The Stats Monkey Take on Testis Cancer

Previous on the Joy Nut Club...

Stats on TC in a Nutshell

One of the things that has been interesting about this whole saga has been the lack of awareness, my own included, around testicular cancer and cancers in general. To that end, I've asked my good friend the Stats Monkey to talk a little about the numbers. Just please, do not make eye contact with him. It puts him on edge. 

The High Level

Stats Monkey wants you to know about banana cancer

When not editorializing at my typewriter, I live most of my life in trees. As a result I have a high level view of most things. Cancer, my overly evolved friends, is no different. Fun fact: as a male chimpanzee, I also have testicles. Also as a chimpanzee, I, unfortunately, have no earthly idea whether I can get cancer in those testicles, but I can tell you they are round, slightly squishy and fun to play with, housed as they are in a similarly ridiculous skin-like enclosure.

While I realize the primate above referred to me as a Stats Monkey, let me assure you, I am, in fact, a Chimpanzee. I believe he meant to use this as a colloquial term of endearment due to my high functioning when it comes to statistics (specifically, and only statistics). But the hour grows long, and I yearn to retire for my evening banana, so I shall not digress again. 

Let us finally speak on my favorite subject: Statistics. 

Fun Monkey Fact: Estimates Suggest 260,000 in US with Testis Cancer

That is to say, my dear hairless simian, testicular cancer is not a common type of cancer as only 1 in 265 men will be diagnosed within their lifetime. Here are a few other fun facts about cancer to plague your amygdala in your sleep: 

1. There are roughly 9,000 new cases of Testicular Cancer per year in the US
2. Of these cases, 410 may prove terminal; commonly, this is due to late diagnosis or complications of age
3. 55% of overall diagnoses for testicular cancer occur in men aged 15 - 35
4. 72% of overall diagnoses for men aged 20 - 44

As the Stats Monkey, let me translate for your Homosapien brains: Testicular Cancer is the cancer of your young. I do not say this to scare you, dear hairless friend.  While I do not understand the term "Cancer" generally, I can sense your muscles tense and what little hair you have stand on end when hearing this term. Perhaps we should explore more? Would you like a banana? They are ripe and delicious.

Having the balls to catch it early and Staging

As I understand it, you enjoy puns. While we chimps cannot vocalize them, please know that puns are an average chimpanzee's favorite pastime. Lucky for you, cancer of your testis offers a chance to go -- as you humans might vulgarly put it -- balls deep in puns? 

Make it your GOAAAAAL to check yourself once per month

You see, catching your Testicular Cancer early is very important. Catching it early -- by, for example, playing with your testis to check them monthly -- can dramatically affect what is known as the Staging of your cancer.

What is Staging? I am so enthusiastic you asked. 

Stage I: The cancer is confined to the testis only (68% of cases)

Stage II:  The cancer has spread "regionally" to the neighboring lymph nodes and tissues but not organs (11% of cases)

Stage III:  The cancer has spread to "distant" lymph nodes or organs, commonly the liver, lungs, bones and/or brain (21% of cases)

The stages are subdivided to increase diagnostic clarity, a term for which I have no good chimpanzian definition. Since the half-man asked me to talk about the subject of statistics, let us subdivide his particular diagnosis: Stage IIIA. 

You see, in later stages of diagnosis, the prognosis may vary based on where the cancer has progressed outside the testis proper, how much it has progressed and measurements of what is known as blood serum tumor markers. 

Stage IIIA:  Cancer has spread to distant lymph nodes and/or the lungs with moderate elevation to tumor markers (Editor's Note: As the monkey said, this is my diagnosis)

Stage IIIB:  Cancer has spread to distant lymph nodes and/or the lungs with at least 1 tumor marker highly elevated 

Stage IIIC: Both or One: Cancer has spread to an organ other than the lungs, at least 1 tumor marker is extremely elevated 

Your friend, if any human can truly be called friend, was diagnosed with Stage IIIA due to two very small "nodules" found in the lungs during a pre-op CT Scan. I have been assured nodule does not mean edible else I would have attempted to groom them out as we chimps are wont to do. With very low tumor markers to boot, your friend was given a strong prognosis of "Good Risk".

