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My 25 year old was diagnosed in December with Stage III Choriocarcenoma. Forgive me if I don't know or use all the correct terms. He completed 4 rounds of BEP in March and had his scans on April 19th. The 23rd we were told they are going to be doing surgery (ies) We are awaiting an appointment to see the urology surgeon but will be meeting his thoratic surgeon on May 7th. His oncologist said he will have both surgeons but isnt sure if it will be at 2 seperate times or done together. Has anyone had 2 seperate surgeons? Any advice? In general or about the surgery what to expect?
He is mainly scared the most reading he could loose the ability to ejaculate. When diagnosed he didnt have time to bank his sperm. It was so far advanced they started chemo the 2 days after the final pathology report came back. The doctor had told him at the time he may be fertile a couple of years after completing Chemo. So he has held onto that possibility all this time because more then anything he wants to be a father someday. But now he is scared he wont ever have hope for it after this surgery.
His markers:
AFP has always been in normal range
HCG 12/20/17 ( dont know exact # doctor said over 57k when diagnosed)
1/16/18 1153.6
1/27/18 412.2
2/1/18 281.7
3/19/18 27.9
4/26/18. 13.3
Here is what his last CT report says:
CT CHEST ABDOMEN PELVIS W - Details
About This Test
Details
Study ResultImpression
Interval improvement in metastatic disease within the chest, with
reduction of multiple nodules/masses within the lungs. Bulky right
paratracheal mass has also noticeably decreased.
There has also been significant interval reduction in previously seen
loculated right pleural effusion with minimal residual pleural fluid
seen on the current study.
In addition, there is improvement in retroperitoneal adenopathy seen
within the abdomen, as described above.
Electronically Signed by: Kurt J. Messer on 04/19/2018 at 11:43:27
Narrative
EXAM DESCRIPTION:
CT CHEST ABDOMEN PELVIS W
CLINICAL INDICATION:
Staging for Metastatic choriocarcinoma.
COMPARISON:
CT chest 01/02/2018, outside CT chest abdomen pelvis 12/16/2017
CT DOSE LENGTH PRODUCT:
2327.9 mGy*cm
TECHNIQUE:
Multiphase axial CT images of the chest, abdomen, and pelvis were
obtained following administration of IV contrast. Arterial phase
obtained through the lower chest and abdomen. Venous phase obtained
through the chest, abdomen, and pelvis. Delayed phase obtained through
the kidneys and bladder. Oral contrast was also given. Sagittal and
coronal reconstructions are provided and reviewed.
FINDINGS:
CHEST: Thyroid is unremarkable. Right injection port is seen with its
tip in the proximal right atrium.
The heart is not enlarged. No pericardial effusion.
Compared to 01/02/2018, there has been significant interval improvement
in metastatic disease within the lungs. Bulky right paratracheal mass
has also noticeably improved, measuring 4.2 x 3.8 cm on the current
study, previously 8.2 x 6.2 cm on 01/02/2018. Examples of improving
nodules/masses within the lungs include a 1.5 cm fissural nodule along
the superior aspect of the left major fissure, previously 2.1 cm on
01/02/2018, as well as a 5.8 x 3.8 cm mass in the right lower lobe at
the base, previously 8.5 x 4.8 cm on 01/02/2018. A 1.4 cm nodule
within the paramediastinal superior lingula previously measured 2.4 cm.
Multiple other nodules within both lungs have also improved.
The previously seen loculated right pleural effusion has also
significantly improved with minimal residual pleural fluid present. No
acute consolidation. No pneumothorax. No suspicious pulmonary nodules.
The thoracic aorta is normal in caliber and demonstrates no significant
atherosclerotic disease.
Small hiatal hernia.
ABDOMEN: The liver is unremarkable. No intra- or extra-hepatic biliary
ductal dilatation. Portal and hepatic veins patent. Gallbladder
present and unremarkable.
The spleen, adrenal glands, and pancreas are unremarkable.
No hydronephrosis. Normal enhancement and excretion of the kidneys.
Interval improvement in retroperitoneal adenopathy compared to prior.
For example, large pre aortic/ pericaval conglomerate adenopathy
currently measures 2.5 x 5.3 x 6.2 cm, previously 5 x 6.8 x 7.9 cm when
measured in similar dimensions. No ascites or pneumoperitoneum.
No evidence of bowel dilatation or obstruction. The appendix is
visualized and unremarkable.
The abdominal aorta is normal in caliber and demonstrates no
significant atherosclerotic disease.
PELVIS: No ascites or free air. No significant lymphadenopathy.
