1

http://www.labcorp.com/datasets/labcorp/...
Alpha-Fetoprotein (AFP), Serum, Tumor Marker.
Author: anonymous
Laboratory Corporation of America® Holdings and Lexi-Comp Inc.
2003.

Tumor marker normals: 0-8.0 ng/mL.
Normal values apply only to males and to nonpregnant females.

Use
The most important application of AFP testing in cancer management is for testicular cancer. Although not present in pure seminoma, elevated serum AFP is closely associated with nonseminomatous testicular cancer. The measurement of AFP in serum, in conjunction with serum hCG, is an established regimen for monitoring patients with nonseminomatous testicular cancer.

In addition, monitoring the rate of AFP clearance from serum after treatment is an indicator of the effectiveness of therapy. Conversely, the growth rate of progressive cancer can be monitored by serially measuring serum AFP concentration over time. Serial serum AFP testing is a useful adjunctive test for managing nonseminomatous testicular cancer.

Limitations
Investigators have demonstrated elevated serum AFP levels in hepatocellular cancer, malignant germ cell tumors of the ovary and testis, and teratocarcinoma of the testis. Although at a very low rate of incidence, increased circulating AFP concentrations may also occur in serum specimens from patients with gastrointestinal, pancreatic, and pulmonary cancers. AFP is not a screening test for cancer [as cancer is a catch-all term for over 100 difficult-to-diagnose illnesses].

Additional Information
AFP is a single chain glycoprotein with a molecular weight of approximately 70,000 daltons. AFP was first described as a fetal protein by Bergstrand and Czar in 1965. AFP and albumin share considerable sequence homology and some physiological functions. In adults, serum AFP concentrations remain low except during pregnancy, benign liver diseases, (hepatitis, cirrhosis), primary hepatocellular carcinoma, and certain germ cell tumors.

2

http://www.tc-cancer.com/tumormarkers.html
Tumor Markers; AFP, HCG, CA-125.
by Anonymous
2000, or later.

Tumor markers are molecules occurring in blood or tissue that are associated with cancer and whose measurement or identification is useful in patient diagnosis or clinical management. ...

Tumor marker, CEA:
Carcinoembryonic antigen (CEA) is a protein found in many types of cells but associated with tumors and the developing fetus. CEA is tested in blood. The normal range is <2.5 ng/ml in an adult non-smoker and <5.0 ng/ml in a smoker. The CEA was one of the first oncofetal antigens to be described and exploited clinically. It is a complex glycoprotein of molecular weight 20,000, that is associated with the plasma membrane of tumor cells, from which it may be released into the blood. >

Although CEA was first identified in colon cancer, an abnormal CEA blood level is specific neither for colon cancer nor for malignancy in general. Elevated CEA levels are found in a variety of cancers other than colonic, including pancreatic, gastric, lung, and breast. It is also detected in benign conditions including cirrhosis, inflammatory bowel disease, chronic lung disease, and pancreatitis. The CEA was found to be elevated in up to 19 percent of smokers and in 3 percent of a healthy control population. Thus, the test for CEA cannot substitute for a pathological diagnosis. ...

3

http://tcrc.acor.org/staging.html
Testicular Cancer Info: Staging.
By Anonymous,
The Testicular Cancer Resource Center,
Dec 08, 2004

What is Staging?

Once testicular cancer has been diagnosed, the doctor will perform more tests to determine whether the cancer has spread from the testicle to other parts of the body. Classifying a person's cancer by the degree to which it has spread is called staging. Staging is used to determine the available treatment options. Keep in mind that staging is only as accurate as the information available, and the stage of a person's cancer can change as more information or more accurate information is gathered. If the doctor comes out of the operating room and tells you he thinks he got it all, don't be so quick to believe him. It takes urologists, pathologists and radiologists to ultimately determine the stage of the cancer.

There are two type of staging: Clinical and Pathological.
Clinical staging uses radiological and physical clues to estimate the stage.
Pathological staging uses stronger evidence like tissue samples and blood tests to determine the stage.

For example, assume you have gone through the orchiectomy and based on all the test results, your doctor says that you have Clinical Stage I Nonseminoma. At this point you choose to have an RPLND. If they find no cancer during the RPLND, they will change you to Pathological Stage I. If they do find cancer, then you will become Pathological Stage II. As you can see, the Pathological Stage is more accurate since it used actual tissue samples to determine the presence or absence of cancer.