You see there are three risk groups for prognosis of later stage cancers. While we chimps prefer more cheerful terms such as "Your Risk is Bananas", the standing risk groups are simply "Good Risk", "Intermediate Risk" and "Poor Risk". Much like the Starbucks Coffee you enjoy so much, these provide very little clarity outside of very specific circles of humans.

Good Risk is Best Risk

While you might expect to call this "Excellent Risk", Good Risk is the best possible world in later stage diagnosis. Survivability remains high to the tune of 95%. Survivability drops significantly for Poor Risk to 50% - 60%. 

In case your large human brain has not "connected the dots", the staging is directly correlated to prognosis/risk. Which is to say: 

Evolve your tennis game, human meatsack.

• Stage IIIA: Good Risk - 90%+ Survivability
• Stage IIIB: Intermediate Risk - 70%+ Survivability
• Stage IIIC:  Poor Risk - 50%+ Survivability (Editor's Note: Lance Armstrong was diagnosed here, riddled with tumors and was given less than 30%)

It is strange to a Stat Monkey like myself that your prognosis seems to discount the lungs so significantly. Have you evolved beyond breathing? Are your lungs not important any longer? We chimps still find ourselves in the stone age from an evolutionary perspective. Please teach us? Perhaps we could share knowledge of climbing trees to entice you towards enlightening us? 

"It was the best of times, it was the blurst of times"

Why This Matters

Okay Stat Monkey, back to your cage and typewriters or whatever the hell you do all day. If only the monkey knew how to graph this post would be much more visually interesting than just pictures of more frickin' monkeys. 

Anyway, why is this important? The general takeaway is to reiterate my survival rate is high (95%) and it was caught early, despite the Stage III diagnosis. My tumor markers were never very high and the spread to my lungs was/is minor. There was no detectable presence in my lymph nodes either (distant or regional). Taking all this together, I got lucky catching it in an obvious yet early way. 

Cancer is a scary word for everyone and sometimes the statistics support that. Other times, cancer is just a bump in the road and chance to take a step back to evaluate your life and mortality. That's what I've chosen to do with my time. It has provided a reset button for my mind and my health. It's an investment in my future. 

It is my hope for this blog and for posts like this, to destigmatize a severe diagnosis like "the Cancerz" and provide more clarity on the disease and the process to cure it.

Next time, as some have requested, I'll hit on more about my daily routine.

A PSA from Deadpool

I'll have an upcoming post going over some basic stuff about TC prior to getting into the story of my first round of Chemo. In the meantime, here's Deadpool with some important information.

Sept 11th to 30th - Round 1, FIGHT! (Part 2)

Previously on Chemo Bloods... 

Week 2 & 3 (prologue)

Before I get into the actual treatment, let's talk about what happened the end of week 2.

Week 3 started off with an uncomfortable sensation of bone pain. What is bone pain? Well, imagine having shin splints but everywhere you have bones. It started with a shooting pain in my back, moving up to my shoulders and even behind my ear and into my skull. Go on, just imagine what shin splints all over your body would feel like. I'll wait.... 

It's worse than you think. 

Nope, probably worse than that. It's sort of a stop you mid-sentence-and-take-your-breath-away-while-you-shudder kind of pain. I believe that's the medical term for it anyway. Now, I would not fault you for thinking, That sounds kind of serious. Did you go to the doctor? No, I did not. Because I am a man. Not much of one, but a MAN! Also, I was sort of getting curious about whether or not I would see any severe side effects and that answered the question. 

It hit me on the Friday of week 2 and I sent a message to my Oncologist that night via the patient portal to document it. Doing a little bit of research on the interwebs for my symptoms, I found that it is a common side effect of the Neulasta white cell booster. 

I had mine put on my stomach because I'm different.

