Skip to Main Content

CASE HISTORY

Case History

image A 32-year-old man presented to his GP with a right-sided painless testicular mass. On examination, he had a 2 cm firm mass in the right testicle. There were no other symptoms, no past medical history and he was not on any regular medication. An ultrasound showed an 18 mm right intra-testicular mass with internal vascularity, suggestive of a testicular tumour. His alpha fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase (LDH) levels were normal.

He underwent radical orchiectomy, which revealed an 18 mm pure seminoma with no rete testis or lymphovascular invasion. Subsequent CT of the abdomen and pelvis showed a 2.1 cm enlarged retroperitoneal lymph node. His post-operative tumour markers remained normal.

He was referred to the oncology clinic for discussion of three cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy and attended with another male. When the oncologist enquired who was accompanying him, the patient broke down in tears, and said that this was his husband. He explained that in previous consultations, it had been assumed this was his friend or brother, and he had felt too embarrassed to correct the doctor. He informed the oncologist that they had been hoping to have children through a surrogate in the next few years and was worried about the potential impact of this treatment on his fertility.

Why is it important to ask patients with cancer about partner status and sexual orientation?

What is the stage of disease and indication for BEP chemotherapy?

What are the effects of BEP chemotherapy on his fertility?

What should the doctor tell the patient about his access to sperm banking and fertility treatment in the UK?

What advice should be given about intercourse during chemotherapy?

What further blood test will be important to check in light of imminent chemotherapy and sperm banking?

Why is it important to ask patients with cancer about partner status and sexual orientation?

Knowing a patient’s partner status and sexuality helps to provide context to subsequent discussions around fertility and side effects of treatment (e.g. teratogenicity, effects on libido and secretion of chemotherapy in ejaculate). The doctor may wish to caveat their questions by explaining this.

The doctor should ask open questions, avoiding assumptions. By making assumptions about the patient’s sexuality and sexual practice, doctors risk failing to provide appropriate information and further disadvantage the patient, as well as damaging rapport.1

What is the stage of disease and indication for BEP chemotherapy?

This was a T1 tumour given that there was no evidence of invasion outside the testicle. He would be classified as N2, as he had an involved lymph node between 2 and 5 cm in size. He had no visceral metastases (M0). His tumour markers were normal (S0). He therefore had a T1N2M0, Stage IIB metastatic seminoma for which the standard therapy would be ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.