Health
CHEMICAL WARFARE
For those men whose cancer has spread, depending on the type of tumor present, the majority of specialists prescribe a course of chemotherapy. While the particular "recipe" of cancer drugs varies, it always includes a medication called cisplatin.
Widely thought to be the magic bullet against testicular cancer, cisplatin—a platinum-based drug that attacks the DNA of the cancer itself—is the reason so many physicians now believe testicular cancer has become curable. "These days," says Dr. Nichols, "even patients with Stage Three cancers stand a very good chance of being cured, thanks to cisplatin."
There are, of course, drawbacks. Because chemotherapy attacks most of the rapidly growing cells in the body, any area where cells are dividing quickly may be damaged. In some men, this causes hair loss, gum sores, tinnitis, a compromised immune system, and a permanent decrease in sperm production in the remaining testicle. Still, because cisplatin-centered treatments are so successful, most doctors employ them as the first line of defense in non-seminoma cancers.
Localized radiation therapy is also an option, but only for men with the slower-moving seminomas. Finally, for aggressive nonseminomas that have spread to the lymphatic system or beyond, there remains a more absolute option: surgery. Specifically, it's called a retroperitoneal lymph-node dissection, or RPLND, a procedure that saved the comedian Tom Green and figure skater Scott Hamilton.
In this operation, which can take from 2-6 hours, an incision is made from just above the pubic bone to the sternum. Then surgeons examine the abdomen to remove all cancerous-looking lymph nodes and tissues throughout the area. Before surgery is over, the gastrointestinal tract's organs have been examined and moved out of the way, since the abdominal lymph nodes are located deep inside, near the kidneys. Further complicating matters, there's a slight chance that the doctor may damage a hard-to-see nerve that controls ejaculation. Severing this nerve results in permanent retrograde ejacu-lation, a condition that causes ejaculate to go into the bladder instead of toward the penis.
"Most of the surgeons who do RPLNDs are extremely familiar with nerve-sparing techniques," says Dr. Sheinfeld. "But even with the best surgeon, there will still be a period of local discomfort after the surgery, and, for several months to up to two years, the patient may also be unable to ejaculate. Make no mistake, this is a big and involved surgery."
DISSECTING THE PROBLEM
Three weeks after receiving that fateful phone call, Perez was under Dr. Sheinfeld's knife for his own RPLND. His combination of seminoma and nonseminoma placed him in a small, rare group for whom this is the optimal treatment. And while his doctors advised him of all his options, Perez was in favor of the most radical therapy first.
"I just wanted to stay away from chemo and radiation," he says, "because, for me, the side effects were more frightening than the surgery. I also wanted my cancer gone the most 100 percent certain way."
Perez's surgery was over in 5 hours. "I checked in to the hospital and they put me under, split me open from crotch to craw, then looked around and fixed what they found."
It would be three weeks before Perez was finally back up and moving around normally. "I tell ya," he says, "for days after the surgery, every time I stood up I felt like my guts were gonna come tumbling out. Literally, they field-dressed me like a deer." He also recalls that for weeks after the surgery he could feel his innards "sloshing around" as they reattached and settled back inside his body. "It wasn't pretty," he adds. "But I also felt assured of this: The RPLND got all my cancer. After the surgery, I knew I was clean."
His doctors had, in fact, gotten it all. However, since there's a 15 percent chance that cancer will develop in the remaining testicle within the next five years, Perez must continue with his self-exams. Except for this, and that big scar down his belly, the unpleasant journey of John Perez's testicular cancer is now behind him.
And he already knows what lies ahead: Only seven months after the surgery, Perez's ability to ejaculate returned and Marisa became pregnant with their first child.
"We did it naturally and everything," he says. "We had a baby girl in June."
» Health archive
Men's Health Philippines - November 2005 Issue
|
|
|
|
|
|
Advertisement
|
