Cancer patient Ben Smith Lucky To Be Alive After GP Told Him He Was Fine

Ben Smith was fobbed off when he told his GP about the hard lump on his left testicle in December.

When the lump swelled and started causing him considerable pain, the 25-year-old was told it was probably just hormonal.



"The GP said it didn't present like cancer and I thought, 'Well, he knows best.' "

By mid-January, when the pain had become "horrific", he had to ask his GP to send him for a scan.

Mr Smith stood outside the imaging centre and Googled the medical terms in his ultrasound report.

It was testicular cancer. He went straight to Royal Prince Alfred Hospital's Emergency Department for a confirmation CT scan and a referral to a urologist.

"Had I not insisted on the ultrasound and followed it up, I would be dead, simple as that," he said.

Though relatively uncommon, testicular cancer is the second most prevalent cancer diagnosed in men aged 20 to 39.

In 2018, 258 new cases will be detected in NSW. The rapidly spreading cancer will kill seven men, according to Cancer Institute NSW projections.

If it's detected early, patients have a 98.6 per cent chance of survival to five years. If it spreads, the treatment and prognosis are considerably grimmer.


Mr Smith was wheeled into surgery at Chris O'Brien Lifehouse the day after he met his urologist Nariman Ahmadi.

But cancer had spread to the back of his abdomen.



After nine weeks of gruelling chemotherapy, the teratoma had grown from four to seven centimetres.

It was buried behind the bowel, stomach, pancreas, colon and intestines. It had attached itself to Mr Smith's aorta and was nestled beside another major vessel, his inferior vena cava.


"The standard treatment would be open surgery involving a large incision and we would have to move the bowel and everything else out of the way because [the tumour] is so deep in the abdomen," Dr Ahmadi said.

Mr Smith watched videos of the procedure - retroperitoneal lymph node dissection (RPLND) - online.




"No one wants to see their guts removed … you're opened up from your breast bone all the way down to your pelvis," he said.

But Dr Ahmadi had an alternative.


After consulting with international and local colleagues, the treating team decided it would be safe and feasible to perform a robotic RPLND.

"I didn't think I had a good chance of dying, but thinking I had any chance of dying at all is pretty intense," Mr Smith said of the surgery performed on May 25.

Through keyhole incisions, Dr Ahmadi delicately manouevred the arms of the Da Vinci robot through Mr Smith's abdomen, "sneaking under" to extract the tumour and clear out the lymph node field.

He was aided by anaesthetist Dr Ryan Downey, urological surgeons Dr Ahmed Goolam and Dr Scott Leslie and a team of nurses trained in robotic surgery.

The nerve-sparing technique left little margin for error.


The risks included injury to the bowel, pancreas, kidney, loss of sexual function, major blood loss and loss of blood supply to the spine, resulting in paraplegia.

Mr Smith's surgery went "incredibly smoothly," Dr Ahmadi said, and he was discharged three days later, instead of spending weeks in hospital after the standard treatment.

Only a handful of institutions globally have the capability to perform the surgery. To the best of his knowledge, this is the first robotic RPLND performed in Australia on a tumour of Ben's size, Dr Ahmadi said.

"It's really novel for us to be able to offer this type of treatment for our patients. If it's technically feasible, we will do more," Dr Ahmadi said.

But the main message to all men who find a lump on their testes: see a doctor, get an ultrasound and a referral to a urologist, Dr Ahmadi said. It may be a harmless cyst, but harder lumps could be cancerous.


Delay in diagnosing the rapidly growing cancer could be the difference between minimal treatment and complex, risky surgery and chemotherapy.

Cancer Institute NSW chief executive David Currow urged all men to be aware of the normal shape and feel of their testicles and to be alert for any changes that may point to cancer.

Symptoms include a swelling or lump, a change in the size or shape of the testicle, a feeling of unevenness or heaviness in the scrotum and a pain or ache in the lower abdomen, testicles or scrotum, he said.

"This is a cancer that grows rapidly but has excellent outcomes if detected early," Professor Currow said.


Andrology Australia's clinical guidelines for diagnosing and managing testicular cancer stresses the role of GPs.

The guidelines - endorsed by the National Health and Medical Research Council - states "all suspected cases must be thoroughly investigated and referred to a urologist".

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