The Metastatic Tumor after Testicular Cancer case presentation has been conducted by the Faradarmani and Psymentology group under provision of Dr.

Transcription

1 The Metastatic Tumor after Testicular Cancer case presentation has been conducted by the Faradarmani and Psymentology group under provision of Dr. M.A Taheri the founder of Faradarmani and Psymentology. This cervical radiculopathy study has been selected from Supplement of Danesh-e Pezeshki Medical Journal. Specialized Faradarmani Edition 2; Tehran, Iran; English Version (Nov, 2011). License holder and director is Shahabedin Sadr.

2 A Case Report on Treatment of Metastatic Tumor after Testicular Cencer via Faradarmani Treatment of patients with testicular carcinoma is a typical multi-disciplinary approach to solid tumors. By efficient surgery, radiotherapy and combined chemotherapy the survival of low risk patients is up to 99% and high risk patients up to 80% respectively. Testicular tumors are the most common solid malignancy in men in the age range of 15 to 34 years old. In 2-3% of patients the tumor is bilateral and in 5 to 10% of patients tumor gradually develops in the other side. Despite the existing spermatogenesis disorder, most patients can have normal fertility rate; therefore fertility assessments are very important in these patients especially those who would need assistant therapies such as radiotherapy and systemic chemotherapy. The most common sign or symptom of testicular cancer is a painful and firm mass in testicles. The tumor hemorrhage may lead to the acute scrotum and up to 33% of patients are treated with a probability of epididymitis. Scrotal sonography is diagnostic; as the obvious parenchymal -and not the adjacent tissues- involvement make it easy to differentiate it from the benign scrotal diseases. Symptoms in advanced stages include cough, gastrointestinal symptoms (mass), back pain (retroperitoneal metastasis), neurologic symptoms (metastasis to brain), lower limb edema (inferior vena cava and iliac thrombosis) and supraclavicular lymphadenopathy. Diagnosis and Staging Primary treatment includes the inguinal orchiectomy along with the ligation of the upper spermatic cord. Pure seminoma is the most common germinal cell tumor (GCT). Teratoma, Yolk sac tumors, embryonic carcinoma and choriocarcinoma are categorized as non-seminoma GCT group and often appear as mixed GCT (more than one tissue pattern in the primary tumor). Retroperitoneal lymph nodes are the most common sites of the primary metastasis; therefore retroperitoneal staging by abdominal CT scan is important in the evaluation of tumor metastasis. However accurate retroperitoneal staging is difficult because of % false positive and negative reports. The most common metastatic lymph nodes are; precaval, inter aortocaval and para-aortic lymph nodes under the renal hilum and above the aortic bifurcation. Thorax radiography or thorax CT scan is complementary 1

3 to the clinical staging measurements as lungs and the posterior mediastinum are the most common sites of remote metastasis. Treatment After inguinal orchiectomy, histopathologic STM staging is used for determining the type of treatment. All patients with high STM will undergo Cisplatin chemotherapy regardless of the histopathologic finding. The radiotherapy and retroperitoneal lymph nodes dissection (RPLND) failure rates are high at the presence of increased serum markers. Relapse occurs in 2 years and most patients are saved by chemotherapy. Side effects of chemotherapy include renal disorder, neuropathy, Raynaud s phenomenon, blood toxicity, cardiovascular toxicity, and 5% risk of secondary leukemia. Case Report The patient is a 45 year old man who was diagnosed with seminoma (testicular cancer) and abdominal & pelvic metastases in February 2008 (1386/11). Abdominal sonograghy on 17/02/2008 (1386/11/28) revealed a solid mass with dimensions of 93*84mm in retroperitoneal region which caused a compression on the posterior wall of stomach, increased distance of aorta and SMA, compression of ureter and the consequent decreased kidney function & left hydronephrosis (Appendix 1). In abdominal CT scan on 2008/02/20 (1386/12/1) a massive retroperitoneal space occupying soft tissue lobulated tumor in the posterior region of pancreas was seen that caused the left kidney to displace and its collecting system to dilate, and by passing through the midline it has increased the distance between the Aorta and SMA (Appendix 2). The definite presence of cancer and metastasis are documented (Appendix 3). Patient underwent a radical left testicular orchiectomy, and 8 sessions of chemotherapy and 20 sessions of radiotherapy were recommended by his physician for controlling the cancer. As the patient was a resident of Tabriz, he went to Tehran for chemotherapy where after the evaluation of his medical documents, the specialists stated that his probable survival rate would be unfortunately 6 months after the chemotherapy; due to the advanced stage of the disease. He started chemotherapy disappointedly and after the first session of chemotherapy he experienced 2

