Introduction
My name is Offer R., I'm 27.5 Years old, 1.87 m (6'2") tall and weigh 100+ Kg (220 lb.). I have been married for 4 years to Limor. She was a Math-Physics teacher at the time of my illness, and she's a secretary in a business firm today. We have no children yet.
On March 1993 I graduated from the Technion with a B.Sc. in Civil Engineering, and enlisted in the Israel Defense Force as a Civil Eng. Today I'm a Captain and I live and work in Tel-Aviv.
My Introduction to TC
On October 14th, 1995 at the age of 25.5, while guarding my base I started to feel a slight pain in my left testicle (Limor alleges that I complained about it for 2 weeks before that). I did not pay much attention to it, and I assumed it was a hernia and in time it would go away.
The next day was a holiday so I came home. The next morning, on October 16th, we went on a trip up north with couple of friends. While returning back in the evening, I started to feel sharp pains, which I could not bear, in my left testicle. We didn't want the other couple to find out, so we told them that I couldn't drive because my knee was hurt. Limor took over for me and took them to their car. Afterward, we drove straight to an army clinic. The doctor, after quick examination, sent me directly to the nearest ER.
In the Hospital I had blood + urine tests and was hospitalized in the Urology dep. There, I was told that it's probably an infection, and I needed an Ultrasound and a chest X-ray. I stayed the night, and Limor went to sleep over at her parents. When she got there, she found out that her father had been hospitalized for brain incident (what a night!).
I spent the next two days in the Hospital, and I hadn't a clue of what I had. The ultrasound revealed a mass in the left testicle, 2.2cm x 3.4cm x 3.3cm, and only after that was I told that I had testicular cancer and the testicle should be removed immediately. Of course it was a shock to us, I'm usually a very health guy, no doctors, no medication whatsoever, frightened of needles. The doctors then explained to us that TC is highly curable.
On Thursday, October 19th, in the afternoon, using Epidural anesthesia I had a left radical orchiectomy. The surgery went OK. The only thing I recall is the difficulty to pee. In my room in the hospital, there were also two guys with hernias who couldn't pee after their surgery, so the nurse opened the tap and I immediately went.
On Friday, October 20th, the doctor explained to us, in general, about TC and that the markers were very high (AFP - 110, HCG - 35). Because of this, he felt that there was a need to go through RPLND or at least to have a close surveillance. Anyway, we had to wait for the Pathology results. He also mentioned that I might need chemo. After this, I was released from the hospital. I came back on October 25th, to remove the stitches.
On October 30th, the Pathology results came back: it was a mixed nonseminomatous testicular tumor composed of:
Mature and Immature Teratoma (80%)
Embryonal Carcinoma (15%)
Yolk Sac Tumor (5%)
- The epididymis and the spermatic cord were without malignancy.
My doctor explained to us that the findings showed a need for further treatment - RPLND. A side effect from such surgery is damage to the nerves in the ejaculation system, which can be irreversible (50% prospect). Therefore, I have to go through sperm freezing. About a year before that, my wife and I tried to conceive without any luck. After 6 months, my wife went through several examinations, which revealed nothing. Then, I went to a sperm check, which showed that my sperm count is medium (we can conceive naturally, but with a help of a thermometer).
The hospitals in Israel are very advanced, and the quality of the doctors very high. Therefore, going for a second opinion is not popular. In spite of that, we felt in our hearts that this hospital didn't have the expertise in TC. A friend of ours, a doctor himself, sent us for consultation with the Head of the Urology Department in a different hospital. The doctor there gave us the same prognosis.
The health system in the army recommended a urologist at the Rabin medical center, Dr. J. Baniel, who had recently trained at Indiana University Medical Center, and specialized in RPLND.
The RPLND
The meeting with Dr. Baniel was very encouraging. He is a remarkable human being. First, he went over the findings (blood tests, CT, Pathology, X-ray). He gave us a full description of TC, in a language we could understand, with lots of patience. Then he talked specifically about my TC and gave us all the options of treatment. He emphasized that testicular cancer is highly curable (over 95% cure).
In the CT scan he found 3 slightly enlarged lymph nodes, and recommended RPLND. Unlike the other doctors, Dr. Baniel was experienced in RPLND from Indiana, and promised 99% success, no touching the nerves in the ejaculation system. We decided immediately that we wanted Dr. Baniel to be my doctor and to continue the treatment at "Rabin" medical center. The surgery was scheduled for Sunday, November 26th, 1995. Meanwhile, the markers went down (AFP - 55, HCG - normal).
On Saturday, November 25th, I returned to the hospital in preparation for the surgery. I was requested to have only liquid food. They gave me a horrible drink, 3 liters (0.8 gal.), to clean out my digestive system. I had to drink it for 3 hours, but it took me over 6 hours. In the evening, they shaved my belly (believe me, they had lots of work!).
On Sunday, November 26th, at noon, (Dr. Baniel performed another RPLND in the morning) I had my RPLND. The surgery took about 5-6 hours, under full anesthesia. Afterward, my wife and parents visited me in the recovering room. Later, my wife told me that I was yellow and in pain. I was connected to tubes. I asked for painkillers and a blanket (I've never suffered from cold). At night I returned to my room.
Besides pains in the stomach and the first night with no sleep (I was too long for the bed) my recovery was pretty easy. I was released on Friday, December 1st.
The surveillance
During my hospitalization, the markers were taken. The AFP was normal (4.4). I started surveillance every 3 months. Because of being spoiled and my wife encouraging it, I returned to my work after a month (in the beginning of January 96). The first check up was OK. The next check up was scheduled for late April 1996. During the last 6 months my wife and I went through 2 In Vitro Fertilization treatment (ICSI) with no success. In those fertilizations we used my fresh sperm.