There is mild circumferential thickening of the urinary bladder, which
may relate to suboptimal distension.. The prostate is not enlarged.
MUSCULOSKELETAL/SOFT TISSUE: No acute osseous abnormality. No
suspicious intraosseous lesion
He is mainly scared the most reading he could loose the ability to ejaculate. When diagnosed he didnt have time to bank his sperm. It was so far advanced they started chemo the 2 days after the final pathology report came back. The doctor had told him at the time he may be fertile a couple of years after completing Chemo. So he has held onto that possibility all this time because more then anything he wants to be a father someday. But now he is scared he wont ever have hope for it after this surgery.
His markers:
AFP has always been in normal range
HCG 12/20/17 ( dont know exact # doctor said over 57k when diagnosed)
1/16/18 1153.6
1/27/18 412.2
2/1/18 281.7
3/19/18 27.9
4/26/18. 13.3
Here is what his last CT report says:
CT CHEST ABDOMEN PELVIS W - Details
About This Test
Details
Study ResultImpression
Interval improvement in metastatic disease within the chest, with
reduction of multiple nodules/masses within the lungs. Bulky right
paratracheal mass has also noticeably decreased.
There has also been significant interval reduction in previously seen
loculated right pleural effusion with minimal residual pleural fluid
seen on the current study.
In addition, there is improvement in retroperitoneal adenopathy seen
within the abdomen, as described above.
Electronically Signed by: Kurt J. Messer on 04/19/2018 at 11:43:27
Narrative
EXAM DESCRIPTION:
CT CHEST ABDOMEN PELVIS W
CLINICAL INDICATION:
Staging for Metastatic choriocarcinoma.
COMPARISON:
CT chest 01/02/2018, outside CT chest abdomen pelvis 12/16/2017
CT DOSE LENGTH PRODUCT:
2327.9 mGy*cm
TECHNIQUE:
Multiphase axial CT images of the chest, abdomen, and pelvis were
obtained following administration of IV contrast. Arterial phase
obtained through the lower chest and abdomen. Venous phase obtained
through the chest, abdomen, and pelvis. Delayed phase obtained through
the kidneys and bladder. Oral contrast was also given. Sagittal and
coronal reconstructions are provided and reviewed.
FINDINGS:
CHEST: Thyroid is unremarkable. Right injection port is seen with its
tip in the proximal right atrium.
The heart is not enlarged. No pericardial effusion.
Compared to 01/02/2018, there has been significant interval improvement
in metastatic disease within the lungs. Bulky right paratracheal mass
has also noticeably improved, measuring 4.2 x 3.8 cm on the current
study, previously 8.2 x 6.2 cm on 01/02/2018. Examples of improving
nodules/masses within the lungs include a 1.5 cm fissural nodule along
the superior aspect of the left major fissure, previously 2.1 cm on
01/02/2018, as well as a 5.8 x 3.8 cm mass in the right lower lobe at
the base, previously 8.5 x 4.8 cm on 01/02/2018. A 1.4 cm nodule
within the paramediastinal superior lingula previously measured 2.4 cm.
Multiple other nodules within both lungs have also improved.
The previously seen loculated right pleural effusion has also
significantly improved with minimal residual pleural fluid present. No
acute consolidation. No pneumothorax. No suspicious pulmonary nodules.
The thoracic aorta is normal in caliber and demonstrates no significant
atherosclerotic disease.
Small hiatal hernia.
ABDOMEN: The liver is unremarkable. No intra- or extra-hepatic biliary
ductal dilatation. Portal and hepatic veins patent. Gallbladder
present and unremarkable.
The spleen, adrenal glands, and pancreas are unremarkable.
No hydronephrosis. Normal enhancement and excretion of the kidneys.
Interval improvement in retroperitoneal adenopathy compared to prior.
For example, large pre aortic/ pericaval conglomerate adenopathy
currently measures 2.5 x 5.3 x 6.2 cm, previously 5 x 6.8 x 7.9 cm when
measured in similar dimensions. No ascites or pneumoperitoneum.
No evidence of bowel dilatation or obstruction. The appendix is
visualized and unremarkable.
The abdominal aorta is normal in caliber and demonstrates no
significant atherosclerotic disease.
PELVIS: No ascites or free air. No significant lymphadenopathy.
There is mild circumferential thickening of the urinary bladder, which
may relate to suboptimal distension.. The prostate is not enlarged.
MUSCULOSKELETAL/SOFT TISSUE: No acute osseous abnormality. No
suspicious intraosseous lesion
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