Tests & Procedures

It is one thing for the doctor to do a physical exam and conclude that you probably have cancer. It is another thing to determine the stage. Usually the stage cannot be estimated until after surgery, blood tests and X-rays have been done. Here is a list of tests that may be used to determine the stage:

Surgery:
Without surgery, in this case an orchiectomy, it is often difficult to conclude that there is cancer there at all, so surgery is usually the first step.

Blood tests:
Some testicular cancers secrete something called tumor markers, high levels of certain proteins that can be detected through blood tests. These markers of testicular cancer include alpha-fetoprotein (AFP), beta human chorionic gonadotropin (ß-HCG) and lactate dehydrogenase (LDH). If a guy's AFP or HCG level are above normal AND there is something wrong with his testicle, then you can assume that he has testicular cancer. If the tumor markers do not fall back to normal after an orchiectomy, then you can usually assume that the cancer has spread, even if no other tests show where it has gone. ...

Computed Tomography (CT) scanning:
This machine uses a rotating X-ray beam to create a series of pictures of the body from many different angles. A computer processes the information and produces a detailed cross-sectional image of selected parts of the body. Sometimes, a dye is injected into a vein to highlight details on the scan. A CT scan is especially valuable for identifying the spread of tumors to lymph nodes. If the tumor markers are high enough, a CT scan may also be done of the brain. Keep in mind, however, that it is hard to see into areas like the abdomen, and just because a CT scan says everything is normal does not mean that the cancer has not spread at all. ...

Chest X-rays:
Simple chest x-rays are often used to determine if the cancer has spread to the lungs. In many cases the doctor will order a CT scan of the chest right after cancer has been diagnosed just to be sure nothing is there. (CT scans can see smaller masses in the lungs than chest x-rays, but in many cases these masses are not tumors.)

Positron Emission Tomography (PET):
PET scanning is a relatively new technology that allows doctors to view biological functions. Areas with increased metabolic activity show up as "hot areas" in a PET image. Instead of using an x-ray, they give you a radioactive substance and use the scanner to try to detect where that radioactive material is collecting in the body. The theory is that the radioactive material is more likely to go to solid tumors than other areas of the body. Its use is promising in the future, particularly in evaluating large masses left over after chemotherapy for seminoma. However, at this time it is still experimental, expensive, hard to interpret, not widely available and probably should not be used in staging.

Magnetic Resonance Imaging (MRI):
An MRI uses magnetic fields and radio waves to create images of selected areas of the body. These images can show enlarged lymph nodes and abnormal growths in certain organs that may indicate that the cancer has spread. MRI's are typically not used with testicular cancer because the CT scan often produces a better result and costs less.

Lymphangiography:
This painful test involves injecting a special radioactive dye into the lymphatic system. Over a period of several hours, the dye collects in areas where cells are dividing and growing quickly. The doctor takes an X-ray, which shows where the dye has gathered and where cancer might be found. This test used to be performed to map out the lymph nodes in the retroperitoneum so the radiation fields could be set up to treat a patient with seminoma tumors. It is rarely used any more because it is not particularly accurate, and it almost certainly is not used for staging. It is a good bet that your doctor is getting on in years if they order this test.

Stages of testicular cancer

1. Stage I: Cancer is found only in the testicle. Removing the testicle alone should cure the patient, though many will choose some form of additional treatment just to be sure...

2. Stage II: Cancer has spread to the lymph nodes in the abdomen. Removing the testicle alone will not cure the patient, and more treatment is necessary.

3. Stage III: Cancer has spread to areas above the diaphragm such as the lungs, neck or brain. There may be also be cancer in parts of the body such as the bones or liver. In this situation, chemotherapy is absolutely required. Surgery may also be needed.

4. Stage IV: To the best of my knowledge, there is no such thing as Stage IV testicular cancer. However, it is possible that Stage IV may still be used in some places in Europe. Suffice to say that Stage IV is probably very similar to Stage III.

5. Recurrent: Recurrent disease means that the cancer has come back after it has been treated. It may recur in the same place or in another part of the body.

... surgical stage may be designated based on the results of surgical removal and microscopic examination of tissue.

Stage I -
Stage I testicular cancer is limited to the testis. Invasion of the scrotal wall by tumor or interruption of the scrotal wall by previous surgery does not change the stage but does increase the risk of spread to the inguinal lymph nodes, and this must be considered in treatment and follow-up. Invasion of the epididymis tunica albuginea and/or the spermatic cord also does not change the stage but does increase the risk of retroperitoneal nodal involvement and the risk of recurrence. This stage corresponds to AJCC stages I and II.