Neulasta is a body injector that delivers a white cell booster over the weekend, 27 hours after chemotherapy for the week is complete. I got mine on the Friday of week 1, you can see what it looks like in the picture. Basically, at the end of treatment, the nurse injects that little beetle looking device with the drug and then adheres it to the patient. 3 minutes later, you feel a puncture (think a rubber band snapping your skin or a finger prick) to insert the catheter that will deliver treatment. 27 hours later, the device beeps and over the course of 45 minutes, it slowly gives you the Neulasta drug to boost your immune system. 

Am I stupid?,  you might start asking because you're lucky enough to not have Shinsplintitis [sic], Why would the white cell booster make your bones hurt?

Well, good news, you're not stupid. According to most of the resources I've found:

“The exact mechanism of this pain is not well understood.”

— Doctors, apparently

The nearest they can figure, bone pain is caused by some combination of histamine release causing bone marrow edema. (Editors note: This should not be confused with the metal band Adema though the effects on the human body are similar.) For the layman, which includes me if I'm being honest, edema is a fancy medical term for swelling. So basically, your body is mad you're asking it to produce more white cells, throws an allergic fit and the spongy stuff inside your bones swells. Being encased in bone, your marrow can do nothing but swell and scream at you, causing severe pain. Hence, shin splints. Everywhere. Did you think about it again yet? 

Luckily, you can take an allergy/antihistamine drug (i.e. Benedryl) to block the histamines and and a simple tylenol to help with the pain. Although I did not know that until well after the pain started so it was a fun thing to deal with for about 48 hours at the end of week 2.  

"Adema broke up? I thought they died from a freak hair gel arson. Also, who asked for this?" - Everyone

Speaking of week 2 (see how good I am at segueing between topics?), that one was a doozy...

Week 2 & 3 (Tuesdays, 1.5/2 hrs a day)

The once a week treatments aren't that bad, usually coming in around 1.5 to 2 hours on Tuesdays. The drug is Bleomycin, which is very caustic, in case you need a reminder. There is usually a good chance of a reaction in the patient so they administer an IV of Benedryl and give you Tylenol to mitigate this up front. They advise you to take another dose when you get home after treatment. Since I was exhausted when I got home, I decided to take a nap instead of taking additional pills. Do you think that was a mistake?

Alright, chills out.

I awoke after about 2 hours of sleep in a cold sweat with the chills. It felt about the same as having the flu, slight fever, cold sweat, chills and shaking, extra layers are too hot, regular is too cold.... This was the one time so far (I'm writing this at the end of my 2nd round) I lost my appetite. I couldn't eat, it was too uncomfortable. I couldn't bundle up to deal with the chills because I got too hot. I couldn't not bundle up because I was too cold. I finally took a Tylenol and Benadryl as I had been advised originally. By then, however, it was a little late. I just had to ride it out. It continued for about 48 hours after treatment. 

That night was the oddest night's sleep I've ever had. I wasn't entirely asleep, nor entirely awake. I had some dreams I think, but they could have just been psychotic fever visions. I could never get very comfortable since the temperature was never right and every shift in position lead to a new round of chills as cool air hit the formerly warm side of my body. At one point, my brain tried to trick me with magical thinking such as burning the chills out of my body with a shot of Fireball Whiskey (Fireball may or may not contain antifreeze and is banned in several countries). Not only was that suggestion unhelpful and stupid but it would require me to get out of bed. There really were no good solutions besides taking the Tylenol and Benadryl like clockwork and riding it out. 

Or you Macgyver your way through it like a Homeopathic couple abusing their children

This seems like a good time to note that there are two very distinct themes that have come out of my treatment course: 

1. Tylenol and Benadryl are the answer for almost everything so buy bulk;

2. Tylenol and Benadryl only really work well if you take them prior to the onset of symptoms or side effects

After sweating through several rounds of clothing, my fever finally broke about 32 hours after onset and the chills began to go away. I was probably back to par around 48 hours after treatment. I made sure I took the Tylenol/Benadryl duet religiously after those two days. They were a nightmare. 

So round 1 was officially over Sept 30th and round 2 began the following day with another Monday-Friday treatment. It really was very similar to Week 1 so I'll be covering something more interesting next time. 

Trivia question of the week: How many new testicular cancer diagnoses occur in the United States annually?