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  • biwi
    replied
    Good news on the RPLND result! What is the lab's range for normal bHCG? Each is slightly different based on their respective labs and handling procedure. I don't think a 3.0 is anything to be concerned about unless it continues to rise.

    Leave a comment:


  • driven2tri24
    replied
    Update:
    Met Dr. E in Mid July shortly after CT scan on the 7th and have had his advice at my disposal for last few months. He recommended an RPLND but no I/O to the VA and they listened.
    Here is where I am currently...
    8/17/17 BHCG 1.0 & AFP 2.8
    8/21/17 RPLND performed removal of 10 lymph nodes and "scarred"plumbing to left testicle.
    8/28/17 BHCG up to 3.0 (AFP not taken)
    9/5/17 pathology report of lymph nodes and other material removed came back negative for teratoma or living cancer.

    -Currently scheduled
    9/14CT scan of chest to observe 3mm nodule in lung and blood draw for BHCG/AFP re-test
    9/15 for staple removal from abdomen...

    Overall I am recovering well from surgery and although concerned about slight rise in BHCG, am happy that all material taken during RPLND was dead...

    Anyones toughts on BHCG?? How significant is a rise from < 1.0 post chemo to 3.0 post RPLND??

    Leave a comment:


  • Davepet
    replied
    Originally posted by driven2tri24 View Post
    Currently the VA has recommended a second opinion on the proposal of performing a Left I/O as precaution despite finding nothing in either Testicle via Ultrasound/MRI/CT/PET. The assumption is that because it was in my Left lymph nodes, it began there and probable source that we should remove soon after chemo completion.
    That assumption may be flawed. I would want an expert opinion before taking off a testicle without positive proof it needed to come out.TC can originate in areas outside of the testicles.

    Dave

    Leave a comment:


  • Trekga
    replied
    DRIVEN~ Congrats on finishing chemo & for your markers normalizing. Keep us updated, especially after our Ct Scan on July7th.

    Leave a comment:


  • Mike
    replied
    Glad to hear that chemotherapy is over for you. I would definitely reach out to Dr. Einhorn. Perhaps a repeat scrotal ultrasound would be worth doing to see if there has been any changes. Extragonadal germ cell cancer is certainly a possibility but it is a bit rare. Perhaps having a more experienced center look at the ultrasounds would help too. Although, I would think the Navy has seen their fair share of TC cases given the age of those serving. Definitely just have them give him a shout and see what he thinks the next steps need to be as far as the orchiectomy and best of luck on the CT results.

    Mike

    Leave a comment:


  • driven2tri24
    replied
    Update: Completed 4th BEP cycle yesterday.
    Prior to starting my 4th cycle on Memorial Day my markers were:
    BHCG=3.0
    AFP=1.4
    LDH=234
    My CT scan is scheduled for July 7th and I've initiated a request for a second opinion through the VA to Dr. Einhorn. Currently the VA has recommended a second opinion on the proposal of performing a Left I/O as precaution despite finding nothing in either Testicle via Ultrasound/MRI/CT/PET. The assumption is that because it was in my Left lymph nodes, it began there and probable source that we should remove soon after chemo completion.

    Leave a comment:


  • driven2tri24
    replied
    They have finally cleared me to start my 3rd cycle (after about 15 hours of delay) with some gentle pushing...and we are now starting everything to be about an effective 24 hour delay in completion. Dr E. said this won't be a problem...

    Leave a comment:


  • Mike
    replied
    I am glad that Dr. Einhorn is available to your team and I hope that they use the resource. The decision to use BEPx3 or BEPx4 is based on your risk classification for advanced disease, which takes into consideration the primary tumor location, location of any metastasis and tumor markers. It is my understanding that BEPx4 would be appropriate for you given your beta-hCG levels prior to the start of cycle one and I am assuming Dr. Einhorn agreed?

    Delaying chemotherapy for a few hours or a day or so to assess the sinus situation seems reasonable as there are some sinus infections/abscesses that can be quite serious and perhaps influence if the next round of chemo should be delayed. However, I would ask my team to run things by Dr. Einhorn if there were going to delay more than the 12 hours.

    Most experts say that any residual masses (abdominal lymphnodes) 1 cm or larger after chemotherapy for nonseminoma will need an RPLND if the markers are normal. Others do the RPLND for smaller nodes. You will have to check with your team and again with Dr. Einhorn when the time comes. The surgery would be after chemotherapy is finished. Any residual lung masses would be worked up differently.

    Mike

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  • Davepet
    replied
    Generally speaking, delays in BEP should be avoided as the risk from the delay ( in terms of efficacy of the treatment) is greater than the risk of pushing on. That said a 12 hour delay is probably not a problem, but I can't imagine what they think is being gained, either. Personally, I would push for taking the antibiotic and going forward with treatment as scheduled.

    Dave

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  • driven2tri24
    replied
    Awaiting start of 3rd cycle and they are delaying at minimum 12 hrs to wait for CT scan results of possible sinus abscess or infection. As a precaution they are putting me on Augmentin...
    Is any of this a problem?

    BTW my markers have dropped
    Prior to 3rd cycle start- Today 5/08/17
    bHCG= 8
    AFP= 3.1
    LDH= 232

    Beginning of 2nd cycle(4/17/17):
    BHCG 148
    AFP 5.2
    LDH 195

    Beginning of 1st cycle 3/2517
    Hcg 103,980
    AFP 19.9
    LDH 435

    Any advice??

    Leave a comment:


  • driven2tri24
    replied
    Makes sense Dave. Does that also apply for any tumors or just lymph nodes?

    Leave a comment:


  • Davepet
    replied
    You will only need an RPLND after chemo, if your enlarged nodes have not shrunk to under 1CM within a reasonable period post chemo.

    Dave

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  • driven2tri24
    replied
    Thanks that explains a lot. I'm now In touch with Dr. E and he is simply awesome! He has confirmed I'm on right track provided some key info to pass onto my Oncology team and made himself available for consultation with my medical team.

    He is an absolute Saint in my mind and I couldn't ask for someone above helping me more than the help this forum and he have been for me in the last couple of days since discovering this place...

    Thank you guys!

    Leave a comment:


  • Nish115
    replied
    You are 3C according to guidelines so 4xBEP is correct.

    RPLND after chemo if required. They should do another scan beforehand to see how the chemo has worked, with an RPLND (I believe) 6-8 weeks after chemo to allow your body to recover. But, not entirely sure on time frames so might be longer or shorter.

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  • driven2tri24
    replied
    I agree I believe I'm actually a stage 3c as well and that makes sense for the 4X. Is it correct to wait to do RPLND until after chemo is complete or in middle of it?

    Leave a comment:

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