I have been a family physician since 2003. In those nine years, despite thousands of patients, I had never diagnosed one case of testicular cancer – that was until October 3, 2011, when I diagnosed myself.
As physicians, we are required to pass a board examination every eight years to remain board certified. In the weeks preceding my exam, I learned a friend was diagnosed at 28 with stage 1b testicular cancer (localized to the teste, but showing invasion into local blood vessels). During my board review, I started to pay more attention to the signs, symptoms, and treatments of testicular cancer – and this likely saved my life.
My board exam was on Saturday morning, October 1. Friday night, after my pregnant wife and two small children finally fell asleep, I had some quiet time to review my notes. I decided a good night’s sleep was more important than additional studying.
Changing for bed, I detected something strange “down below”; it was subtle, but obvious enough to notice. It didn't hurt per se, one side just felt heavier. I went into the bathroom and after examining both testicles, concluded the right one was slightly larger and felt firmer than the left. I started to panic. It was so obviously different that I questioned how long it was there and how I didn’t notice sooner. Even as a physician, I probably had not checked myself as often as I should, but how could I not notice this?
Between the anxiety of the board exam and concern I may have cancer, needless to say, that was a difficult night’s sleep. When I woke up Saturday morning, ready for the boards, I nearly forgot about the night before. Maybe, I thought, it was a bad dream – but those hopes dashed once I squeezed the right testicle again, palpating the hard, enlarged mass. I made a decision not to tell anyone and would not think about it until I could verify the diagnosis with an ultrasound.
Monday, I woke up early, called the imaging center, and begged the staff to squeeze me in and luckily, they fit me in that morning. I laid on the exam table, testicles covered in ultrasound gel – all modesty out the door – and did my best to relax, taking deep breaths and thinking calming thoughts. Inside, though, I was a mess, crying internally while doing my best to remain stoic. As the exam progressed and finished, I could see the look on the technician’s face, and my worst fears were confirmed. Minutes later, I was with the radiologist staring at what looked like an asteroid inside my testicle.
I called my wife first, trying to hold back the tears as I told her I had cancer. She was seven months pregnant with our third child and I really did not want to stress her, but she had to know now. She is a melanoma survivor (and we are so grateful she is five years clear) so she processed the news better than I anticipated. Next was Mom and Dad, another difficult call to make. They were very upset, as expected, once they heard the word cancer. I assured them I'd be fine, but inside I was scared to death.
I saw the urologist the next morning and he confirmed the diagnosis and scheduled the surgery for October 7, just seven days after I discovered the tumor. I had already drawn tumor markers and they had all come back normal - a good sign. I read page upon page of information on testicular cancer, determined to know as much as possible. Some of it scared me – stories of young men dying, fathers leaving children and widows way too soon, parents losing teenage sons. I cried often, especially late at night when my family was asleep.
The surgery was not as bad as I expected - I checked into the hospital at 7am and was home by 1pm. The surgeon’s exact words were, “The tissues looked pristine; this was likely localized.”
Four days later, I had my chest x-ray, which the radiologist read as possible lung metastasis – a spread of cancer to the lung. This shocked me, but, again, being a physician has its benefits! I read my own film and decided she was looking at blood vessels on end and not tumors; a classic example of an “over-read.”
So, instead of just a CT scan of abdomen/pelvis, an additional chest CT was ordered (extra radiation is never preferred). The scans use oral and IV contrast, and although I’ve ordered this test for many patients, I had never done the test myself. The oral contrast tastes like a mix between liquid chalk, Sprite, and a watery pina colada - not terrible, but no summer cocktail either. The IV contrast is another treat; it feels like hot sauce is injected through your arm and into your entire body, concentrating in your pelvis. That was the hardest day by far, knowing clean scans would mean a better prognosis, while abnormal scans would mean chemo or radiation.
