Saturday, February 18, 2012

An Update On Man Cancer: Translating the Doctors


From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…(Sorry this is late today, but my new granddaughter was born on Thursday and we just moved the newly expanded family home this afternoon!)

My old friend who had a radical orchiectomy (http://breastcancerreaper.blogspot.com/2011/12/man-cancer-and-orchiectomy.html) faces a second operation next week. The procedure is a real mouthful so to speak because it doesn’t have a “common name”. He will be undergoing a retroperitoneal lymph node dissection or an RPLND – which really doesn’t do anything to make it easier to remember, because the letters might make up the word “ResPLeNDent”, but that’s not helpful and I doubt very much that it’s particularly descriptive of how my old friend will feel AFTER the procedure.

Not even Wikipedia has a simple explanation, so as I am wont to do, let’s see about translating the doctors:

Retro (= behind) peritoneal (= a sack that lines the area below the lungs and above the bladder that holds the kidneys, liver, parts of the large and small colon, most of the pancreas and the stomach) is surgery that tries to get at and remove abdominal lymph nodes.

The nodes are outside of the sack that holds all the abdominal organs and lie against the INSIDE part of the spine. Lymph nodes are usually found at “bending points” like knees, ankles, arms, elbows, etc. Humans bend at the waist as well and a node in the abdomen pumps lymph through the body just as the others do. But it is close to the testicles and the nodes are the first to be attacked by cancer cells if they metastasize from there. Testicular cancer spreads in a well-known pattern, and these nodes are a primary landing site during spread of the disease.

 Doctors need to remove the nodes in order to treat testicular cancer, as well as help establish its exact stage and type. This has been done in the past by surgery so invasive that it required cutting a man open from the bottom of the sternum (middle of the rib cage) to below the belly button! There are dangers in this as well that I prefer not to go into.

But several doctors do the same surgery laparoscopically and while some surgeons consider it “less effective” others, it is less painful, runs fewer risks and joins the ranks of laparoscopic surgeries for repairing knees, shoulders, hernias and prostrates. It’s more expensive and detractors point out that not “all hospitals” have the capability of doing this, but it is far less incapacitating than the invasive older surgery.

Once the nodes are removed, an oncologist can examine the tissue to determine the extent of spread of the cancer. If no malignant tissue is found, the cancer may be more accurately considered as a stage I cancer, limited to the testicle and the orchiectomy may either be considered the “final solution” or they can follow it with chemotherapy or possibly radiation therapy. The low mortality and relapse rate with this procedure, as compared with the alternative, which is observation is the main reason my old friend has considered this as an alternative to the invasive surgery.

If you have testicular cancer – and any of us with testicles are susceptible. Warning signs are NOT LIMITED TO but may include: a lump or mass in either testicle, any enlargement or swelling of a testicle, a collection of fluid in the scrotum, a dull ache in the lower abdomen, back, or in the groin, a feeling of heaviness in the scrotum, discomfort or pain in a testicle or in the scrotum, enlargement or tenderness of the breasts. If you’re worried, go to your doctor! If you’re wondering, try the link below.


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