As I said, I was diagnosed with a Stage II nonseminomous testicular cancer. I figured it was worth going into more detail what this all means, and how the various aspects of my cancer have determined the treatment.
Nonseminomous refers to the type of germ cells. Testicular cancer is categorized into two general types of cancer, seminoma and nonseminoma. Seminomas are easier to treat since they are sensitive to radiation therapy. My tumor is classified as a nonseminoma tumor consisting of 90% embryonal carcinoma and 10% seminoma. The tumor itself wasn’t very large, measuring 1.7 cm at its largest point.
Stage II means that the cancer was not confined to the testis. Blood drains from the groin into the abdomen, so testicular cancers typically spread first to the retroperitoneal lymph nodes in the stomach area. This is what happened here, with one lymph node swelling to 2.0 cm in width and other sub-centimeter lymph nodes present.
The first step was the orchiectomy I had last month, which removed the original mass. Because my cancer is Stage II, I need additional treatment. With Stage II nonsemimoma cancers, a lymph node dissection (RPLND) is often performed. This is a fairly invasive surgery, where the surgeon goes in through the stomach and removes the affected lymph nodes.
There are a few reasons I’m not having this surgery right now. First, my tumor showed “extensive lymphovascular invasion”, which means that there are likely micrometastases in my blood. This means there is a nearly 100% chance of a recurrence with surgery alone. Chemotherapy, meanwhile, is a systemic treatment – when I’m done, it will have killed (nearly) all of the cancer cells in my body including these micrometastases. There’s a good chance I will still need the RPLND surgery after my treatments, but this also makes the surgery easier since it will largely reduce the size of the lymph nodes.
The other big reason is that, as I mentioned, RPLND is a fairly major surgery – I will spend several days in the hospital afterwards and the full recovery time could be over a month without complications. If the surgeon goes in for the RPLND and sees “more volume” than he expected, he may not be able to get all of the cancer cells out. At this point, I will still have viable cancer cells in my body, but I won’t be healthy enough to have the necessary chemotherapy (and in general my body will be weaker which will amplify the effects of the chemo).
For chemotherapy, there are two general schools: a 2-drug regimen over 4 cycles (Sloan-Kettering) or a 3-drug regimen over 3 cycles (University of Indiana). Both have been found to be equally effective. The three drug regimen is bleomycin, etoposide and Platinol (BEP), while the two drug regimen is etoposide and Platinol. Bleomycin is very toxic to the lungs and can lead to impaired lung function, which is the reason that Lance Armstrong chose to avoid it. While I am not a professional athlete, I’m still young and very physically active, so agreed with Dr. Nanus that the 2-drug treatment was better for me.
Each cycle is three weeks - one week on and two weeks off. For the "on" weeks, it's a 5 day cycle Monday through Friday, 7-8 hours each day. Basically, I will just sit there with my laptop and EVDO card, working with an IV drip. The off weeks are recovery - I'm told the second week will be the worst as the body flushes the drugs, while the third week is basically getting healthy enough for the next cycle.
So, assuming all goes well, I will finish my final chemotherapy treatment on April 17th. I will be monitored throughout, including CT scans to see how the cancer (and my body) reacts to the drugs. At that point, my doctors will determine whether or not I need the RPLND, and they will continue surveillance to ensure the cancer has not returned.