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  • #16
    Dave, what would you recommend at this point considering the size of the node/mass..? I mean what type of Chemo, what dose.?

    do you think a Ct-Scan it's really necessary considering a month ago I had a abdominal Ct-Scan and Chest Xray..?
    39 year old diagnosed Right Mass as per U/S
    Pre/o CT-Scan Chest Xray all Clear march 24 2017
    Right I/O April 8th 2017
    Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
    Tumor Markers never elevated
    Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
    May 11 BHCG Mild elevated 3.1 Reference Value 2.7
    May 25 2018 Chest CT-Scan Clear
    May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

    Comment


    • #17
      Well, at this point, wait for the new radiologist report, hard to make decisions until you get that. If you do indeed have an enlarged node, and decide on chemo, 3xBEP or 4xEP is the standard treatment.

      I can't see much value to a chest CT at this point, other than to know for sure it's as clear as the chest x-ray has shown. A new image of your abdomen is probably a good idea if the new report is also a bit vague. However the original report said "Retroperitoneal adenopathy" which is how docs say "enlarged lymph node" in the area where TC tends to spread.

      Dave
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP

      Comment


      • #18
        Hello
        Today I had a phone small talk with the last Uro-oncologist I saw. He said he met with another Drs checked the abdomen Ct-Scan and they think the 18x14 mm aortocaval node it's a relapse. So The Uro-Oncologist Dr. insisted in ordering a Chest Ct-Scan which he said it's the guidelines even when I said to him that I already had a Chest Xray which was clear. So he mentioned the Chest Xray does not give the level of detail he needs to discard any issue in the Chest. What I understood is that until I get the Chest Ct-Scan, he will not order the Chemo or radiation treatment. Well I'm not sure if getting the Xray or not. I have heard that Chest Ct-scan is risky and have higher dose of radiation at least that's what My original Uro said and that's why he've never ordered a Chest Ct-scan and because he believes I'm still a low risk patient. So this is making me feel so confused and nervous. I don't know if I should follow his indications or not, or just stick with my original Uro's belief that Chest Ct-Scan it's risky and unnecessary.

        Last but not least the Uro-Oncologist said that once I get the Chest Ct-Scan we can meet and discuss pros and cons of choosing either Chemo or radiation.
        He said he believes that if chemo is selected BEP will be the best, but the Ct-Scan is required because is more specific and it's used for patients with a Tumor of the size I had

        100% Pure Seminoma Tumor Size 2.5cm x 1.3cm

        Appreciate your comments
        Last edited by mauroeg7; 03-08-18, 10:14 PM.
        39 year old diagnosed Right Mass as per U/S
        Pre/o CT-Scan Chest Xray all Clear march 24 2017
        Right I/O April 8th 2017
        Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
        Tumor Markers never elevated
        Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
        May 11 BHCG Mild elevated 3.1 Reference Value 2.7
        May 25 2018 Chest CT-Scan Clear
        May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

        Comment


        • #19
          A CT scan is NOT "risky" yes it's another dose of radiation, but in the greater scheme of things, one extra dose is insignificant by the time you get to a final 5 year "all clear". The amount of radiation you will get as treatment, if you go that route will be a lot more. Is your first onc a radiation onc or a medical onc? There are two type & each one will use the hammer they are used to using.

          If you are going to chemo, your clear chest xray is certainly all you need, chemo will take out any TC anywhere in your body.I'm pretty sure the NCCN guidelines only call for xray of the chest. If that finds something suspicious, than a chest CT might be warranted.

          My advice is to choose the doc you have the most confidence in/ feel the most comfortable with, or worst case, look for another. Even though it's not necessary an additional CT will give you less rads than radiation treatment.

          Dave
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #20
            Sorry Dave I could not get your question. "Is your first onc a radiation onc or a medical onc? "

            As far as treatment options the Uro-Onco said we will meet to discuss that once I have the Chest Ct-Scan. Seems like he'll definitely not order any treatment for me until I bring a Chest-Ctscan to his desk. But he mentioned both BEP Chemo or radiation as my options. I have an appointment tomorrow morning to see an oncologist. I'll have her take a look at all my tests including the last abdomen Ct-Scan that shows the 18x14 mm aortocaval node. I'll let you know what she says about all.

            another question who is most appropriate to discuss and order my treatment and Urologist-Oncologist or just the Oncologist..?

            Good night
            Last edited by mauroeg7; 03-09-18, 10:27 PM.
            39 year old diagnosed Right Mass as per U/S
            Pre/o CT-Scan Chest Xray all Clear march 24 2017
            Right I/O April 8th 2017
            Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
            Tumor Markers never elevated
            Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
            May 11 BHCG Mild elevated 3.1 Reference Value 2.7
            May 25 2018 Chest CT-Scan Clear
            May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

            Comment


            • #21
              Originally posted by mauroeg7 View Post
              Sorry Dave I could not get your question. "Is your first onc a radiation onc or a medical onc? "
              There are oncologists that specialize in radiation therapy ( radiation onc ) & there are oncologists that specialize in chemotherapy (medical onc). I'm wondering if your first onc is a radiation specialist? It can be important to know these things when you are trying to make decisions, since each type will tend to steer you in the direction they specialize in (most of the time).

