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NSTC, post O/l four months, HCG elevated

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  • #16
    Injection or not, he needs to have his T levels checked, it is a simple blood test and the only way to be positive his levels are in a normal range. An U/S on the remaining guy is a good idea, but get his levels checked as well.

    Dave
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

    Comment


    • #17
      I would think with not having a change in b-hCG after the testosterone challenge that the slight elevation is not related to low testosterone/elevated LH but I would discuss with the doctor. An ultrasound of the remaining testicle seems reasonable to me. If ultrasound is negative, then I suppose I would ask if looking in the pelvis, chest and/or brain is reasonable (just as a precaution and I am not sure what areas he has had a CT of already) or if holding off and waiting for a more pronounced rise in the b-hCG would be appropriate. If definitive decisions are not made than asking if re-doing the CT at an earlier interval would be appropriate.

      MIke
      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Surveillance...
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

      For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

      Comment


      • #18
        Hi Dave
        Hi Mike,

        Many thanks for your suggestions.

        My son had a CT (abdomen,Pelvis and pulmonary). All in stable ( 2mm nodules in pulmonary seems benign and 7mm nodules in abdomen no change compared with CT Feb.)

        Is it usual that bhcg elevated but imagine show nothing? Is it dangerous than meantime something grow up?

        Please advise! Many many thanks for your time!

        BRs

        Amy, Ryan’s mumm
        Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

        Comment


        • #19
          Originally posted by Ryan Bi View Post
          Is it usual that bhcg elevated but imagine show nothing? Is it dangerous than meantime something grow up?
          It is not usual, but it happens sometimes. A steady rise to much higher levels is reason for concern, but at this point monitoring is appropriate.He can not miss any scheduled scans/appointments, because that is the only way any problems will be detected early enough to get treated successfully.

          Dave

          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #20
            Dave, I really appreciate your advice.

            Till now both his urologist and oncologist don’t call back. We are waiting and willing to know what and when will us move to next steps.

            I will keep updating.. with big anxiety.

            BRs

            Amy, Ryan’s mumm
            Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

            Comment


            • #21
              Today my son’s HCG up to 15(reference range is < 5). And Dr.Molthrop from Orlando called my son said : Dr.Einhorn suggested BEPx3.

              I have some questions: two weeks ago bhcg is 7.2 with reference 2.6, this time HCG up to 15 reference
              Last edited by Ryan Bi; 10-17-18, 04:07 PM.
              Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

              Comment


              • #22
                So sorry. BEPx3 My son had much higher tumor markers that never normalized post Orchietcomy and a clear initial scan. Eventually his markers started climbing higher & higher and several weeks loater a repeat scans showed definite spread. Keeping your son & you in my thoughts.
                Son Grant
                dx 12/21/16 at age 17

                BEP x3
                Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

                Comment


                • #23
                  Did they ever check his testosterone level? I think I would send an email to Doc E directly, based on other advise his given to others here, I find it hard to believe he recommended chemo at this point, especially without a testosterone test.

                  Dave
                  Jan, 1975: Right I/O, followed by RPLND
                  Dec, 2009: Left I/O, followed by 3xBEP

                  Comment


                  • #24
                    Hi Trekga,

                    Thank you very much for this information of your son. It is nice to see after treatment , your son is in almost two years remission, I am really happy for you. Could you remember, how long was two CT scans interval? My son had 18th September last CT scan, everything is stable. I think doctors should order repeat CT.

                    Hi Dave,

                    I agree with you. Dr.Molthrop did not order ultrasound, did not test testosterone, I can’t believe just base bhcg or hcg 15 starts chemo right now. This sounds too easy to start chemo treatment from my opinion, sure I am not an expert, I will follow all that doctor tell me.

                    BRs

                    Amy, Ryan’s mum
                    Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

                    Comment


                    • #25
                      Update, Dr.E said my needs no more Cts and Ultrasound, maybe one bhcg testing, then my son should start BEPx3.

                      I will fly to USA next week and try to start chemo ASAP.

                      Thanks everyone for your support!

                      BRs

                      Amy, Ryan’s mum
                      Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

                      Comment


                      • #26
                        Hi to all.

                        I have a question, my son is undergoing BEP x3, today is the cycle 1 ,9th day with Bleomycin. His tumor markers before chemo treatment was only bhcg up to 28.6, today he got blood work back, his afp is raising up to 6.3, but bhcg is going down to 19.4, should I worry about this afp report?


                        Your input is really helpy and appreciated.

                        BRs

                        Amy,Ryan’s mum
                        Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

                        Comment


                        • #27
                          No need to worry about the AFP just yet. That is still a very low #. Unless it goes much higher, it is probably just cancer cells releasing markers as they die off.

                          Dave
                          Jan, 1975: Right I/O, followed by RPLND
                          Dec, 2009: Left I/O, followed by 3xBEP

                          Comment


                          • #28
                            Good luck with chemo. It is not uncommon for tumor markers to rise and fall during chemo. Unless it is a dramatic rise.
                            Son Grant
                            dx 12/21/16 at age 17

                            BEP x3
                            Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                            2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                            Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

                            Comment


                            • #29
                              Thank you Dave , thank youTrekga.

                              Now I feel much better of the explanations.

                              Have a nice weekend!

                              Amy, Ryan’s mum
                              Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary

                              Comment


                              • #30
                                I am just getting caught up and so sorry to hear that your son ended up needing chemotherapy but I am sure he is in good hands with Dr.Molthrop. It sounds like he was already in consultation with Dr. Einhorn which is great to see as well. I too would not be worried about the AFP level at this point. At Indiana University they consider any AFP < 25 as normal and here is a little commentary about it that might help: http://ascopubs.org/doi/pdf/10.1200/JCO.2014.56.0607

                                Wishing you and your son all the best during treatments.

                                Mike
                                Oct. 2005 felt lump but waited over 7 months.
                                06.15.06 "You have Cancer"
                                06.26.06 Left I/O
                                06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                                06.30.06 It's Official - Stage I Seminoma
                                Surveillance...
                                Founded the Testicular Cancer Society
                                6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                                For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

                                Comment

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