Health
CUT AND RUN
But before any patient can begin to hope for a cure, his doctor has to identify the type of testicular cancer he has. And, unfortunately, there's only one way to find out: Remove the testicle.
Using an outpatient procedure called an inguinal orchiectomy, surgeons make a small incision in the groin a few inches below the belt line and pull the affected testicle up and out. (Picture a large, somewhat misshapen pearl onion.) "We need to take out not only the testicle but also its spermatic cord, which is how the cancer most often spreads to other parts of the body," says Dr. Richie. The good news: Because the cancer travels up the spermatic cord, there's no way for it to spread to the remaining testicle. And that sole survivor is all a man needs to retain normal fertility, sensitivity, and sex drive.
Perez underwent the procedure three weeks after his diagnosis. By this time, he had switched physicians, to specialists George Bosl, MD, and Joel Sheinfeld, MD, at New York City's Memorial Sloan-Kettering Cancer Center.
Perez had good reason to make the jump, says Dr. Sheinfeld—and not only because Sheinfeld got the business. With 7,400 testicular cancers diagnosed a year and roughly 8,000 urologists around the country, a doctor may see only one case a year. "And while an orchiectomy is a pretty straightforward surgical approach," Dr. Sheinfeld says, "the cancer management beyond that step becomes more difficult. You want somebody who has performed all of the treatments sev-eral—if not dozens or hundreds—of times."
Perez agreed. "I wanted treatment by the best. It's like my work as a chef. I do a better job filleting a salmon or preparing a chicken than somebody who does it once a year."
His orchiectomy was a success. (Some men will opt for a prosthetic testicle—saline-filled, like a breast implant—but not Perez. "Dressed, there's no difference. After a shower, when your testes are more pendulous, it becomes more apparent," he says. "I actually like the spare room.")
Dr. Sheinfeld's next step: Determine the type of cancer—seminoma or non-seminoma—and the stage.
The less aggressive of the two types, seminomas usually remain localized and spread slowly; they account for about 35-40 percent of all testicular cancers. Non-seminomas move quickly up the spermatic cord to the lymphatic system and comprise about 60 percent of all testicular cancers.
To help orient doctors toward the best treatment after an orchiectomy, more blood tests are performed. If the cancer is gone, existing blood markers usually drop off significantly or disappear. Doctors also use ultrasound or CT-scan imaging to pinpoint other cancerous growths, and sometimes do further biopsies. Finally, after reviewing all this data, they label, or categorize, the stage of the disease.
In Stage One, the cancer is confined to the testicle; Stage Two cancers have spread to the lymph nodes located at the back of the abdominal cavity and below the diaphragm; and finally, Stage Three cancers have spread beyond the lymph nodes and into other parts of the body, such as the lungs, liver, and brain. This type almost killed Lance Armstrong.
In Perez's case, his pathology report indicated that he had a form of cancer with both seminomas and nonseminomas in evidence. But it was Stage One. "The plan," Perez says, "was just to do regular surveillance, just periodic checkups."
Life, after a distracting detour, was back on the main highway. "It was as if this strange bad dream was finally over," says Perez. "Then, a week after the surgery, I got a phone call. And, well, the bad dream was back."
It was the pathologist. After further review, he discovered that he'd missed something. The nonseminoma cancer had spread and may have entered Perez's lymph nodes.
» Health archive
Men's Health Philippines - November 2005 Issue
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