              Dave
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #22
                Dave to answer your question. The first one, the one Who ordered the Chest-Ctscan is an Urologist specialist in oncology he is a Uro-Onco or thats how we Call it in this country. And I saw an oncologist yesterday. She is a raditation specialist and recommended radiation therapy which She said it would be about a fiften Day treatment. So in three or four weeks I'd be done and radiation would melt the aortocaval lymph node. She said I'm like stage IIa seminoma and as per guidelines radiation is what's stablished. So not sure what to do. If following her treatment, get the chest CT-scan and go see and discuss the treatment options with the Uro-onco, or wait and do the MRI as my original Uro ordered or just see another Dr. I feel a bit frustrated and confused I just want to start the right treatment and do the right thing.
                Last edited by mauroeg7; 03-11-18, 09:45 PM.
                39 year old diagnosed Right Mass as per U/S
                Pre/o CT-Scan Chest Xray all Clear march 24 2017
                Right I/O April 8th 2017
                Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
                Tumor Markers never elevated
                Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
                May 11 BHCG Mild elevated 3.1 Reference Value 2.7
                May 25 2018 Chest CT-Scan Clear
                May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

                Comment


                • #23
                  Hello
                  I saw one more Uro-Onco last week. He checked the Abdomen Ct-Scan on his PC and said something that made me feel very concerned. According to him the 18x14 mm aortocaval node is actually bigger than the radiologist report. He measured it on the PC screen using the mouse pointer and shows to be something like 31x19 mm instead of 18x14. So he said it's a relapse and you need to start treatment, he said he would recommend chemo BEP or EP, but that needs to be decided by a medical Oncologist. Also th Uro-onco ordered a PET-Scan od abdomen, chest and head. Not sure if a Pet is appropriate at this point or not. So I have an appointment on Friday with the Oncologist.
                  39 year old diagnosed Right Mass as per U/S
                  Pre/o CT-Scan Chest Xray all Clear march 24 2017
                  Right I/O April 8th 2017
                  Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
                  Tumor Markers never elevated
                  Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
                  May 11 BHCG Mild elevated 3.1 Reference Value 2.7
                  May 25 2018 Chest CT-Scan Clear
                  May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

                  Comment


                  • #24
                    My oncologist only did PET/CT scans throughout my treatment & post treatment surveillance.That is not necessary or even recommended most of the time, discuss it with your oncologist tomorrow. At this point you know you need treatment & the scan is unlikely to change anything so why do it?

                    Dave
                    Jan, 1975: Right I/O, followed by RPLND
                    Dec, 2009: Left I/O, followed by 3xBEP

                    Comment


                    • #25
                      I saw the oncologist today. Surprisingly he said surgery could be the way to get rid of the 18x14 mm aortocaval node. So he ordered another Abdomen Ct-Scan, and blood test. He said he needs to compare the previous Ct-scan with new one to see if the Lymph node is still there same size, bigger, or it's gone....!

                      As for the surgery I asked the oncologist why not chemo instead of Surgery and his answer was that with surgery I get two things. 1. Get the Lymph node treated/removed and 2. Get the Lymph node checked by pathology and find out and it really is. He mentioned that since chances are that the Lymph node could be a Teratoma, he'd prefer surgery at this time over Chemo. But he said first go get the abdomen Ct-scan and blood test and come see me again

                      So my question is what's the deal with Teratoma..? is it a TC tumor or is it a mass that will not cause trouble like seminona.?

                      Last edited by mauroeg7; 04-06-18, 09:07 PM.
                      39 year old diagnosed Right Mass as per U/S
                      Pre/o CT-Scan Chest Xray all Clear march 24 2017
                      Right I/O April 8th 2017
                      Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
                      Tumor Markers never elevated
                      Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
                      May 11 BHCG Mild elevated 3.1 Reference Value 2.7
                      May 25 2018 Chest CT-Scan Clear
                      May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

                      Comment


                      • #26
                        Here's what the Testicular Cancer Resource Center dictionary ( http://thetcrc.org/dictionary.html#GlossT ) has to say about teratoma:
                        Teratoma - (1) Strictly speaking, teratoma is a benign growth. It is an odd sort of tumor in that it is basically composed of a number of different normal types of tissue, growing in abnormal places. I say strictly speaking it is benign, but it can act like a malignant tumor and spread. It is most commonly discussed in the post-chemo situation where the doctors want to remove masses left behind by the chemo because they may have teratoma in them. They do this because any tumor can grow and cause problems later on, plus teratoma tumors can become cancerous themselves, and those cancers are not as easy to treat as germ cell tumors. Because teratoma is made up of normal cells, chemotherapy does not affect it. (2) In the UK, teratoma is synonymous with nonseminoma. Here is a cross reference between the AFIP/World Health Organization and the UK classifications:
                        British WHO
                        Teratoma Non seminomatous germ cell tumour
                        teratoma differentiated mature teratoma
                        malignant teratoma intermediate (MTI) teratocarcinoma, embryonal carcinoma with teratoma
                        malignant teratoma undifferentiated (MTU) embryonal carcinoma
                        yolk sac tumour yolk sac tumor, endodermal sinus tumor
                        malignant teratoma trophoblastic choriocarcinoma
                        So while not as serious as TC, teratoma can cause problems, however, I have no idea why your doc is jumping to that conclusion, especially with a pure seminoma, it is a bit unusual.