Stage II -
Stage II testicular cancer involves the testis and the retroperitoneal or para-aortic lymph nodes usually in the region of the kidney. Retroperitoneal involvement should be further characterized by the number of nodes involved and the size of involved nodes. The risk of recurrence is increased if more than 5 nodes are involved, if the size of 1 or more involved nodes is larger than 2 centimeters, or if there is extranodal fat involvement. Bulky stage II disease describes patients with extensive retroperitoneal nodes (>5 centimeters) who require primary chemotherapy and who have a less favorable prognosis. This stage corresponds to AJCC stages III and IV (no distant metastasis).

Stage III -
Stage III implies spread beyond the retroperitoneal nodes based on physical examination, x-rays, and/or blood tests. Stage III is subdivided into nonbulky stage III versus bulky stage III. In nonbulky stage III, metastases are limited to lymph nodes and lung with no mass larger than 2 centimeters in diameter. Bulky stage III includes extensive retroperitoneal nodal involvement, plus lung nodules or spread to other organs such as liver or brain. This stage corresponds to AJCC stage IV (distant metastasis).

... classify ... according to risk.
In many cancers you can determine how bad the cancer is by looking at the staging information. With testicular cancer, it isn't often that simple. You may have stage III cancer and be more likely to be cured than someone else with stage II cancer. ...

4

http://www.privatekits.com/kit.php?objid=71
Home Testing Kits.
By Anonymous,
Price: $39.95
2005

Private Kits AFP Carcinoma Test, is for the aid in the diagnosis of primary hepatocellular carcinomas, testicular teratocarcinomas and neural tube defects.

INTRODUCTION
Private Kits AFP Carcinoma Test is a rapid, direct binding test for the detection of Alpha Fetoprotein in serum. It is used as an aid in the diagnosis of primary hepatocellular carcinomas, testicular teratocarcinomas and neural tube defects. The test is based on the principle of sandwich immunoassay. Monoclonal and polyclonal antibodies are employed to identity AFP specifically. This test takes only 10-20 minutes to detected 25 ng/mL AFP in serum.

TEST KIT CONTENTS
Your test kit should contain the following items:

• 1 finger pricking lancet
• 1 sealed test cassette and pipette
• 1 alcohol swab
• 1 microtube (for collecting sample)
• 1 set of Instructions

SPECIMEN COLLECTION

1. Clean finger with alcohol swap provided.
2. Prick finger with the lancet provided.
3. For serum, collect 10-20 drops of blood into the provided container. Allow the blood to clot and separate the serum from the clot. Use the serum for testing. You will require approximately 4 drops of serum for testing.

4. If the specimen cannot be tested on the day of collection, store the serum specimen in a refrigerator or freezer.

5. Bring the specimens to room temperature before testing.
   Do not freeze and thaw the specimen repeatedly.

6. Ensure that sample is adequate.
   This test requires approximately 4 drops of serum to be accurate.

TEST PROCEDURE

1. Review specimen collection instructions.
   Test device, specimens and controls should be brought to room temperature (18-30°C) prior to testing.

2. Remove the test device from its protective pouch (bring the device to room temperature before opening of the pouch to avoid condensation of moisture on the membrane). Label if necessary.

3. Draw approximately 0.2m1 sample.
   Dispense entire contents into the sample well. Alternatively, hold the pipette in a straight up and down position - not at an angle. Dispense 4 drops (approximately 0.2m1) of the specimen or control into the sample well. For each sample or control, use a separate pipette and device.

4. Wait for 10-20 minutes and read results.
   Do not read results after 30 minutes.

PRECAUTIONS

1. For in vitro diagnostic use only.
2. Do not use test kit beyond expiry date.
3. If you suspect that you may have Cancer, you should contact a health care professional immediately to seek medical attention

4. It is recommended that testing be performed by a licensed practitioner (doctor) or other professional medical staff as found in a hospital or medical clinic.

5. This test device should not be reused.

The test kit can be stored at temperatures between 2 to 30°C in the sealed pouch to the date of expiration. The test kit should be kept away from direct sunlight, moisture and heat.

INTERPRETATION OF RESULTS

• Negative: Only one colored band appears on the control (C) region. No apparent band on the test (T) region. This means that AFP level is below 25 ng/mL.

