My Cancer: The Basics

What type of cancer do you have?

I have testicular cancer. More specifically, my cancer is called seminoma, to distinguish it from other testicular cancers that are called non-seminomas. The seminoma has spread to my lymph nodes which makes it metastatic seminoma.

How and when were you diagnosed?

In the fall of 2020, I started feeling something like a very subtle pressure in my left testicle. It wasn’t painful or even uncomfortable, and for a while it came and went, but eventually it became more consistent, and I started to notice a significant difference in size.

On November 2, I went to my primary care doctor. There are a number of reasons why testicular swelling can happen, many of which are not serious. She ordered an ultrasound which was performed that same afternoon. Later that day, she called me and told me that I had a mass in my testicle that was consistent with cancer.

Did they do a biopsy to confirm that it was cancer?

No. The standard treatment for a testicular tumor skips the biopsy and goes straight to removal of the testicle. There are several reasons for this: 1) this is a tricky and risky part of the body to biopsy; 2) testicular masses are usually cancer anyway; 3) removal of a testicle is a relatively safe and simple surgery with little in the way of negative impacts or side effects on the patient.

So I underwent an orchiectomy (the fancy name for the removal surgery) on November 11. The surgery was successful, and while I was really sore for the first few days, after that I bounced back pretty quickly.

About 10 days after the surgery, the surgeon called and confirmed that the tumor was malignant (seminoma).

How did they determine that the cancer had spread?

The next step was to determine whether the cancer had metastasized (spread). In the best-case scenario, there is no metastasis and therefore no need for further treatment. In late November, I went in for a CT scan. The results of the CT scan indicated two enlarged periaortic lymph nodes that were described by the radiologist as indicative of metastasis.

What stage is your cancer?

Testicular cancer has three stages. Stage I is when there is no evidence of metastasis. Stage II is when there is metastasis to the lymph nodes. Stage 3 is when there is metastasis beyond the lymph nodes. Stages II and III are further broken down into substages, which are determined based on size of the tumors, markers that are detectable in the bloodstream, and other factors.

I am Stage IIa. This is the earliest stage of metastatic seminoma.

Did the doctors recommend treatment right away?

No. My oncologist recommended a biopsy of the lymph nodes in order to confirm that the enlargement was due to cancer. He said there was a 20-30% chance that the enlargement could be benign, in which case they would be treating me for nothing.

The challenge with a biopsy is that these particular lymph nodes are difficult to get to with a needle, without hitting something important. Like your kidneys, your aorta… important stuff. Plan A was to do a traditional biopsy with a very long needle, but the radiologist determined that to be too risky. Plan B was to perform the biopsy via an endoscopic ultrasound. This is a procedure where they put an endoscope down your throat and through your esophagus into your stomach and small intestine, using ultrasound technology to look around your abdomen. If they can find the spot, the endoscope has a needle that can collect a biopsy.

This procedure was performed on January 25. A few days later, the doctor called and confirmed that the biopsy showed metastatic seminoma in my lymph nodes.

How is Stage IIa seminoma treated?

Seminomas are among the most treatable and curable cancers. They respond well to both radiation and chemotherapy. Radiation is a localized therapy, meaning it is focused on one particular spot, and is therefore used only in early stage metastasis. Later stages are treated with chemotherapy.

Historically with Stage IIa seminoma, radiation has been used more frequently, but my doctors gave me a choice between radiation and chemotherapy. After much deliberation, I chose chemotherapy.

What is your prognosis?

According to this article at cancer.org, Stage II testicular cancers in general have a 5-year survival rate of 96%. The treatments are highly effective in eliminating the cancer. Like other cancers, seminoma can come back, but many seminoma patients never have a recurrence and go on to live normal lives after their treatment.

What kind of chemotherapy regimen are you doing?

I am doing 3 cycles of BEP (bleomycin/etoposide/cisplatin). Each cycle lasts 3 weeks, so a total of 9 weeks. All the drugs are given via an intravenous infusion.

Bleomycin is given every Tuesday for all 9 weeks. Etoposide and cisplatin are given for 5 consecutive days in the first week of the cycle.

Week	M	Tu	W	Th	F	Sa	Su
Weeks 1/4/7	E,P	B,E,P	E,P	E,P	E,P
Weeks 2/5/8		B
Weeks 3/6/9		B

When do you start your chemo?

On Monday, February 22, 2021.

Are you experiencing any symptoms from the cancer?

No. As of this writing in mid-February 2021, I feel totally normal.