The preparations for the check up in April included blood tests and a CT scan. The HCG was normal, but the AFP was 80. That meant a recurrence. I called Dr. Baniel and informed him about the bad news. He added ultrasound of the right testicle with the CT. The US was OK, but the CT showed a residual mass in the pelvis, putting pressure on the bladder. The size of the mass was 2 x 3.5cm.
It was clarified to me that such development of a tumor is very rare. Dr. Baniel introduced me to Dr. Sela, an Oncologist, who had been trained at MD Anderson. Dr. Sela decided immediately to hospitalize me for 3 courses of BEP.
The chemotherapy
On Monday, April 29th, 1996, a Port-a-Cath was implanted in the upper right part of my chest. It was implanted in a minor surgical procedure done with a local anesthetic. The procedure was very simple. The Port-a-Cath is composed of a tiny metal box, a membrane, and a tube, which connects to the main vein. They told me that using the Port-a-Cath could prevent a lot of suffering in the long run. It did, however, require hygienic treatment.
On Wednesday, May 1st, 1996, I arrived at the hospital to start the first course of my chemo. Dr. Sela explained the procedure to me, the nature of the BEP treatment that I was about to receive - an aggressive treatment.
The BEP course included: 5 days in the hospital, 24 hours a day with liquid maintenance and hydration, The actual treat (Platinol, VP-16, and Zofran or Kytril for antinausea) is given for 9 hours a day. In days 2,9,16 - Bleomycin
Chemo #1
The first course went smoothly. The Port-a-Cath functioned very well. I didn't feel any nausea. My hair didn't fall off. My wife, who didn't approve of the food in the hospital, came every morning at 6:00 with a breakfast (home made), went to work and came back with lunch at noon. My parents and my brother stayed with me during the day, and Limor came back in the afternoon.
At night I barely slept, a habit, which went and increased in the followed courses. The lack of sleeping stemmed from my need to pee all the time. In order to follow up my liquid balance, I collected the urine in a bottle. The smell was terrible because of the medicines. After 5 days I was released home, and generally I felt OK. After 2 weeks my hair started to fall out, so I shaved my head.
Chemo #2
In this course I started to feel the changes in my body. In the beginning the doctor couldn't penetrate the needle into the Port-a-Cath, so I had to get the medicines through an IV in the hand. The metal taste in my mouth started to become dominant, and my sense of smell drove me crazy (even the smell of liquid soap for children bothered me). I started to throw up and felt a lot of nausea (throwing up has never been a problem with me, it makes me feel a relief).
Every morning all the patients had to weigh themselves. In the 2nd or 3rd day of the cycle, I gained about 3kg. That meant that my body was accumulating liquids and that's not a good thing. To drain the liquids, I was given more powerful stuff to increase the amount of urine. At that point I had to pee every 10-15 min.
From the beginning of this cycle I stopped collecting the urine in a bottle and emptying it when it was full. Instead of that I took the bottle with me to the toilet, wrote down in a little notebook and then pour it down the toilet (very recommended!).
After the 5th day I was released home with instructions to have, every day for 7 days, an injection of GCSF 480mg (those injections are to prevent a marrow bone distraction - also called neupogen). Every morning I went to the hospital to get the injection in the shoulder. The GCSF is oily stuff and rapid injection makes it really hurt. The GCSF also makes the fever go higher and causes horrible backaches, which are hard to bear.
Chemo #3
In preparation for chemo #3 I had a CT scan. The results came in the first day of the course. The first result was very encouraging - there was no sign of the mass. Dr. Sela asked to see the CT personally, and in the afternoon he told me that the prognosis was wrong, and the mass was even bigger. This phenomena is known to the doctors, because when a tumor is composed of Teratoma, like mine, the chemo does not affect it. The rest of the tumor responded exactly like it should have, according to the markers, which went down every week by 50%, as they should have. By the end of this course, they were down to normal.
During all 3 courses, I had treatment with a guy, about 40 years old with seminoma that had metastasized to his lungs. In spite of the bad taste in our mouths and the smelling problem, our favorite topic of discussion was food.
Post chemo
At the end of the last course, I had another CT scan. At this time, again, the roentgenologist was wrong. The mass was still there. Due to the fact that the markers dropped down to normal, Dr. Sela and Dr. Baniel decided to surgically remove the mass.
On Sunday, July 14th, 1996, with full anesthesia, the mass was removed. This surgery was similar to RPLND in nature, but a little bit smaller. My recovery was fast, and I was released on Wednesday, July 17th.
The pathology results showed that the mass was composed of Teratoma and other malignant tumors. Dr. Sela, after examining the mass, didn't agree with that diagnosis and sent the slides to Indiana for a second opinion. There, the diagnosis was pure Teratoma.
Follow up
Today I am under surveillance, every 3 months - markers and a Chest X-ray and every 6 months - CT scan. The surveillance is taking place both in the Urology Department and in the Oncology Department. The last check up was in September 1997 - everything was OK. This year we are going to have a 4 month check up program.
Present - October 1997
During the last year Limor and I went for another 3 attempts at IVF, all unsuccessful. Now, we are about to starting the 6th treatment. I returned to work full time, still in the army. Except for the 20kg that I gained and the scar that crosses my stomach, there is no evidence of what happened for the last two years.
Our whole point of view about life has changed dramatically. Nowadays, it takes lots of effort to get me upset. Our quality of life is the most important thing to us; our happiness is above everything.
The TCRC site is very encouraging, knowing that you are not alone in this fight. I would be very happy to answer any question about my experience. My main recommendation is to pick your doctors carefully, and never hesitate to get a second opinion.
Thank you for your time and patience.
Offer.