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  • Scans after BEP x 3

    I just finished cycle 2 and am starting cycle 3 Monday. My oncologist wants to do a CT scan tomorrow and PET scan after cycle 3. Is it routine to do a scan after cycle 2? I want to avoid as much radiation as possible...is this routine?
    May 6 - R/O Left Testicle
    Pathology Report - Mixed Germ Cell Tumor - Non-Seminoma
    80% Embryonal 20% Yolk Sac
    Margin Free, No LVI.
    Tumor Markers - Normal
    Stage 1A - On Surveillance

    September CT Scan showed 2 Para-Aortic enlarged lymph nodes measuring 1.6cm and 1.3cm
    Restaged 2A
    9/26 Started BEP x 3
    11/21 Ended BEP x 3
    11/21 On Surveillance Again - Lymph Nodes on post chemotherapy scan were 9mm and are expected to shrink further. Merry Christmas to me!!

  • #2
    I am not sure why your physician would want to do a CT scan after round two. Are they concerned that there is disease progression, such as are your tumor markers increasing or are you having new symptoms? If not, then what are they going to do with the information? If the CT is good then it isn't like they are going to stop chemotherapy or at least that shouldn't be crossing their mind.

    As far as the PET scan, I am not aware of a role of PET in nonseminoma cases. Do they have a good reason for doing the PET? There are false positives that could cause more bad than good and I personally would avoid the PET and just go with CT scan after chemotherapy is completed.

    If my physician did not have great reasons for doing a CT scan after round two and for doing a PET scan then I would ask them to consult a center of excellence to get input for my treatment and monitoring plan. Our friends at the TCRC have a great list of those centers of excellence at: http://tcrc.acor.org/experts.html

    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


    • #3
      Mike,
      Thanks for the response. I called my primary oncologist at KU med and he also questioned why the oncologist who is overseeing my chemo in my hometown wanted to do a scan after 2 cycles. With that being said, I went ahead and did the scan. There was no need for a scan other than to make sure that the treatment plan is working according to my hometown oncologist. I got my results today and both paraaortic lymph nodes have decreased from 1.6 and 1.5 to .9 cm respectively. Once cycle 3 is complete, I plan on going back to KU med for all of my follow up appointments. Dr. Hashmi - KU doctor has said that there is no need for a PET scan. Because I went ahead and got the scan after 2 cycles, I wonder if we will do another after cycle 3. Guess we will wait and see. Thanks for posting the centers, I didn't' know there was such a list. I appreciate the information.

      Scott
      May 6 - R/O Left Testicle
      Pathology Report - Mixed Germ Cell Tumor - Non-Seminoma
      80% Embryonal 20% Yolk Sac
      Margin Free, No LVI.
      Tumor Markers - Normal
      Stage 1A - On Surveillance

      September CT Scan showed 2 Para-Aortic enlarged lymph nodes measuring 1.6cm and 1.3cm
      Restaged 2A
      9/26 Started BEP x 3
      11/21 Ended BEP x 3
      11/21 On Surveillance Again - Lymph Nodes on post chemotherapy scan were 9mm and are expected to shrink further. Merry Christmas to me!!

      Comment


      • #4
        Hi Scott,

        I am glad that your KU doctor weighed in and also agreed that there is no need for a PET scan. The shrinkage of the nodes is great and hopefully, they shrink further. If the nodes are 1 cm or greater after chemotherapy then an RPLND would be needed but, if less than 1 cm, some experts just watch things while others do an RPLND if they are visible at all. Hopefully, they will just disappear but you can worry about that after getting through the next cycle as they have shrink quite a bit already. Usually, I have seen the CT scans done a month or so after chemotherapy has ended to get the final results.

        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


        • #5
          Scott,

          Your CT scan in the middle of chemo is not usual; as you now know. I am glad it's showing that the chemo is working. Typically you would get a CT done about 4-6 weeks post chemo. I am not too sure what they will do now.

          In my opinion I would want to get a scan done sometime after chemo just to be sure that nothing changed after that last cycle and the tumors are still shrinking. It may be that you go for one 6 weeks after or maybe at the 3 or 6 month checkup. This first year or two post chemo is when a recurrence would be most likely, so in either case you are likely to get a scan or two in before the big 1 year post chemo anniversary.

          On another note: Is your Onco at the KU campus in Lawrence or Wichita ?

          My wife and I are both grads from KU (Lawrence) and my wife grew up just north of Wichita. We usually travel up there once a year or so.

          - Matt

          March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
          March 13th: Left IO 100% Classic Seminoma
          6.3 x 5.1 x 3.8 cm, no invasion of anything
          LDH never fully normalized
          Stage: IS
          Watchful Waiting
          May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
          May 12th: started 3xBEP
          Neupogen during Cycle 2 and 3
          July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
          August 4th: Post Chemo CT/PET scan
          September 4th: Port removed
          July 10th 2018: 4 YEARS ALL CLEAR !

          Comment


          • #6
            Thanks for the reply. My primary oncologist is Dr. Hashmi at KU campus in Shawnee Mission. I really like him; he's thorough and has great bed side manner. He cancelled the PET scan that my overseeing oncologist wanted to schedule. I see Dr. Hashmi December 16th as my first follow up. I am not sure when we will do another scan, but like you all both said I would imagine 6 weeks or so once the chemo is completed; then get on some sort of surveillance. I am not sure if the surveillance will be the same as when I was stage 1a, but i expect it to be pretty regimented and thorough to make sure we catch any sort of relapse. Doc told me I have a 95% cure rate with chemo; however, I know that my tumor is 80% embryonal and those grow back easily.
            May 6 - R/O Left Testicle
            Pathology Report - Mixed Germ Cell Tumor - Non-Seminoma
            80% Embryonal 20% Yolk Sac
            Margin Free, No LVI.
            Tumor Markers - Normal
            Stage 1A - On Surveillance

            September CT Scan showed 2 Para-Aortic enlarged lymph nodes measuring 1.6cm and 1.3cm
            Restaged 2A
            9/26 Started BEP x 3
            11/21 Ended BEP x 3
            11/21 On Surveillance Again - Lymph Nodes on post chemotherapy scan were 9mm and are expected to shrink further. Merry Christmas to me!!

            Comment

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