Presentation at WHRHS Alex Hohmann February 21-22, 2012 Testicular Cancer Presentation at WHRHS Alex Hohmann February 21-22, 2012

Alex’s testicular cancer First in 1996 (age 30): surgery & radiotherapy Second in 2008: surgery and surveillance

Alex’s post-diagnosis goals Healthy lifestyle and surviving cancer well Advocacy, fund raising and education 2009 LIVESTRONG 5K 2010 LIVESTRONG 45-mile ride 2011 LIVESTRONG 5K

Basic facts about TC Testicular cancer includes different cancer cell types (seminoma vs non-seminoma) that typically appear first in the testes TC does not have any clearly identified causes Men with TC were most likely born predisposed to it TC rates seem to be higher in men born with an undescended testicle and are highest among Caucasian men

TC by the numbers* 8300 men diagnosed with TC in US in 2011 Most common cancer in men ages 15 to 40 Overall 5-year survival rate of 95% Localized (confined to testes) survival of 99% Almost 400 men die each year as from TC Early detection is critical to survival If TC is caught early and treated correctly, survivors live full and healthy lives * All figures from the Sean Kimerling Testicular Cancer Foundation, National Cancer Institute, and American Cancer Society

Structure of the testes http://nurse-practitioners-and-physician-assistants.advanceweb.com

Early detection of TC Examine testicles at least once a month Look for presence of a pea-sized mass attached to testes or for scrotal enlargement Other symptoms may include feeling of heaviness in scrotum, severe and worsening back ache, breast tenderness See a urologist at the first sign of any of these symptoms. Do not delay.

Diagnosis of TC Urologist will examine testicle and, if indicated, order a scrotal ultrasound to be done right away The ultrasound is quick and painless Ultrasound images are examined by a radiologist who will report back to the urologist if there are signs of a tumor Urologist will draw blood and order a CT scan to be done right away

Treatment of TC: first steps Entire testicle must be removed in a short procedure called an inguinal orchiectomy, usually down outpatient Biopsy of the testicle, as well as CT scan and blood tests determine type (seminoma vs non-seminoma) and staging (1, 2, 3) Post-orchiectomy treatment and follow-up vary according to type and stage and are done under the care of an oncologist

Treatment of TC: next steps Depending on cell type, stage 1 TC may require only follow-up testing Non-seminoma may require further surgery (RPLND) for biopsy or treatment Some patients elect adjuvant radio- or chemotherapy to reduce relapse risk Relapse (cancer shows up again, often in lymph nodes) must be treated immediately with chemo- or radiotherapy

Effects of TC and treatment Loss of one testicle does not usually impair testosterone and sperm production Radio- or chemotherapy can impair sperm production so some men bank sperm A second TC is very rare, resulting in loss of fertility and need for hormone replacement Properly treated and followed up by a doctor, majority of TC survivors have normal sexual performance and live a fully and healthy life

Memorial Sloan-Kettering Cancer Center, New York Alex’s treatment First TC (‘96) stage 1 seminoma: surgery, radiotherapy, 5 years of surveillance Second TC (‘08) also stage 1 seminoma: surgery, prostheses installed, up to 20 years of surveillance, lifetime testosterone replacement Bilateral TC (2x) is extremely rare Healthier than ever Memorial Sloan-Kettering Cancer Center, New York

Alex’s lessons from cancer There was no way of avoiding TC There are others facing the same thing Keep a sense of humor

Alex’s lessons from cancer Don’t take health for granted Be grateful for life by giving back to others Don’t be shy about speaking up

Points to remember Know your body Live a healthy lifestyle Get a complete physical regularly See a doctor ASAP at any sign of trouble Have someone (e.g. loved ones) with you Ask questions and take good notes Reach out for support Don’t be shy about discussing health issues Above all, don’t die of embarrassment!

Other disorders of the testes Varicocele: swelling of testicular blood vessels Hydrocele: accumulation of fluid in scrotum Epididymitis: inflammation of the epididymis Orchitis: inflammation of the testicles Primary hypogonadism: low testosterone due to failure of testes to produce it Cryptorchidism: undescended testicle Testicular torsion: interruption of blood supply due to twisting of spermatic chord Testicular rupture due to blunt force