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Testicular Cancer Archive Questions

Below are Dr. Heather Mannuel’s answers to Testicular Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 16.

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Q : 1

What are the usual side effects of the contrast used in CT? Can it cause painful urination after the scan?

Generally contrast media doesn't produce any irritative urination. The oral contrast that patients have to drink prior to receiving scans can cause some GI upset and I've had patients report episodes of constipation and diarrhea for a day or so after their scans.

Q : 2

What do you think about using carboplatin to treat a seminoma in place of radiation? My doctors believe the cancer is confined to the testicle, but said that they couldn't be completely sure.

Recent studies have indicated that substituting 1 to 2 cycles of carboplatin in place of radiation decreases the risk of relapse without exposing the patient to the potential side-effects of radiation, including the risk of development of secondary cancers. Our institutional practice is generally to use two cycles of carboplatin, as recent data suggests that this may better decrease the risk of relapse than one single cycle.

Q : 3

My 20-year-old son found a lump in his right testicle. His doctor performed an exam and sent him to the hospital for an ultrasound and blood work. Two hours later, the doctor called him and said he would like to see him in his office in the morning to discuss the results. To me, this sounds bad. He has no pain in the testicle but he mentioned to me today that for about 1 year, he has had a pain in the area between his testicles and his penis. He said it feels like someone is taking a knife and stabbing it through this area. Can you give us any advice?

The most important thing your son can do is follow up with his doctor as suggested. A variety of issues can cause pain in the penis and testicles, and while cancer is certainly the most pressing thing to rule out, his doctor may also want to discuss other things that 20-year-old men can be at risk for, such as infections or injuries. One advantage to a face-to-face meeting is the opportunity for your son to ask questions and plan for anything else that needs to be done to address the cause of his pain.

Q : 4

My son has testicular cancer and will be starting chemo soon. His doctor has said he will get 6 cycles of EP. I think he has stage III cancer (lung involvement) but don't have his marker numbers yet. All sites that I read recommend 4 cyles of EP for good risk patients and different regimens such as BP or VIP for intermediate to poor risk. I have an appointment to talk to his doctor for clarification. I don't want to delay treatment, but how else can I ensure he's getting the right chemo therapy?

As you say, the final staging and determination of risk group (and therefore treatment) depends on a variety of variables for any individual patient, including the type of tumor (seminoma vs. non-seminoma), the location of metastases, and the degree of abnormality of tumor markers. Generally for good risk patients and based on the NCCN Guidelines, either 3 cycles of BEP or 4 cycles of EP are recommended; this may be altered a bit depending upon an individual patient's lung function, as Bleomycin (the "B" in BEP) can cause lung toxicity in certain patients with underlying pulmonary problems or active smoking histories, etc. I generally don't recommend six cycles of EP as this deviates somewhat from the established guidelines; however, the guidelines are meant to be a starting point which should then be individualized to best and most safely treat individual patients. I agree that it's very important for you and your son to sit down and discuss this with his oncologist, to clarify why this is the treatment plan and to be sure that all your questions are answered to your satisfaction.

Q : 5

Are there any known links between testicular cancer and sexually transmitted diseases?

The only STD that has a known association with increased risk for testicular cancer is HIV/AIDS. Although certain other STDs like chlamydia can produce painful lumps or masses that mimic testicular tumors, they aren't associated with an actual increase in cancer risk.

Q : 6

My partner is 70 and a cancer survivor. For the last few months he has been troubled with hot flashes. Could cancer of the prostate cause this symptom?

In general, it is the treatment for prostate cancer ("hormonal therapy") rather than the disease itself that causes hot flashes.

Q : 7

My father, 56 years, having advance prostate cancer with multiple bone mets, Hormone refractory disease, is experiencing slight pain in lower back and more in thighs and calves, even with Cyclophosphamide 1GM, Thalidomide 100mg and Zoledronic acid 4mg. Doctor had suggested Mitoxantrone 20mg and dexamethasone. Is it ok? Already 9 cycles of Zoledronic acid have been taken (every month).