• Positive: In addition to a pink colored control (C) band, a distinct pink colored band will also appear in the test (T) region. This indicates that the AFP concentration is more than 25 ng/mL. If the test band is equal to or darker than the control band, it indicates that the AFP concentration of specimen has reached to or is greater then 400 ng/mL. Please consult your physician to perform a much more detailed exam.

• Invalid: A total absence of color in both regions is an indication of procedure error and/or that the test reagent has deteriorated. Repeat with a new test kit. If the problem persists, discontinue using the test kit immediately and contact your local distributor.

LIMITATIONS

1. This test provides a presumptive diagnosis for primary hepatocellular carcinomas, testicular teratocarcinomas and neural tube defects. A detailed diagnosis should only be made by a physician after all clinical and laboratory findings have been evaluated.

2. This test is limited to the detection AFP in human serum only.
3. Although the test is very accurate in detecting elevated AFP levels, a low incidence of false results may occur.

5

http://www.meb.uni-bonn.de/cancer.gov/...
Treatment statement for Health professionals.
By Dr. Gustav Quade,
Institut of Medical Biometry, Informatics and Epidemiology
National Cancer Institute, Med-News,
October 04, 2005

... Radical inguinal orchiectomy with initial high ligation of the spermatic cord is the procedure of choice in treating a malignant testicular mass. Transscrotal biopsy is not considered appropriate because of the risk of local dissemination of tumor into the scrotum or its spread to inguinal lymph nodes. A retrospective analysis of reported series in which transscrotal approaches had been used showed a small but statistically significant increase in local recurrence rates compared with the recurrence rates when the inguinal approach was used (2.9% vs. 0.4%). Distant recurrence and survival rates, however, were indistinguishable in the 2 approaches. Local recurrence was similar in patients who did not have scrotal violation, regardless of whether or not additional treatments, such as hemiscrotal radiation, hemiscrotal resection, or inguinal lymph node dissection, were used.

An important aspect of the diagnosis and follow-up of testicular cancer is the use of serum markers. Serum markers include AFP, hCG (measurement of the beta subunit reduces luteinizing hormone cross-reactivity), and lactate dehydrogenase. They may detect a tumor that is too small to be detected on physical examination or x-rays. Below the age of 15, about 90% of testicular germ cell cancers are yolk sac tumors. In virtually all of these patients, the AFP is elevated at diagnosis and is an excellent indicator of response to therapy and disease status.

Serum markers plus chest x-rays are important parts of the monthly checkups for patients after definitive therapy of testicular cancer as well as periodic abdominal computed tomographic (CT) scans for 2 to 3 years. The absence of markers does not mean the absence of tumor. Patients typically receive follow-up monthly for the first year and every other month for the second year after diagnosis and treatment. While the majority of tumor recurrences appear within 2 years, late relapse has been reported, and lifelong marker, radiologic, and physical examination is recommended.

Evaluation of the retroperitoneal lymph nodes is an important aspect of treatment planning in adults with testicular cancer. These types of nodes are usually evaluated by CT scanning. Patients with a negative result, however, have a 25% to 30% chance of having microscopic involvement of the lymph nodes. For seminoma, however, some physicians think that knowing the results of both the lymphangiogram and the CT scan is important for treatment planning. For nonseminoma, the inaccuracy of both is a problem, and frequently surgical staging is required. ...

Patients who have been cured of testicular cancer have approximately a 2% to 5% cumulative risk of developing a cancer in the opposite testicle over the 25 years after initial diagnosis. In a single series, however, the risk of a second cancer in the opposite testicle was not increased in patients who had been treated with chemotherapy for their original tumor. ...

Radiation therapy, often used in the management of pure seminomatous germ cell cancers, has been linked to the development of secondary cancers, especially solid tumors in the radiation portal, usually after a latency period of a decade or more. These include cancers of the stomach, bladder, colon, rectum, and possibly the pancreas. ...

Radiation therapy and/or chemotherapy for testicular cancer are associated with an approximately 2.5-fold increase in cardiovascular morbidity. In a retrospective series of 992 patients followed after diagnosis of testicular cancer, the actuarial risks of cardiac events were 7.2% for radiation therapy (92% of whom did not receive mediastinal radiation), 3.4% for chemotherapy (primarily platinum-based), 4.1% for combined therapy, and 1.4% for surveillance management after 10 years of follow-up. ...

