Chemo or Radiation? Any other thoughts?

[Aneidkowski]

Got pathology report today and went over it with urologist. He stated that my next step was either chemo(2 rounds of carboplatin) or 20 rounds of radiation. Im just looking to get opinions on both of these treatments and anyone who has had either treatment, how it went for them.

On the pathology report it stated tumor is organ confined, no lympho-vascular invasion seen, germ cell neoplasia in situ identified. My initial CT scan said, Few scattered retroperitoneal lymph nodes is seen largest anterior to the IVC measures 1.6 x 1 cm Just trying to make sense of all the information and give thought to my next steps!

Any other thoughts or comments are appreciated. Thanks!!

10/3/2018 - ER Visit/CT Scan/Ultra Sound/BHCG-156/AFP-1.2
10/11/2018- Radical Orchiectomy Right Testicle
10/18/2018 - BHCG-5/AFP-1.7/LDH-135
11/5/2018 - Pathology Report-100% Seminoma

[Mike]

Personally, I think it may be a bit too early to have been offered carboplatin x 2 or 20 rounds of radiation as I am assuming they are meaning the doses of these would be for adjuvant therapy for stage I disease.

I would ask my doctor the significance of the 1.6 cm precaval lymphnode (not sure of the details on the other nodes mentioned) and if this is a sign of spread for a right-sided testicular cancer and if more definitive treatments are needed or if re-imaging to assess for changes in 4-6 weeks from the fist CT is appropriate.

Mike

[Trekga]

I agree w/Mike.

[Aneidkowski]

Thanks guys, my initial reaction after all the late night research Ive been doing the past month lead me to believe that it may be a bit early for chemo or radiation as well.

He did order a follow up CT scan as well as tumor marker blood test, which I’ll be going for next week. They didn'™t mention the size or anything else on intial ct scan of other lymph nodes, but it did say it was likely reactive and not metastatic.

[Mike]

Well, I am glad that they are re-imaging to confirm what may be going on and I think that information next week will shed more light on the situation. With you having the CT before the orchiectomy, vs after the orchiectomy, I think that it may be less likely to be reactive but we will know that next week.

If it were me, I would ask for copies of the CT dictations and any tumor marker results so that you have them and can refer to them outside of the doctors office if needed.

Keep us posted.

Mike

[Aneidkowski]

Hey,

Just got the copy of the follow up CT scan I had done on 11/19. Basically says the same thing as the first, few scattered lymph nodes, largest seen was 1.5cm. Did also mention signs of IBD, but I’m guessing that’s unrelated to this.
Beta HCG was also retested and is now less than 1. Meeting with radiation oncologist on Tuesday to see what he has to say.

[JoeTheAstronaut]

Maybe it is a wait and see - perhaps you postpone a decision until it's clear what's going on!

[Mike]

Unfortunately, I think you may be in the same spot of are these nodes of significance where I need full treatment vs. are they nothing where adjuvant treatments are an option? The fact that the beta-hCG has not increased may be a good sign. I would ask too if there is and IBD may it be what is casing the slightly enlarged nodes and too, why it was not seen on the original CT, except that I would assume that the IBD can fluctuate.

Please keep us posted on next weeks appointment.

​Mike

[Aneidkowski]

Met with radiation oncologist today, stated he felt I had a 90 percent chance of no occurrence with surveillance. However, because of the slightly enlarged lymph nodes (1.5cm) that 10 days of radiation would be increase my cure rate to 99 percent. He also mentioned carboplatin as an option for chemo as well. Leaning towards the 10 days of radiation, but surveillance doesn't seem like a bad route either, just think Id rather be more on the offensive and do the radiation now. Also, he offered to do the treatments for free, and my insurance is awful, so that is a factor as well. Any thoughts or ideas?

[Davepet]

In my way of looking at things, taking treatments that have risks of their own to improve odds from 10 in 100 to 1 in 100 is not something I would consider. Both chemo & rads increase the odds of other cancers down the road. I would not do them if they are not absolutely needed to save my life, JMHO.

Dave