4 side effects such as severe dyspepsia and pain; consequently he was discouraged from continuing the therapy. Upon returning to Tabriz one of his friends suggested Energy therapy which failed despite the very expensive cost of this therapy. His family insisted on chemotherapy and after the second session of chemotherapy he was introduced to Faradarmani. According to his statement he noticed interesting changes after the first session of Faradarmani, however continued chemotherapy upon his family request. Meanwhile the patient undertook Faradarmani more seriously. After the fourth session of chemotherapy -in the view that his symptoms such as dyspepsia and pain disappearedhe requested his physician for another scan. The physician said it was too soon to do another scan but eventually they proceeded upon his request. In abdominal sonograghy on 2008/04/29 (1387/2/10) no solid or cystic tumor was detected and the kidneys and pancreas were also normal (Appendix 4). In the view of the impossibility of such phenomena, all the investigations and tests were repeated and his physician acknowledged this as a miracle. In lung Spiral CT Scan on 24/05/2008 (1387/3/4) no tumor or lymphadenopathy, no tracheal or bronchial system displacement was reported (Appendix 5). In abdominal and pelvic Spiral CT Scan no space occupying (mass) lesion was reported, pancreas and vascular structures were normal, and kidneys had normal function (Appendix 6). The medical report by specialist physician confirmed that the widespread tumor completely disappeared and the left kidney became smaller in size (Appendix 7). During the course of the disease, patient had four periods of chemotherapy in total in which two sessions, on 12/03/2008 (1386/12/22) and 05/04/2008 (1387/1/17), were before undertaking Faradarmani treatment. On 12/04/2008 (87/1/24) the therapy was continued along with Faradarmani treatment; two periods of (28/04/2008 to 03/05/2008) and (24/05/2008 to 29/05/2008). Upon the fourth session of chemotherapy metastatic lesions incredibly disappeared and in less than two months after initiating Faradarmani treatment, upon the physician s recommendation, chemotherapy was discontinued as it was no longer required. The patient has been in good state of health up to this date. 3

5 Discussion In the view that in this patient the cancer was diagnosed as advanced and metastatic, based on the classic medical treatments there was not any hope for recovery even after chemotherapy (the specialists stated that his convenient survival rate would be 6 months after the chemotherapy); nevertheless through Faradarmani treatment method the entire problem was completely resolved including the kidney problem and according to the patient s statement his life has been revolutionized. Conclusion Up to this date no treatment method has been able to totally eradicate such massive tumors without any invasive method in such a short time, in addition, with no cost or side effect and regardless of patient s age or their condition. This report confirms the broad spectrum of diseases in which can be treated by Faradarmani. Consent Form The patient has given full consent to publish this report. Patient s View He is totally satisfied with the treatment results and acknowledges that he owes his quick recovery to Faradarmani treatment. Documents The original reports of all the medical evaluations and test results are available at the journal s office. Faratherapists Members of Faradarmani Medical Research Group References 1. Schwartz Principles of Surgery 2005, D.M.I.T Firouzabadi, Andishe Rafi Publication Tehran Mohamad Ali Taheri, Human From Another Outlook, Bijan Publication

6 Date: 17/02/2008 Abdominal Plain Radiography: Increased density in the middle of abdomen that caused bowel gases to scatter around. Liver and Gallbladder: Liver has normal size and shape and normal parenchymal Echogenicity. Choledochal duct caliber is 3 mm and the portal caliber is 7mm. No pathologic lesion is observed in the gallbladder. Spleen: The size of spleen was 82*34mm in coronal section. The shape, size and Echogenicity of spleen were normal. Other: A solid mass with dimensions of 93*84mm is observed in the retroperitoneal region and is located mostly on the left side of the vertebral column. This mass has caused a compression on the posterior wall of stomach and consequently its displacement anteriorly. A part of the mass is located between the aorta and SMA and has increased the distance of aorta and SMA. Left kidney hydronephrosis is observed (with a high probability secondary to the compression of the ureter by the mass). Comment: Massive retroperitoneal tumor (with a high probability pancreatic origin) along with the compressing effect on the adjacent organs as mentioned above. For more investigation CT Scan with oral and intravenous contrast media is recommended. Appendix 1 Date: 20/02/2008 Abdominal and Pelvic Spiral CT Scan with IV injection and oral contrast material Massive retroperitoneal space occupying soft tissue lobulated lesion, posterior to the body of pancreas is observed that caused the left kidney to displace and its collecting system to dilate, and by passing through the midline it has increased the distance between the Aorta and SMA. Other regions of kidneys have normal appearances, with normal and simultaneous excretion of the contrast substance. The shape, size and density of liver are normal. The diameters of intra and extra hepatic bile ducts are normal. There was no pathologic lesion in gallbladder (It should be mentioned that gallstones which are isodense with bile are not observable through CT scan and in such cases sonograghic findings are necessary). There were no pathologic changes in spleen, pancreas and adrenal gland. Pelvis: The shape, size and thickness of the bladder wall were normal. Pelvic fats have normal appearance. There is no lymphadenopathy in pelvic areas, there is no intra-peritoneal free fluid. Asymmetry in testicles is observed; enlargement and irregular echodensity of left testicle. There is an elliptical hypo-dense focus due to the inguinal lymphadenopathy on the left side. Comment Retroperitoneal soft tissue lobulated mass, extensive lymphadenopathy type probably due to a Neoplastic lesion (seminoma) in the left testicle. Appendix 2 5

