Doctor diagnoses first case of testicular cancer on himself
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.
Doctor diagnoses first case of testicular cancer on himself
Matt Pinto
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.
Good for you doctor!— Sportyrider71- Being a physician has its perks, huh. Plenty of them too. I would have had to wait for weeks to get into the UT machine, and weeks after that to get into surgery. Don't worry, bro - step right to the front of the line...— Bobphxville
- This classless, baseless and vicious post is to be condemned. Unless there is blatant malpractice going on, your statement about "weeks" on an imaging wait list and "weeks" for surgery" in a patient with a high suspicion of cancer is a disgusting lie - and I know that first hand. Instead of the countless, wasted hours of your life you spend posting this garbage, why don't you fill it with something meaningful? Dr. Pinto, who has made that life sacrifice by choosing medicine, took the high road by responding to your rotten words in a professional way. It's not too late for you to learn that lesson. — Bob1
- doc you had me until the "being a physician has its perks" and all the entitled expectations. surgery within a week of diagnosis? must be nice but next time share it with your family and not the rest of us. I lost my mother to cancer and the s l o w treatment process.— lostinthebigcity
- Dr. Matt- Wow, your article brought back a flood of emotion for me. I, too, am a testicular cancer survivor, and went through a very similar ordeal, including oncology treatment from Dr. Vaughn! Good to know he's still there helping patients deal with this. From surgery through follow up(no initial radiation/chemo ordered) the first year I felt sorry for myself, while on the outside I would simply joke around about it in a self-depricating way. Inside, though, I was a mess. After about a year or so of follow up treatment, I was ordered into radiation for a relapse. This was about 10 years ago, and I don't remember exactly what they saw, but something wasn't quite right. Anyway, I started going to HUP for my radiation treatments, trying to take it all in stride. It was during these treatments when everything changed for me. As I would sit there in the radiation waiting room feeling sorry for myself, I'd see these children walk in, heads shaved, smiles on their faces as they were also waiting for their treatment. Chemo treatment that was much, much more difficult and devastating to their tiny bodies. I realized how absolutely ridiculous it was for me to be feeling sorry for myself for a little radiation treatment. It really changed my life. Anyway, good luck with everything and hope you come through with a clean bill of health. I've been clear for over 10 years now!— EZRider
- God bless you EZRider and you too Dr. Matt! It's sooo good to hear of those who have gone through the horrible suffering and treatments are now back up and running again. I salute your strength! Stay strong.— pcummin0722
- Terrific story. Thanks for sharing. It tooks guts to share this on the web too. All the best.— Frankie2
- You are a very lucky man Dr Matt. My son passed from this cancer April 1 ,2004 @34 yrs old with three chrildren. We had also found Dr Vaughn for a second opinon but he never got a chance to work his wonders as the cancer had spread to my sons brain which we found out from Dr Vaughn's original workup.Unfortunatily he was then put in the care of Dr Kevin Judy. Dr Judy's skill may be ok but his bedside manners are terrible. After brain surgery we were sent home with very little instruction from Dr Judy. It's a long story but I wouldn't take my dog to Dr Judy ,on the other hand our family thinks Dr Vaughn is the best.
To those that think Dr Matt had a perk , my son was tested the day he was diagnosed at Lancaster General Hospital and chemo treatment started within a week. Dr Vaughn's office saw my son they very next day after I called and even waited for over an hour as we were late coming from a previous dr. appointment in Lancaster. Good luck Dr Matt and thank you Dr Vaughn.
Frank O'Connell— faoc - The purpose of this story was not to brag about how being a doctor has some perks, rather, to help spread the word about a disease that should have 0 deaths associated with it. Most men and definitely most boys are never aware this cancer even exists. A simple self examination once a month is all that is needed to find this cancer at an early enough stage to treat it. While being a physician certainly didn't hurt me, the ability to have my ultrasound the day I called and the surgery one week later is normal. I send patients for testing and they are tested in the same day or the next all the time. I send patients to surgeons and, if required, the surgery is planned asap. lostinthebigcity and Bobphxville, I'm sorry you feel the way you do, but you are entitled to your own opinion. But by "being squeezed in" and by seeing the urologist quickly, I didn't push anyone out of the way to get there. If you don't feel that your relationship with your primary care doctor is one where you would feel comfortable asking them to see if they can get you into a specialist sooner, or have a study done sooner if the situation demands it, then perhaps you should consider switching to a provider that would do that for you. I do it for my patients every day.— PintoDO
- Matt, there is no reason to explain the fast rack for suspected cancer patients as you and I know it happens every day. One can only hope that the creeps who maligned you will educate themselves before they make foolish and hurtful statements. Anyone who takes and passes a board exam under that pressure is unique. If even one man is saved by this article you have done a tremendous job. — Bob1
- Every job comes with perks. Dr. Pinto, I know you have worked hard to get where you are today and I am sure you did it with a mountain of debt following you. It's a shame people can not take this story as informative and have to pick on people for their career choices. Glad the story has a happy ending and wishing you many more years of health. You are the kind of doctor I wish I had.— hrlad
- it never ceases to amaze me what it takes to teach a doctor compassion for his patients.
— ekw555 - Thanks for sharing - great story - wonderful that you are cancer free now.— Kim Ruoff
- This was a great story. Thanks for sharing. It helps to hear from people who have the same problems. I am also a testicular cancer survivor, having dealt with it last June. My story is remarkably similar. I can attest to the anxiety you can feel upon self discovery. The "How did I not notice this sooner? Is this really cancer, or just some swelling?" feeling. Not being a doctor, I was not sure of the symptoms and scheduled appointments with my primary doctor and a urologist. It took about 3 weeks to get to see the specialist at the urologist office since I was too modest/embarrassed to stress that I thought I had testicular cancer (I wasn't sure, really). But after seeing him he scheduled all my tests to be taken that same day at the hospital and the testicle was removed by him 3 days later. They have to work on these things fast! It felt like a whirlwind. Thankfully I had the same early stage prognosis and opted for the same surveillance follow-up option. We were lucky to spot it and treat it early. Early detection has incredibly high success rate. Late, not so much. The moral of the story, don't be shy about it. If you detect a lump, get it checked right away by an expert. On a side note, you can opt for MRIs instead of CT scans to be exposed to less radiation when taking your regularly scheduled follow up exams. Sadly for me, my last MRI showed an early-stage unrelated stomach tumor and I just had that removed as well. Not quite cancer, but it probably would have led to it if it remained there. I am still recovering from surgery. It is another example of how early detection has probably saved me from a worse fate later on. 2 Cancer surgeries in the span of 7 months. They both may have sucked to get in the first place, but in truth I am extremely lucky to have them dealt with early. God bless those out there with worse issues than mine, I have met some of them throughout this ordeal.— edf
The Patient #1 blog will update the progress of T.J.'s fight against cancer, and also touch on many cancer-related topics.
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