Chemo v. Surveillance ?

[Nicholas]

Hey Team,

I am new to this group and am wondering if anyone can help me with this decision. I was diagnosed with testicular cancer and had a right orcheictomy at the end of this April. Pre-surgery, my HCG markers were at 1905 and no metastases were discovered. The biopsy revealed 60% of the tumor was embryonal carcinoma. My HCG is now near zero and CT scans have continued to come back clean. I need to decide this weekend if I would like to have adjuvant chemotherapy (2 x BEP) or just surveillance, since there is a 35%+ risk of recurrence. I just finished my undergrad and hope to attend graduate school beginning in September 2010, so if I am going to need further treatment, now is as convenient a time as any other. I'm sure that many of you have been in a similar situation and I would appreciate any advice..

Thanks!

-Nick

[HCG]

YOu had pretty high HCG. Are you sure that you didnt have any choriocarcinoma in your pathology. This may have an impact on your decision. Also, what was the rate of decline of your HCG? Do you have your blood tests along with the dates? Did the HCG normalize according to the expected half-life?

Ron

[Paul54]

Hi, Nick. Good to hear the markers dropping and clean scans. In addition to HCG's questions, what was the remainder of your tumor? Also, was there any LVI invasion, and were you staged 1A or 1B? I think that 1A would give you a great shot at surveillance. Not that I'm suggesting RPLND, but did you doctor discuss it?

By the book, 2xBEP is standard adjuvant chemo for non-seminoma. However, some recent studies show that 1xBEP is nearly as effective (within a couple of percent points) as 2xBEP. (See the Research Library.) But all other factors need to be good. It seems to be gaining traction at even some of the centers of excellence such as Indiana University (Dr. Einhorn). You and your onc might want to give him a call or email.

Best wishes with your decision. Let us know how it goes.

[Nicholas]

Thank you both for replying so quickly. The tumor was 4.4cm and was composed of 60% embryonal, 10% choriocarcinoma, and 30% yolk sac and there was vascular invasion. Unfortunately I don't have any information about HCG decline (I moved and was referred to a different hospital a few days after my surgery, and had to wait about a month before being seen there). Thanks for mentioning the 1xBEP studies, Paul - I will look into this and bring it up with my oncologist..

[HCG]

One more thing, the HCG should be normal now. What do you mean by saying it is close to zero? Does it mean that it is below 5?

Ron

[RyanSeattle]

I would be concerned with doing surveillance having 10% chorio in my pathology. Chorio is the most aggressive and with LV invasion, I would consult with Dr. Einhorn or Dr. Nichols.

[jonwil]

Hi Nick. Paul has summed it up well. I've just completed my first year of surveillance and everything seems to be going well. For me, surveillance has been a good option as I have avoided any further treatment. Given what I now know about TC, at my age I would make the same decision. However, I think if I was still looking to finish my education, I would sway towards the chemo option as that would greatly reduce the odds of recurrence. Surveillance can be quite stressful at times and you may not want to have that extra stress while you are studying. If you go down the surveillance route, make sure you make all your appointments. Best wishes and good luck. Jon

[Itsadeepbluesea]

Nicholas I can't tell you which you should do, as it has to be what you are most comfortable with. But there is some advice I can give you. I was diagnosed my first semester in grad school. The important thing is for you to get better. Don't make grad school a factor in your decision. Any school that is worth going to should work with you and if your are accepted they should let you defer to the next year because of your diagnosis. Mine let me take a leave of absence and pick up when the cycle comes around again. Good luck keep us posted and if you have and cancer/gradschool questions PM me.

Matt