6

http://www.kantrowitz.com/cancer/chronology.html
Testicular Cancer Chronology.
By Mark Kantrowitz,
MK Consulting, Inc., PA,
2003

Age at diagnosis: 37 years old ...

My doctor demonstrated a reluctance to speculate about the diagnosis, beyond stating that it was a testicular mass. Strictly speaking, he should have assumed that it was testicular cancer until proven otherwise, and scheduled the ultrasound with greater urgency. He should have called various hospitals and labs until he found one that could conduct a testicular ultrasound the same day, instead of forcing me to wait two weeks. ...

My doctor called with the [ultrasound] results, confirming the presence of a solid tumor. I asked him to fax me a copy of the ultrasound report. In addition to the tumor, the report showed bilateral microlithiasis, something my doctor forgot to mention. ...

My urologist said that it was urgent to remove the cancerous tissue within the next 24-48 hours ...

During the orchiectomy they make a three-inch horizontal incision in the abdomen just below the belt line. They use it to remove not only the testicle but also some of the plumbing connected to it. This prevents the cancer from contaminating adjacent tissue, and also allows the pathologist to determine how much the cancer has spread. ...

For the next two days I had to keep ice on the incision and scrotum to keep the swelling down, changing the ice every 15-20 minutes. The painkillers weren't very effective, only taking the pain down a notch or two. The bags of ice were much more effective. Since the ice was rather cold, wrapping it in a paper towel helped. The pain and the painkillers interfered with my ability to concentrate. ...

I find it kind of amazing that people expect me to be embarrassed or emotional about the cancer or the orchiectomy. Yes, I have cancer, and yes, I now have only one testicle, and yes, there's a good chance I may die. So what? Will running around like a headless chicken cure the cancer? Worrying won't accomplish anything. Educating myself about testicular cancer and treatment options is the best use of my time. I prefer to be pragmatic and rational about it. ...

After the steri-strips from the orchiectomy came off, I tried using a half dozen regular bandaids, since there was a small amount of bleeding every time the scabs cracked. This didn't work well. What worked much better is an adhesive pad, like the 3M Medipore +Pad (brand name "Nexcare"). The bandage part is 1" x 2-3/8", which is too short to cover the full length of the incision. But if you cut off the end of one pad and overlap it with the end of another, it works well. ...

I went to the hospital for CT scans of my pelvis, abdomen, and chest, with and without contrast die. As with the ultrasounds, I asked for and received a copy of the CT scans. They made me drink two quarts of a milky white barium sulfate solution. The berry flavor barely masks the chemical taste, and does nothing about the texture. I drank so much of the stuff that I was full to the gills. They also hooked me up to an IV for intravenous contrast die (120 cc of Optiray 320). ...

During the CT scan itself I felt very hot, the way a piece of food must feel when it is being nuked in a microwave. About an hour after the CT scan I had massive diarrhea, with a considerable amount of liquid coming out all at once. Luckily I was near a bathroom at the time. ...

I had heard that it is a good idea to have complete dental work before starting chemotherapy, as chemotherapy patients are more prone to mouth sores, bleeding and infection. ...

The radiologist's report said that the CT scan found three tumors in lymph nodes, two in the chest and one in the abdomen ...

3 cycles of BEP chemotherapy (BEP = Bleomycin, Etoposide, and cisPlatin) or 4 cycles of EP chemotherapy. 4EP is thought to be about as effective as 3BEP for good risk patients, but with less toxicity. ...

Dr. Einhorn responded right away that Culine had presented a paper this week at ASCO showing a cure rate of 96% for 3BEP and 92% for 4EP, with 5 3BEP deaths and 10 4EP deaths. He also noted that he feels that 4EP is far more toxic than 3BEP because of "cumulative platinum related neurotoxicity, anorexia, nausea, and ototoxicity as well as the small risk of leukemia with etoposide at higher total dosage". ...

My beta-HCG levels are 37 mIU/ML as of June 2, 2003, down from 156 mIU/ML on May 20, 2003. The latter was before the orchiectomy and the former after. The half-life of beta-HCG is 24 to 36 hours, meaning that beta-HCG should return to normal about a week after surgery. Normal levels are less than 5 mIU/ML. The fact that the levels are dropping is a good sign. However, the fact that they are still above normal is probably an indication that the other three tumors are still producing beta-HCG. This is good news, because it means we can use beta-HCG levels as an indication of the cancer's response to treatment.

