Background – Surgery

My orchidectomy took place in October 2018. It is an operation performed under general anaesthetic which completely removes a testicle. During the two or three weeks leading up to surgery, my enlarged testicle had grown even more and become noticeable heavier. It wasn’t causing me any discomfort, but it was becoming something of an inconvenient obstacle.

A few days before the surgery, I visited the hospital for a pre-med screening. This was an opportunity for a nurse to check that I was fit for surgery and that there were no risk factors that might cause any issues or reason to delay. The screening predominantly consisted of a long list of questions and checks on blood pressure, heart and lungs.

On the day of surgery, my wife Pia and I arrived at the hospital around 9 am. I started with a CT scan of my chest to groin region. This was to check for any signs of metastasis, or spread, of the cancer. The most common places that metastasis is encountered in testicular cancer patients are in lymph nodes and the lungs. A CT scan is usually performed within a week or so of surgery and aids oncologists in deciding whether or not to recommend any additional treatment (i.e. chemotherapy and/or radiation). I was lucky enough to have my scan scheduled on the morning of my surgery, which saved another trip to the hospital during recovery.

I had a cannula inserted into a vein before the scan. This was so that during the scan I could have a contrast dye injected into my bloodstream. This helps to give more clarity to the scanned images, making it easier to identify any abnormalities. The first attempt to insert the cannula “popped” the vein, but the second attempt was successful.

I’d had a CT scan once before, although many years earlier, so I knew pretty much what was going to happen. I lay on a platform which moved back and forwards through the centre of a large donut shaped machine. I inhaled and held my breath at certain times, as instructed. When the contrast dye is injected, people tend to get particular feelings in the body. I mostly experienced this as a slightly metallic taste and a hot flush. Some people get a feeling that they need to urinate, but I didn’t notice that. It only takes a couple of minutes to complete the scanning.

The scan itself takes a series of images of slices through the body at close intervals. When these are being analysed by doctors, they are viewed on screen in sequence and the analyst can move from slice to slice in either direction, as if watching a video.

In the couple of hours before starting surgery, I had the opportunity to speak with my anaesthetist. She had a long list of questions for me, most of which had been covered during the pre-med screening. I then saw the surgeon who asked me many of the same questions again (it never hurts to ask things multiple times). He also gave me an examination and drew some arrows on my skin to ensure that once I was in theatre, there would be no ambiguity as to which testicle was being removed.

When they were ready for me, I donned a hospital gown and compression socks, and walked through to the theatre. There I met the anaesthetist again and the nurses who would be assisting with the operation. I was positioned on a bed and had a cannula inserted into the back of my hand through which the anaesthetic would be administered. I went through another round of questions to ensure I was the right patient, in for the right operation, and that I was still not knowingly allergic to any drugs, etc. Once I was given the anaesthetic, I was under within about twenty seconds.

The operation took 30-40 minutes. An incision was made in the groin and the testicle was essentially pushed up from the scrotum and popped out. All the connected vessels were tied off and the incision was stitched and glued closed.

I woke up in a recovery room. The anaesthetist was there to see me come around and was on her way after she’d checked that I was alright. She left me in the care of a nurse and I must have stayed there for almost an hour before being moved to a ward, where Pia was waiting for me.

On the ward, recovering after the surgery

With the anaesthetic still in my system, I wasn’t able to move my legs straight away. But over two or three hours that became easier and I could eventually lift each leg independently. Before I could be discharged, I needed to eat and drink a little and also show that I could make a trip to the toilet and provide a urine sample. I drank some water and ate a few pieces of fruit. When it came to making a toilet visit, Pia supported me as I walked. Once I’d finished and turned to wash my hands, I made the mistake of bending my left knee just a little too far and placing too much weight on it. That caused me to collapse, as the residual effect of the anaesthetic meant that I still didn’t have the full strength in my legs. That was a bit of a shock, but fortunately I didn’t hurt myself.

The surgeon also dropped by to see me. He was very happy with how the operation had gone and said that it definitely looked like cancer.

We finally got away and were home around 10 pm.

My recovery from the operation went quite smoothly, although I experienced some severe cramps in my left leg over a number of days. I think that this was due to my leg having caved in when I made my toilet visit before leaving the hospital. I must have caused a little damage. At one point, I had to revisit the hospital to have an ultrasound scan on the veins in my leg to ensure there was no evidence of a blood clot. Fortunately it was all ok.

I also visited my GP a couple of times in the week after the operation to have blood taken to check for changes to tumour markers. My HCG level, which had been very high before the operation, showed progressively lower readings after each new test, which is what would be expected had the operation been a success.

Background – Diagnosis

My journey began in August 2018, a couple of months after turning 40, when I noticed that one of my testicles seemed a bit larger than it was supposed to be. Quite a bit larger. There were no discernible lumps, just more overall mass. I didn’t pay too much attention to it to begin with and waited to see if it might go back to normal after a week or two. However, it didn’t go back to normal but rather continued to increase in size.

I visited my GP who was concerned that the growth had been completely painless and that there were no obvious signs of infection. In case it was in any way related, I mentioned to him that I’d also had a couple of episodes during the previous few weeks in which I had become slightly faint and disoriented when standing, for several hours on each occasion. For this I had my blood pressure checked and an ECG to monitor my heart activity, both of which reported no issue. The doctor referred me for an ultrasound of my testicle at the Royal United Hospitals (RUH) in Bath, which I attended the following week.

During the ultrasound, the sonographer noticed a number of dark patches within the testicle in question. There was also evidence of angiogenesis – a profusion of new blood vessels that were entering the testicle. It looked to be a fairly textbook case of testicular cancer, with no real evidence for any alternative condition, such as an infection. The good news was that the other testicle, my bladder and kidneys all looked in perfectly good health.

Following the ultrasound I was referred to a urologist, who I saw a week or two afterwards. I was made to do a “flow test”, which involves peeing into a glorified bucket with a sensor attached to measure the rate of flow. This is a standard test for any patient passing through the department of urology, regardless of the purpose for visiting. My flow was very good, unsurprisingly.

The urologist was a fairly serious chap who didn’t smile much. He gave me an inspection, having already reviewed my ultrasound results. He suggested that I get booked in immediately for an orchidectomy operation, i.e. the complete removal of the testicle. I didn’t commit to the surgery straight away, but said that I would give them a call after I’d had the opportunity to talk it over at home.

I had bloods taken to check for tumour markers: AFP, HCG and LDH (of which HCG was significantly elevated). I also got to sit down in a brightly coloured room with a comfortable sofa and chairs for a while to speak to a specialist nurse. This was clearly the room they use to try to make people more at ease when giving them bad news. At this point, perhaps unusually, I wasn’t feeling the slightest bit fazed. In fact, I’ve not really been worried or fearful at all during the entire episode. I’ve just taken everything in my stride knowing that it will all turn out for the best, whatever happens.

A few days later, I was booked in for surgery in early October.