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

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

3. 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

4. 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

5. 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

6. Structure of the testes

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. 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!

16. 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