Beta-HCG levels are also elevated during pregnancy, typically reaching 10-50 mIU/ML in the week following conception, and peaking at 288,000 mIU/ML about two months after conception. Home pregnancy tests typically signal a result when beta HCG levels are at least 25 mIU/ML (e.g., the ept test requires 40 mIU/ML, Clearblue Easy 25 mIU/ML, and Confirm 25 mIU/ML). ...

Because Bleomycin can cause pulmonary fibrosis and impair lung function, a prerequisite for 3BEP chemotherapy is to check lung function. ...

... to have my head examined, to make sure there are no tumors in the brain. This time ... they did give me contrast dye through an IV ... in my arm. ...

First he showed me normal testicular tissue. I saw the seminiferous tubules lined with Sertoli cells and with small round germ cells in the center and some spermatids (immature sperm). He also showed me a few Leydig cells, which produce testosterone. Then he showed me the cancerous tissue, which was completely filled with germ cells. He showed me examples from the testicle, the epididymis, and the spermatic cord. Except for occasional lymphocytes responding to the cancer, it was uniformly germ cells. That's a pretty clear indication of a seminoma. ...

I've noticed in myself a tendency to indulge a little more since the cancer diagnosis. But it seems to be limited to things that I need, not things that I want. If I need something and would have hesitated before because of cost, I'm more likely to buy it now. ...

My oncologist still wants me to have a PET scan, and is fighting with my insurance company to get it approved. In particular, he wants to know whether the mass near my heart is metabolically active. He says that if the PET scan is to happen, it must happen no later than next week. If my insurance doesn't cover it, it will cost me approximately $4,000. ...

I am not worried about the cancer, nor do I fear it.
I'm not the sort to worry about much of anything. If something is beyond my control, I don't waste time worrying about it, because nothing I can do can affect it. If I can do something about it, I take action, rather than waste time worrying about it.

When I first suspected that I might have cancer, I started reading everything I could find on the topic. I've absorbed a considerable amount of material. I understand what will happen and what might happen (and also what won't happen). So even if the future is indeterminate, it is still well-defined. Knowledge is the antidote to fear. ...

I do feel some anger.
I did not cause the cancer and it is disrupting my life. I do not have any of the risk factors other than age. ...

.. why cancer patients describe getting chemotherapy as having paint remover poured into your veins. Chemotherapy is, after all, a derivative of chemical weapons like mustard gas. Doctors treating soldiers exposed to mustard gas noticed in 1942 that mustard gas affected rapidly dividing cells, suggesting that it might be an effective agent against cancer. They subsequently found that lymphoma patients given it by injection showed some improvement. Many modern chemotherapy drugs (alkylating agents) are descendants of mustard gas, albeit less toxic. ...

Bleomycin is known to cause fever and chills about four hours after administration. The oncology nurse told me to take two Tylenol if this happens ...

severe abdominal pain ...
I underwent multiple blood tests, X-rays, and an ERCP (Endoscopic Retrograde Cholangio-Pancreatography) because they suspected an inflamed pancreas. During an ERCP they put you under with general anesthesia and send a tiny camera down your throat to examine the pancreas, gallbladder and duodenum. The camera has attachments for making certain repairs (e.g., an inflatable balloon and a cauterizer) so they can fix certain problems while they're diagnosing the condition. In my case they found that I had acute pancreatitis and gall stones.

They believe that the pancreatitis was caused by the chemotherapy and not by the gall stones. But they were concerned that the gall stones could potentially reinflame the pancreas so they recommended removing the gall bladder now, ... I underwent laprascopic surgery to remove my gall bladder. During this procedure they go in through the belly button and two small holes in the chest and conduct the surgery in a minimally invasive manner.

I am still neutropenic (reduced white blood cell counts), but there's no reason why I need to be hospitalized for this. While I was in the hospital they trained me to give myself my own Neupogen shots, so I will be taking care of this. Since I'm neutropenic, I need to avoid people (especially anybody who has been sick recently), flowers, fresh fruit and fresh vegetables and so on for a while. ...

The tinnitus was much better today, not much worse than it was before the chemotherapy. So perhaps the tinnitus is temporary. The otolaryngologist recommended staying away from caffeine, alcohol, chocolate, and steroid medications (e.g., the decadron) to help minimize the tinnitus. ...

