Spotlight: testicular Cancer
The Enemy Within
December 6, 2016 | Matt Batcheldor
Mike Janowski was prepared to fight for his country.
He had just graduated from the U.S. Military Academy at West Point in May 2014 and was stationed at Fort Benning, Georgia, his first duty assignment. Soon, he would find out the foe was in his body.
Janowski, then 23, had just completed his first week of U.S. Army Ranger School, a 61-day training program known as the toughest course in the Army, the kind of training that makes somebody hurt all over. But Janowski noticed swelling in his groin and didn’t remember hurting himself there. He described his symptoms to one of his friends, a medic, and his response was immediate.
“I think you have cancer,” the medic said. “I would go to the instructors immediately.”
That’s what Janowski did, and he was quickly diagnosed with stage 1 testicular cancer.
“I had surgery that night,” Janowski recalled, “and after the surgery, they did the typical stuff, biopsies … and then they told me that I was clear. I didn’t need chemo. The surgery had gotten everything.”
He didn’t know it at the time, but Janowski’s cancer journey was just beginning, and it would lead to Vanderbilt-Ingram Cancer Center (VICC). For the time being, he returned to the Army and started Ranger School from the beginning. He had just enough time to finish the first, 20-day phase of training before the next setback came.
As a cancer survivor, Janowski underwent monthly blood tests and CT scans to ensure the cancer didn’t reappear. His first regimen of tests after his surgery revealed the cancer had returned and spread to his abdomen and lungs. Again, he was medically dropped from Ranger School.
He underwent three months of chemotherapy.
“I felt like someone had hollowed me out and filled me with ash,” he said. “I felt like a dead body breathing, pretty much. It was miserable.”
Janowski was facing a medical retirement from the Army. He fought it and managed to stay on active duty. He even went back to Ranger School—and completed it, something less than half of participants do. Next, he completed Airborne School, followed by Pathfinder School, and was transferred to Fort Campbell, Kentucky, and assigned to the 101st Airborne Division.
All seemed well until January 2016, when a CT scan showed a 10 cm tumor in his abdomen, wrapped around his kidney. Janowski was referred to David Penson, M.D., MPH, director of the Center for Surgical Quality and Outcomes Research at Vanderbilt University Medical Center.
He quickly got an appointment to see Penson, the Paul V. Hamilton M.D. and Virginia E. Howd Professor of Urologic Oncology and chair of the Department of Urologic Surgery.
“He sat me down and he told me, ‘This is what I’m going to do, and you’re going to be completely fine,’” Janowski said.
Penson’s plan of attack on the cancer was a retroperitoneal lymph node dissection surgery—removing the lymph nodes in a part of the abdomen called the retroperitoneum. “The space where the lymph nodes are is behind all the bowels, around the aorta and the vena cava—the great vessels,” Penson said. “And it’s a big operation.”
Janowski recalled, “Going into the surgery, they told me they were probably going to end up taking my left kidney. Surgery went extremely well. They didn’t take my kidney. They got all of the tumor.”
He gives a lot of credit to Penson, not only for the physical act of surgery, but for the way he cared for him and his family outside of the operating room.
“I’ve had a lot of doctors, obviously, over the course of my fight with cancer,” he said. “When people ask me about Dr. Penson, the best way to explain Dr. Penson is he is a too-good-to-be-true doctor.”
Janowski said Penson was always available.
“My family would send him emails. He would respond within minutes. I would send him an email and I’d get a phone call from him minutes later. He’d call on the weekends. He’d call at night. He’d call any time.”
AFFECTS YOUNG MEN
If testicular cancers were like other cancers, Janowski would be the unlikely young patient who got a cancer that normally affects much older people. However, testicular cancer is the rare kind of cancer that mostly affects the young—it is the most common tumor for American men in their 20s and 30s, Penson said.
“While it still doesn’t happen really often, if you’re 25 years old and you’re a guy, this is the cancer you should be worrying about,” Penson said.
He recommends that men examine their testicles at least once a month, and if they feel a lump, bump or bruise, they should see their doctor for simple ultrasound and blood tests.
“The test to see if there’s anything there is just an ultrasound, so it’s non-invasive, doesn’t hurt,” Penson said. “It’s easy. The problem is a lot of guys feel something down there and they sort of go into denial. Like, ‘oh, it’ll go away.’ Then they come in six months later and they have a football-sized tumor. I’ve seen that, and their cancer has spread everywhere.”
Testicular cancer is highly treatable and curable. When caught early, a simple outpatient operation to remove one testicle is often the course of action, Penson said. A prosthesis can be implanted to replace the lost testicle, if requested. Most men go on to live normal lives after surgery.
“There’s enough testosterone made by one testicle and enough sperm made by one testicle for men to have normal hormone production, normal fertility with one testicle,” he said. “The reality of it is, and if I was the patient, I’d rather have it out than leave it in. Leaving it in is not really an option.”
Family history has very little to do with whether a man is at risk for testicular cancer, Penson said. One of the biggest risk factors is whether a man has an undescended testicle.
Janowski survived cancer, and his life is still changing as a result. Now 25, he is pondering his next move after receiving a medical retirement from the Army.
“I don’t know what I’m going to do now,” he said. “I thought I was going to serve a career in the Army. Maybe I’ll go back to school.”
Starting in July, he became a volunteer for VICC. He meets with patients who have been diagnosed with cancer, in person or over the phone, sharing his story and words of encouragement.
“It helps talking to someone who’s survived it and still seems healthy and just to remind people that yeah its going to be a fight and it’s going to be a grind, but the human body is absolutely incredible,” he said. “That’s one thing that I’ve learned—the body is going to go for a long, long time. It can take much more of a beating than we can possibly imagine.”
Janowski said he loves what he does now, and is leaning toward working for a cancer-fighting organization.
Meanwhile, his brush with cancer appears smaller and smaller in the rear-view mirror of his life. Penson said Janowski’s prognosis is excellent, and credited him with becoming an advocate for cancer care.
“The thing I like the most about Mike is he’s someone who has a sense of loyalty and a sense of duty, whether it’s to his country, to other cancer survivors, to his folks,” he said. “He’s a man of integrity.”
Janowski’s biggest advice is for cancer patients to always get a second opinion.
“When I was told after the first surgery that I didn’t need chemo, from my standpoint, that was the best news I could’ve gotten,” he said. “I wasn’t going to question what I was being told. Whereas, in reality, I should’ve gotten a second opinion. I should’ve been a little more hesitant. Because, as a result of that, it spread to my lungs. So even though it might be scary to question good news in the long run, it’s probably better for you to just get confirmation from another source.”
“It’s lessons like that that can help other people.”
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