Luckily, the scans were normal and the abnormal chest x-ray was indeed an over-read. That same day, I received the pathology report, stage 1a seminoma with no lymphovascular invasion and no rete teste invasion – in layman’s terms, the tumor was limited to the testicle and had not invaded the surrounding blood vessels or tissue. As my surgeon put it, “You hit the lottery of cancers.” If being lucky and having cancer go together, this was one of those times.
Just to be sure, I had my pathology slides sent to another doctor to verify the staging, and he concurred. Everyone should do this, and, in my case, sending it somewhere that had experience with testicular cancer (since it is so rare) gave me even more reason to verify. This was the first day of my journey that I breathed a sigh of relief. I was back to work within 10 days of my surgery, although the incision was tender and sore.
Over the next few weeks I met with the radiation oncologist and Dr. David Vaughn, an expert in testicular cancer at the University of Pennsylvania. His first words to me were, “It’s not a matter of if we can cure you, it’s a matter of how.” The way he described it – if 100 men had my exact diagnosis, 90-92 of them are already cured, and the remaining 8-10 will need further treatment. He offered prophylactic radiation or chemotherapy, but together we chose surveillance. This meant no further treatment, just careful and regular check-ups with blood work, chest x-rays and CT scans every four months for two years.
Three months into surveillance, I felt something odd in my left testicle. The problem now is I had nothing to compare it to. I panicked and immediately scheduled an ultrasound. The chance of being a “double warrior” (having cancer in both testicles) is very rare, around 2 percent, but it is possible. Although the surgery wasn’t bad, I was not mentally prepared for it again. As I laid on that table (again), humility thrown out the window (again), I prayed. Not that I didn’t have cancer - just that if I did, I would have the strength to go through everything once more. This time, though, the reflection of the video monitor in the tech’s eyeglasses showed me it looked ok, and the radiologist confirmed I was clear. The next four surveillance checks went similarly smooth - normal labs, CT scans, and exams. With each passing day, I felt stronger and more like a cancer survivor.
Since my diagnosis, my life has changed – for the better. My love of life, my appreciation for health, and my compassion for my patients has changed. It made me a better doctor, father, husband, son, and person. I cherish every moment, I hug and kiss my family as often as possible, and I thank God every day I wake up feeling well. I try to eat foods that are known cancer fighters, I exercise regularly, and I do my best to not sweat the small stuff.
On November 17th, 2011, our third child was born, a beautiful baby girl named Laila Grace. She blessed our family and our lives shortly after one of the worst months of my life. My children are too young to understand now, but one day I will explain to them what cancer is and how it affected us. I want them to have the same appreciation for life I now have.
I am now 15 months cancer free, I feel great, and am probably the healthiest I have been in years. The CT scans are no longer a big deal; I even grew accustomed to the oral contrast – surprisingly it grows on you. When a “newbie” is having their first CT scan, they look at this Big Gulp-sized cup filled with chalky white slurry with much disdain and fear. I try to make them feel better by asking for seconds on mine. The tech always laughs; she knows I’m kidding, and it provides a little comic relief for the new guys. [T.J.’s note: Moffitt mixes their contrast with Crystal Light – sooooo much better]
My practice has shifted from family medicine to medically supervised weight loss. In the past three years, I helped many people change their lives by losing weight and learning how to maintain it. While this doesn’t usually involve cancer screening or cancer treatment, I let all my patients know the higher incidence of many cancers in obese and morbidly obese patients. I preach the use of cancer fighting foods (many of which T.J. discussed in his prior blog), annual wellness exams, preventive cancer screenings, and lifestyle changes... all to promote health and wellness.
When I heard of TJ’s situation, I wanted to reach out to let him know he is in my prayers, and also let him know I had overcome cancer. Part of my healing process has involved educating others about testicular cancer - not just as a physician, but as a survivor. My Mom once asked if I wanted her friends or our extended family to hear what I was going through. I answered, without hesitation, “Yes! Mom, people need to know what happened to me so it doesn’t happen to them.” The best way to cope is to make sure everyone I know is aware and checks themselves regularly, so if this ever happens to one of them, they will join me in the survivor’s circle.