... the information I posted on a mailing list about my cancer caused him to check out a testicular mass. It turned out to be stage I non-seminoma. I'm glad that my email helped him catch his cancer early. ...

My PCP explained that the high Hemoglobin A1C tends to be a long-term measure, and so elevated levels are an indication that the diabetes was on its way before I started chemotherapy. He did acknowledge that some folks believe it represents blood sugar levels over 6 weeks instead of 6 months. He also said that the pancreatitis and decadron could have accelerated matters. So now I have three different doctors telling me three different things ....

My [early] CT scan showed three tumors in the lymph nodes: a 5 mm tumor adjacent to my heart, a 1 cm tumor just below the diaphragm (in the right retrocrural lymph node), and a 3 cm tumor just above where the aorta splits to go into the legs. ...

( FDG is fluorodeoxyglucose, a radioactive sugar.
Metabolic activity consumes sugar, causing areas of metabolic activity to show up on the PET scan as hot spots. Many types of cancer, including testicular cancer, show increased metabolic activity. The fact that there were no abnormal hot spots on the PET scan is an indication that the cancer has responded to treatment and is no longer present.) ...

It pays to have a copy of your full health insurance plan document (not the short 2-page summary, but the 100-pager) and to be persistent in appealing claims. ...

I just got the CT scan report, and it has some bad news.
The radiologist says that there may be evidence of metastatic disease in the lower right lobe of the lungs. My oncologist says that it is at the edge of the resolution of the CT scan, so he wants me to have a PET scan on Wednesday. The PET scan offers higher resolution and also indicates whether the nodules are metabollically active or not. ...

According to the research literature, 20% to 25% of patients receiving cisplatin-based chemotherapy develop tinnitus and high pitch hearing loss that lasts at least two years after the end of treatment. (The hearing loss and tinnitus are bilateral and permanent.) The hearing loss is mostly above the speech range, although a small percentage of patients may experience hearing loss at the higher end of speech frequencies. Total cumulative dosage of cisplatin seems to be the primary risk factor, with about 20% of testicular cancer patients suffering from ototoxicity at standard dosages, increasing to 50% at 400 mg/m2. The severity increases with higher cumulative and higher individual doses. ...

I've been showing some signs of testosterone deficiency, such as night sweats, diminished libido since the orchiectomy, increased irritability, and a persistent decrease in strength despite exercising. I also sleep more than I did before the orchiectomy, but my mood is unchanged. A slight difficulty concentrating ... also noticed an increased tendency to make valid word spelling errors (i.e., "principle" vs "principal"), especially involving context priming of phonologically similar words .... I have also had minor short-term memory lapses, such as forgetting a number when my concentration is interrupted. ...

Long-term potential consequences of low testosterone, besides a reduced risk of prostate cancer, include loss of muscle mass, increase in body fat, and osteoporosis. ...

My testosterone levels were 261 ng/dL (normal for men is 241-827, with most men my age in the 600s). So I'm at the low end of the normal range. However, they didn't check LH, FSH and Prolactin, which are used to determine whether one's body considers the testosterone levels to be normal. If FSH and LH levels are elevated while testosterone levels are low or low normal, that's an indication of a problem with testosterone production in the testis. ...

My doctor prescribed ketoconazole shampoo for some dermatitis just above my eyebrows. This dermatitis started during my chemotherapy, but had recently gotten worse. I had never had any dermatitus or eczema before. ...

A common problem with high resolution CT scans is the higher resolution doesn't always increase the accuracy. Often the higher resolution means the CT scan detects more artifacts that ultimately turn out to be benign. ...

see also Testicular Cancer COSTS,
http://www.kantrowitz.com/cancer/costs.html
... The grand total so far is $175,712.97

7

http://www.cancer-info.com/testes.htm
Testicle Self-Test.
by Anonymous
date unknown

TESTING: It is best to do a testicle exam during or just after a hot shower, when the scrotum is softest and most pliable.

Using one hand hold the testicle to stabilize it.
Gently probe it and roll it between your thumb and first 2 fingers of the free hand. Press softly, it should not be painful. Feel for imperfections on the surface, swelling or any changes in size or shape over time. Feel for bumps or lumps. You should think of the testicle as an eggplant shaped object only much smaller. It is OVOID except at the top, where the group of sperm ducts (epididymis) connects like a stem. Except for the epididymis, the testicles should feel alike and smooth, although it is normal to have one testicle larger than the other. You should also feel the skin of the scrotum for dry or hard patches.