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Is this recurrence..advice on next steps

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  • Is this recurrence..advice on next steps

    I'm from Minneapolis.

    08/21/2015: HCG 5, AFP 3.9, LDH 387
    9/10/2015:
    Orchiectomy, left
    1. Embryonal carcinoma
    2. Macroscopic Extent of Tumor: Tumor Limited to testis Microscopic Tumor Extension: No involvement of rete testis, hilar fat, epididymis, tunica vaginalis or spermatic cord (rete testis, hilar fat, epididymis, tunica vaginalis, or spermatic cord)
    10/20/2015: HCG <3, AFP 3.8, LDH 387
    2/23/2016: HCG 416, AFP 41.5, LDH 445
    2/29/2016: PET FDG/CT: Single enlarged, markedly FDG avid left para-aortic retroperitoneal lymph
    node is highly suspicious for metastatic testicular cancer. ABDOMEN/PELVIS: A 2.1 x 1.5 cm left para-aortic lymph node has enlarged from 1.1 x 0.8 cm .

    Planned for BEP, but after first day of Bleomycin, I had some breathing issue, so continued with 4xEP
    Chemotherapy completed on 5/28/2016
    06/13/2016: PET scan showed that there has been a complete response to the therapy and there is no evidence of active malignancy or metastases on the exam. A hypermetabolic left
    para-aortic retroperitoneal lymph node depicted previously has normalized
    in size measuring 0.6 x 0.9 cm (previously 1.5 x 2.1 cm).
    06/13/2016: HCG < 3, AFP 4.7, LDH 444
    RPLND on 7/1/2016
    DIAGNOSIS: A. Spermatic cord, left, excision: Benign spermatic cord. B. Lymph nodes, left common iliac, dissection: Multiple (7) lymph nodes are negative for tumor. C. Lymph nodes, para-aortic, dissection: Multiple (4) lymph nodes are negative for tumor. D. Lymph nodes, right external iliac, dissection: A single (1) lymph node is negative for tumor. E. Lymph nodes, interaortocaval, dissection: Multiple (15) lymph nodes are negative for tumor. F. Lymph nodes, paracaval, dissection: Multiple (10) lymph nodes are negative for tumor.
    7/25/2016: HCG < 1, AFP 3.0, LDH 443
    3/24/2017: HCG < 1, AFP 4.1
    6/5/2017: HCG 24, AFP 4.5, LDH 147. CT scan normal. But High HCG is a concern and possible recurrence of cancer.
    6/6/2017: Testosterone 230 ng/dl, LH 9 mIU/ml. Ultrasound for right testicle normal.
    6/7/2017: PET FDG/CT: No evidence of disease
    6/19/2017: LDH 147. Waiting for other results.

    Does this look like a case of recurrence? Waiting for other tumor market results. If this is recurrence, what will be next steps? What are chances for cure? After HCG elevated, PET scan was normal, ultrasound normal, then why it was elevated? is cancer hidden somewhere or will show up later?

  • #2
    Could be a false positive bHCG test result. I had one at this same time last year my bHCG came back at 12 when it's never been elevated since the Orciectomy.

    With a normal PET scan I would re-do that bHCG test asap.

    It's be a quick way to get results....If it's still going up then I'd say it's a recurrence.

    - 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 8th 2017: 3 YEARS ALL CLEAR !

    Comment


    • #3
      Where are you being treated? 4xEP + RPLND means you have a very low chance for recurrence. With nothing visible on the scans and no other marker elevation I'm not sure I would do any treatment just yet. Absolutely get another blood test too, lab errors do happen, even improper handling or timing can mess up some of the blood tests. It would be worth contacting an expert, if you have not already. FYI I am from MPLS as well...
      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 - 9/18/15: 4xEP
      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!
      9/18/2017 all clears up to this date!

      Comment


      • #4
        I'm going to Regions Cancer Care Hospital in St. Paul for all my treatment. I had my RPLND at Mayo Clinic, Rochester.
        06/21/2017: bHCG < 1, AFP 3.9
        So I think that spike was may be because of lab error. I still need to talk to Dr.

        Comment


        • #5
          Great to see the number is back to normal!

          I went to Minnesota Oncology in minneapolis for treatment. I went to the Mayo and saw Dr. Quevedo for second opinions both at diagnosis and post-chemo. I had my RPLND at Indiana University though.
          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 - 9/18/15: 4xEP
          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!
          9/18/2017 all clears up to this date!

          Comment


          • #6
            Very relieved the number is back down for you!
            24 year old diagnosed 6/11/16
            Pre/o markers 9/11/16 - HCG 15, AFP 210, LDH 539
            Pre/o CT Clear
            Non-seminoma (80% embryonal carcinoma, 10% yolk sac tumour, 5% chorea carcinoma, 5% seminoma)
            Post-op markers - 14/12/16 - HCG 35, AFP 1050, LDH 430
            Post-op CT with one enlarged lymph node - 1.5x1cm
            Borderline stage 2B/3B
            BEPx3 started 15/12/16 (Borderline BEPx4 - Advise of Dr. E to only do 3 rounds)
            CT and markers clear - in remission - 28/2/16

            Comment


            • #7
              Please note that hcg can go up due to low levels of testosterone:
              Human Chorionic Gonadotropin (hCG), beta subunit - In adults, significant elevation of levels of beta HCG occurs only during pregnancy and in patients with trophoblastic neoplasms or nonseminomatous germ cell tumors. As a result, it is used as a tumor marker. Essentially, 100 per cent of patients with trophoblastic tumors and 40-60 per cent of patients with nonseminomatous germ cell tumors, including all patients with choriocarcinoma, 80% of patients with embryonal carcinoma, and 10-25% of patients with pure seminoma are diagnosed with elevated levels of beta HCG. The serum half life of beta hCG is 24 to 36 hours, which implies that elevated concentrations should return to normal within 5 to 7.5 days after surgery if all tumor is removed. Please note that the normal HCG level is usually less than 5 miu/ml. Also note that the HCG level can become elevated (falsely positive) due to abnormally low levels of testosterone or because of marijuana us
              A T level of 230 ng/dl is quite low unless you are in your 70's. I would pursue the T levels even though the hcg seems to have normalized.
              Dave
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #8
                Glad to hear that the lab may have been in error and that can always happen but it does shoot the anxiety up quite a bit. Just keep an eye on things and get the testosterone rechecked as Dave mentioned.

                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

                Comment


                • #9
                  Keep us updated, glad it might be lab error! Whew!
                  17 year old son Grant dx 12/21/16
                  pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
                  pre/o CT Scan 12/22/16 normal
                  r/o 12/22/16
                  Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
                  PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

                  -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
                  2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
                  BEP x 3 1/27/17
                  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

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