7 Appendix 3 Appendix 4 6

8 Appendix 5 Appendix 6 7

9 Consultation Request Sheet Ward: 4 Room: 465 Age: 45 Date of admission: 2008/05/24 Kind of consultation: Non emergency Physician s Observation and Notes: The patient underwent a radical left testicular orchiectomy about four months ago in Tabriz. Patient s markers after the surgery are normal. Four Chemotherapy periods have been undertaken. This CT Scan has been compared to the previous scan; the widespread tumor has completely disappeared and the left kidney has become smaller in size. Appendix 7 Medical History Sheet Date of Admission: 2008/ 04/28 Ward: 4 Room: 23 History of Present Illness: Patient is a 45 year old male and a known case of testicular cancer with abdominal & pelvic metastases. The patient is under the care of Dr ( Name reserved) and is undertaking the 3rd period of the chemotherapy treatment. Nausea: N (negative) Vomiting: N Lack of appetite: N Weight loss: N Urinary symptoms: N Past Disease History: Lung diseases: N HLP: N DM: N Surgery: + Orchiectomy: + Current Drug-therapy and other addictions:?? Acid Folic Allergy to: Cigarette + Family History: All Negative Appendix 8 8

10 They said you have only 6 months to live I, Seyed Jalal Razavi Movahed, am a resident of Tabriz. It was in February 2008 when I felt pain in my reproductive glands. As time passed by, the pain got much worst and also due to the swelling, I visited a doctor. Without telling me what the problem was, they booked a surgery appointment for me and I underwent an operation. The pain, however, continued after the operation. They said I must undergo chemotherapy. Until then, I didn t know chemotherapy was for cancer. I went to another doctor for consultation. He looked at the test results and told me it was too late for chemotherapy. He told me straightforwardly you only have six months to live. My family pressured me to undergo chemotherapy. We went to Tehran and I was hospitalized to begin chemotherapy. It was a very painful experience for me. In the first session of chemotherapy, my body s entire system was disturbed and I became very ill. I refused to continue chemotherapy and instead endure the pain. One of my friends suggested Energy therapy. An Energy therapist in Tabriz advised me to undergo five sessions of Energy therapy and he charged me $500 for each session. Every session, he gave me energy with his hands for five minutes, but my condition didn t improve at all. I had no choice but to return to chemotherapy. After the second session of chemotherapy, I was introduced to Faradarmani. I went to one of Fara-Therapists of Tabriz who gave me Etesal [Faradarmani session]. I suddenly realized a white light passed in front of my closed eyes, my body became warm and I felt some changes within me. I continued chemotherapy because of my family s concerns, but I continued Faradarmani on the side. It was after the fourth session of chemotherapy, during one of my Faradarmani sessions; I felt there was a pen, painlessly moving through my arm and towards my stomach and arrived at my cancerous tumor. Like pulling a tooth, I felt something was pulled out of my stomach and then I felt I was healed. I went for a CT scan, but my physician told me it was too early for a CT scan and I must go through four more sessions of chemotherapy. Due to my insistence, my physician agreed to perform the CT scan and when he saw the result he told me, Razavi, what have you done? I was afraid and he continued, There are no cancer tumors in your body. Four physicians held meetings for two days to understand what had happened. They finally accepted my state of health and prescribed 35 sessions of radiotherapy; where the surgery was done on my body and also where the tumor in my stomach had disappeared. After several sessions of radiotherapy, tests and CT scans showed that my left kidney had shrunk and must be removed. They arranged an operation but I took Faradarmani seriously and did not accept the surgery. After five months of Etesal with Faradarmani, my left kidney became active again and now it is normal. I now feel like I ve been born again and life has a new meaning for me. 9