Mitoxantrone is a very reasonable option. Other chemotherapy agents for your father's situation would include taxanes, in particular taxotere.

Q : 8

I recently came across this site and hopefully this will help me. I have a lump at the bottom right of my left testicle. When reading the articles about testicular cancer, I saw that a lump is a common symptom of testicular cancer. I have had this lump for a long time (over a year), it doesn't hurt and has not grown in size. Could this possibly be something other than tc? Thank you.

My suggestion is that you see a urologist who can better determine the significance of this lump, both by exam and possibly an ultrasound.

Q : 9

I would like to know whether any link has been established between consumption of soya products and testicular cancer. I read in an article that the phytoestrogens in soy products can cause testicular cancer. I want to know whether this is true or whether more research is needed to detect the link. I'm concerned because in the past I used to drink a lot of soy milk.

In general, soy products are good for you, including the cardiovascular system. If there is a link between testicular cancer and soy products, I suspect it is likely to be a weak one, and certainly more work is required before any definitive conclusions can be made.

Q : 10

I noticed a small bean-like growth on the bottom of my right testicle. I had an ultrasound test done, but nothing was detected. Could you please let me know what it can be? I have had it for about a year and I am very worried about it.

I am not sure what to make of this, but generally an ultrasound is quite accurate in delineating if an abnormality exists within the testicle. I would follow up with your urologist in 3 to 6 months, and if clinically indicated, they can then do additional work up. Given that the current ultrasound is normal, it would be reasonable to continue with watchful waiting for now and do the follow up in the next few months.

Q : 11

My husband has been having pain around the testicals and pain running up into his right side. Doctors have run all kinds of test, not finding any thing. Pain is worse after any type of lifting or working. What should we do next?

I am not sure what the etiology of these symptoms are, but continued follow up with a urologist would be appropriate. I assume CTs of the abdomen/pelvis and ultrasound of the testicles were done. Question is whether this is some sort of referred pain (e.g., ? lumbosacral plexus) and it may be reasonable to get a neurology evaluation at some point if the symptoms persist.

Q : 12

How often should the AFP be checked during chemotherapy for yolk sac tumor (post op)?

It should be checked once every three weeks during chemotherapy. In addition, beta HCG should also be checked even though with YST the former tends to be elevated.

Q : 13

My husband has had recurring testicular symptoms which we would like your advice on. Approximately 18 months ago, he began experiencing sudden acute pains and some swelling in his left testicle. These symtoms lasted several months before he went to his internist. He had ultrasound and also a CT scan using contrast. Some "abnormality or swelling" was detected. His doctor put him on a fairly long dose of CIPRO and the symptoms subsided. Over the last year he has also complained of a dull ache in his lower abdomen, but has never had it checked out. Now the testicular symptoms have returned. What should be our next steps? I am concerned and wonder whether this is not a recurring infection and if it warrants more investigation. I would like him to see a specialist, and would like your advice. He is an otherwise healthy 47-year old Caucasian male with no family history of testicular cancer.

I am not sure what to make of the symptoms your husband is experiencing. For testicular symptoms, both clinical exam and imaging (ultrasound) generally help identify the problem. Whether there is a component of inflammation or possible malignancy needs to be evaluated further, particularly if the symptoms have recurred. I would suggest follow up with your urologist.

Q : 14

I went to the doctors about a month ago about a testicular problem. They said it was just a testicular infection and gave me pills. After taking the pills the problem went away for a couple of weeks, but now hurts again. I was looking online and it sounds like testicular torsion. Would the doctor have found that during my examanation?

Yes, it is a clinical diagnosis. An ultrasound of the testicles can also help. If the problem persists, then you should follow up with your doctor.

Q : 15

Re: testicular cancer: do these lumps usually move around?

Generally not if it is a mass within the testicle.

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