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Starting the road of surveillance

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  • Starting the road of surveillance

    Hello guys,

    This forum has been a good way to get information, get hope and meet other survivors.

    Last week I had my first follow-up appointment with my oncologist after chemotherapy. I had my blood work and my abdomen/pelvis/chest CT Scan (since my insurance didn't approved a PET Scan). I never got a true stage because with what I read I should have been stage IIC seminoma, my doctor said 3A, but at my documents it was 3B (weird).

    Blood work: Before starting chemo I had my LDH at 650, now 5 weeks after chemo it is 210 (within the range of 220). Other markes never been escalated.

    CT Scan of my lymph nodes: I had 3 enlarged lymph nodes - a) 3.7 x 3.7cm which now is 1.1 x 1.5 cm - b) 2.5 x 2.8cm which now is 1.2 x 0.6cm - c) 5 x 6 cm which now is 2.4 x 0.8cm
    I was looking at the images of the CT Scan and even the 2.4 x 0.8cm lymph node was just some small dots and it looked like they were trying to measure it. This was also the opinion of my oncologist, who said that it looks like they were just trying to give an estimate of it. What my doctor told was that probably what is left are just scares or concrete, so I did good during my chemo. Even with guidelines everything under 3cm with seminomas goes under surveillance.

    Giving this details, I have some questions that I need some opinion from others:

    1) Is the follow-up schedule after 6 months good with seminomas?
    2) What are the chances that those nodes more than 1cm could still be cancer?

    Thank you guys!
    Dec 2017 - felt lump and never checked it out.
    07.17.18 - Diagnosed with TC
    07.20.18 - Left I/O
    08.04.18 - Pathology - Seminoma
    08.24.18 - CT Scan shows 3 enlarged lymph nodes (3.3x3.1cm & 3.3x3.2cm & 5.1x3.9cm) no other organs met
    09.04.18 - OFFICIAL STAGE 3A Seminoma
    09.06.18 - Started 4xEP @ MD Anderson
    11.12.18 - Finished 4xEP
    12.20.18 - Lymph nodes under 3cm - Starting surveillance
    06.16-19 - Next CT Scan/Blood work/X-Ray

  • #2
    Happy NEW year to you! I do not know Seminoma NCCN Guidelines, sorry.
    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.


    • #3
      NCCN recommends a 3 month follow up for imaging/labs if I am reading it right. After that follow up, then it goes to a 6 month, then it goes to annual for imaging, and labs remain at every 6 months.

      I think chances of there being any remaining cancer are pretty low, given your response and the way you fall into the guidelines.
      6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
      6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
      7/7/15: bHCG 56, AFP 42, LDH 322
      7/13/15: begin 4xEP, end 9/18/15
      10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
      10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
      4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
      4/20/16: RPLND @ IU - teratoma only!
      4/15/19: all clears up to this date!