer is 99.9% curable.? This was very comforting to hear, although I was in shock and skeptical. I was scared that cancer might have already spread all over my body. The urologist used Lance Armstrong as an example of the fact that even if it had spread, it was treatable with a high cure rate. He then sent me for some blood tests and scheduled the surgery, an inguinal orchiectomy, to remove the tumor along with the right testicle. I remember walking out of the office, feeling in a fog and feeling very different from the people I passed by in the parking lot.
Surgery
I was somewhat nervous about the surgery. This was my first surgery of any kind and no man likes the idea of having a testicle removed. Fortunately, like a kidney, you only need one to function normally. Keep in mind, if and when you decide to tell people about your diagnosis, that there are a few ignorant people who actually find it funny and say stupid things. I admit talking about testicles is funny, and I used to make as many testicle jokes as the next guy. But testicular cancer is not funny, and is serious. There is a difference. Anyway, on the day of the surgery I remember talking to the doctors one minute, and waking up an hour later and it was all done. With an ice pack (which was my best friend for the next week) I was soon walking out of the outpatient surgery center. I remember my wife said she talked to my urologist after the surgery and he said I did well, and it looked like a contained seminoma. He also told her to call the office to set up a CT scan of the abdomen/pelvis/thorax.
CT Scan
A few days later, I had to drink the chalky-orange flavored oral contrast and then the Kool-Aid tasting contrast drink before the CT scan. The weirdest part during the CT was the IV that sent a warm feeling down my arm to my whole body. The three-day wait for my results (pathology report, tumor marker labs, and CT scan) seemed like the longest three days of my life. Then I got the call from my urologist. Path report says pure seminoma limited to the testis, labs (AFP,b-HCG, LDH) were negative, and CT was negative for evidence of metastatic disease. In other words, good news - no detectable spread of the cancer. Few times in my life had I ever been this happy and relieved.
Treatment
To be sure I was doing everything right, I went to Indiana University for an expert consultation. They assured me I was on track and gave me my options. I was kind of expecting these experts to say here is what you should do... A, B, then C, but all doctors kept presenting ?options? and wanted me to participate in deciding what to actually do next. Maybe because I was a medical professional myself, a pharmacist. Maybe because I?d spent uncountable hours learning everything I could about this disease and my options. Most likely because there is no expert consensus on exactly which option is best for stage I seminoma. Eventually, my radiation oncologist and I decided on a limited radiation plan to the abdomen targeting the retroperitoneal lymph nodes. Other options considered were adjuvant single agent carboplatin therapy, surveillance (do nothing with more rigorous monitoring), and a more extensive radiation plan. I underwent the radiation for a total of 15 treatments. The treatment itself is like getting an X-ray everyday, Monday - Friday with weekends off. I remember always being the youngest person in the waiting room by about 30 years. I got to know other patients that had the same radiation appointment times as me. I will always remember the positive outlook of one older man I met with throat cancer . His prognosis was much worse than mine, yet he always was upbeat and positive. That impressed me. You don?t feel the radiation during the actual treatment, which only takes a few seconds. Although you may feel the side effects as you continue treatments. I took Zofran an hour before every treatment for nausea, and it helped greatly and I never did vomit. I did feel crappy after about a week of radiation treatments with heartburn, constipation, and a general yucky feeling that lasted even after my last treatment. I also had skin irritation like being sunburned in the area being treated front and back that itched and stayed irritated for weeks. All things considered, these side effects were messy and uncomfortable but tolerable.
I had decided early on that I was going to fight and beat this disease. I have stayed focused on my treatment and most importantly, maintained a good attitude. There is certainly a lot more to it than just my story, but we have a choice -- whether to suffer or to focus on making a full and complete recovery. I chose the latter.
Mark