                        Dave
                        Last edited by Davepet; 04-12-18, 11:35 PM.
                        Jan, 1975: Right I/O, followed by RPLND
                        Dec, 2009: Left I/O, followed by 3xBEP

                        Comment


                        • #27
                          So I'm waiting for a mild flu to end to get blood count tests and abdomen Ct-Scan ordered by last oncologist I saw. Should I wait until this flu is gone since I still feel some throat discomfort, or get them now.? I just feel flu may alter these tests, but not sure about that.
                          The other thing I question myself a lot is if I should get the Chest Ct-Scan the same day I do the Abdomen Ct-Scan since I have an order from the another Dr. to do so.

                          I really wish my treatment was defined now, and not sure if Surgery RPLND is the right path to go as suggested by oncologist. Something that really frightened me was what the Urologist told me that the 18x14 mm aortocaval node is actually bigger. According to him it's about 32mm instead. I mentioned this to the Oncologist and He said well I'm not a radiologist so I just read the report and didn't want to check the CD imaging.

                          This makes confused.
                          Last edited by mauroeg7; 04-12-18, 10:31 PM.
                          39 year old diagnosed Right Mass as per U/S
                          Pre/o CT-Scan Chest Xray all Clear march 24 2017
                          Right I/O April 8th 2017
                          Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
                          Tumor Markers never elevated
                          Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
                          May 11 BHCG Mild elevated 3.1 Reference Value 2.7
                          May 25 2018 Chest CT-Scan Clear
                          May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

                          Comment


                          • #28
                            Originally posted by mauroeg7 View Post
                            The other thing I question myself a lot is if I should get the Chest Ct-Scan the same day I do the Abdomen Ct-Scan since I have an order from the another Dr. to do so.
                            They can do both in one scan, no reason to not do so if you are given the option.

                            Originally posted by mauroeg7 View Post
                            I mentioned this to the Oncologist and He said well I'm not a radiologist so I just read the report and didn't want to check the CD imaging.
                            I would seriously consider finding a new oncologist. Yours does not seem like someone I would trust.

                            Dave

                            Jan, 1975: Right I/O, followed by RPLND
                            Dec, 2009: Left I/O, followed by 3xBEP

                            Comment


                            • #29
                              Hello So few weeks back I did my abdomen and pelvis MRI and Chest CT-Scan as recommended by my Urologist whom did not want another abdomen CT-Scan due to too much radiation to my abdomen since I have already had two in less than a year. The chest CT only showed a 5.5 mm lymph node of reactive aspect close to the windpipe but everything else was clear. However, the MRI is showing the aortocaval node is now 35mm so its size has increased a little. Other thing important to mention that BHCG came with a slight increase, it has nver been elevated before or after I/O but on May 11 BHCG was 3.13 reference value being 2.6. I repeated blood markers again on June 16 and BHCG was 3.16 same reference value 2.6. AFP and LDH are clear so far.

                              My urologist had some meeting board with another uologists and onlcologists, he said after discussing my situation they all agree to do Chemo, also my urologist now wants me to get some ultrasound of my other testicle eventhough he did not find anything abnormal but Urologist wants to discard since BHCG is a bit elevated. I m scheduling appointment to the Oncologist next week to determine my best treatment options

                              Appreciate your comments based on your experience

                              Also, I'm from Colombia so apologies if my English is bad
                              Last edited by mauroeg7; 07-07-18, 01:21 PM.
                              39 year old diagnosed Right Mass as per U/S
                              Pre/o CT-Scan Chest Xray all Clear march 24 2017
                              Right I/O April 8th 2017
                              Path report 100% Pure Seminoma Tumor Size 2.5cm x 1.3cm no invasion/surveillance decided
                              Tumor Markers never elevated
                              Chest Xray clear Ct-Scan January 28 2018 shows 18x14 mm aortocaval node.
                              May 11 BHCG Mild elevated 3.1 Reference Value 2.7
                              May 25 2018 Chest CT-Scan Clear
                              May 31 2018 MRI showing aortocaval node is now 35mm, everything else clear

                              Comment


                              • #30
                                I have not scrolled back, but have you reached out to Dr. Lawrence Einhorn via email? Please do so at leinhorn@iu.edu if you lay out your info above.
                                I do not think your HCG is high enough to be a red flag. They can redo in another 2 weeks. The imaging is what I want Dr. E to chime in on as I know countries outside the US treat TC in different ways.
                                Son Grant
                                dx 12/21/16 at age 17

                                BEP x3
                                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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