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  • Pathology report - input please!

    Hi All -

    I'm Patrick and I'm relatively new here.

    To make a long story short, I'm a 27 year old guy living in NYC. I saw my PCP and had an ultrasound on 1/23/12, got told it was a "solid mass" that day, saw a urologist the next day who said it needed to come out ASAP, had my I/O last week on 2/1/12.

    I got my pathology report back on Tuesday of this week (2/7) and just wanted some opinions from the ones with experience

    I have an appointment next week (on 2/14) with a medical oncologist and the following week with a radiation oncologist (on 2/22). I'm going to go to both with an open mind but of course the treatment vs. surveillance question is all I can think about.

    So here's what the pathology report said:

    -- Seminoma, classic
    -- Tumor size: greatest dimension of main tumor mass: 4.5cm (nodules from 0.9 to 2.2cm) [this is considered large, yes?]
    -- Macroscopic extent of tumor: confined to the testis
    -- Margins: spermatic cord margin: uninvolved by tumor
    -- Microscopic tumor extension: Rete testis [what does this mean? doesn't sound good.]
    -- Lymph-Vascular Invasion: Present
    -- Pathologic staging: pT 2, Nx, Mx
    pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis

    Sooooooo...

    I had CT scans done the day before my surgery and they are clear. My urologist staged me at IB.

    Based on some reading, it sounds like the size of my tumor and the whole rete testis thing (whatever that means) give me some risk factors that may make a relapse a bigger possibility. True?

    I didn't get a copy of the blood work, but he did tell me that my bhcg was at 57 before the surgery. I would love if someone could explain this number to me -- I know that bhcg is not supposed to be present in a man so it should be at 0, correct? What does 57 mean? Is that way off the chart?? Also not really sure what this number means going forward from here -- is it more of a tool to identify the presence of cancer and will become less important post-op?

    Lastly, the big question -- treatment vs. surveillance? I know this is to be discussed with my doctors in the next few weeks but I just wanted to see what everyone thought. What I'm gathering from stuff I've read is that the size of my tumor, lymph-vascular presence thing, the rete testis thing all sound like surveillance may not be the best way to go at this point. Sounds like I may need to be more aggressive. Would ya'll agree?

    Sorry for the length of this -- I've noticed lately that I tend to word vomit when it comes to testicular cancer!!

    Any and all thoughts would be appreciated.

    Best,

    Patrick
    Patrick
    29 years old

    U/s on 1/23/12, I/O on 2/1/12

    Stage IB
    Classical seminoma, 4.5cm, RT invasion, LVI, no spermatic cord margin invasion.
    CT scans clear
    pre op bHCG: 57, post op: 2.4
    On surveillance:
    Clear: 5/17/12, 8/23/12
    11/29/12 -- CT scan shows 1 enlarged retroperitoneal lymph node 20mmx15mm, stage changed to IIA
    12/17/12 - 3/17/13 -- EPx4 @ MSKCC
    Clear: 3/7/13, 3/28/13, 5/2/13, 5/30/13, 6/27/13, 7/25/13, 9/5/13, 10/10/13, 11/7/13, 12/16/13, 2/19/14, more to come...

  • #2
    Newer studies have not been able to confirm that rete-testis invasion, lymph-vascular invasion, or larger tumor sizes are actually risk factors for a higher rate of relapse for pure seminoma. beta-HCG should basically be zero in men, yes. You should be getting repeat bloodwork done 7-10 days after the I/O (around now) to see where the numbers still are. They should be back to nil, which would confirm you're Stage IB. If they're still elevated though, you'd be staged "IS" (persistent marker elevation with negative CT scans) for which the treatment is primary chemo, 4xEP/3xBEP. I would expect your markers are probably normal by now. Since your I/O was on the 1st, having your markers checked at your first onco appointment on the 14th is fine.

    Surveillance is the preferred option believe it or not. Assuming everything checks out and you're still clinically stage I, it's 80-90% likely that you're already cured just from the I/O alone regardless of tumor size or rete testis invasion or LVI or anything. Adjuvant chemo (carboplatin) or radiation therapy (RT) are also options though that will drop your odds of relapse down to a few percent, but it's 80-90% likely you don't need it. It's a personal decision. Everybody and their preferences and situations are all different, so there's not really a wrong way to go. Just what works for you best.

    Steve - My CaringBridge
    Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
    My Survivorship Thread (all my links)
    Now Blogging for the Testicular Cancer Awareness Foundation

    Comment


    • #3
      Thank you so much for the thoughts -- I can't tell you how much I appreciate it. Sorry, I should've added - I am having blood work done on Monday 2/13.
      Patrick
      29 years old

      U/s on 1/23/12, I/O on 2/1/12

      Stage IB
      Classical seminoma, 4.5cm, RT invasion, LVI, no spermatic cord margin invasion.
      CT scans clear
      pre op bHCG: 57, post op: 2.4
      On surveillance:
      Clear: 5/17/12, 8/23/12
      11/29/12 -- CT scan shows 1 enlarged retroperitoneal lymph node 20mmx15mm, stage changed to IIA
      12/17/12 - 3/17/13 -- EPx4 @ MSKCC
      Clear: 3/7/13, 3/28/13, 5/2/13, 5/30/13, 6/27/13, 7/25/13, 9/5/13, 10/10/13, 11/7/13, 12/16/13, 2/19/14, more to come...

      Comment


      • #4
        Yup, so you're I-B as your doc said. Steve covered the basics, though I do need to note a point. The odds of having been cured by the I/O with I-B seminoma are closer to 75-85%. Either way, you do have the three options of surveillance, adjuvant radiation, or adjuvant chemotherapy. All three if followed appropriately will confer a near 100% chance of disease-specific survival, so that is why all of them are considered equally good. Adjuvant radiation and chemo will decrease the odds of relapse to 2-5%, and will keep going down as time goes by.

        Seminomas sometimes produce HCG, so in your case, you need to ensure your markers go down before deciding on the course of action. Have you been scheduled for post-op bloodwork?
        "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
        11.22.06 -Dx the day before Thanksgiving
        12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

        Comment


        • #5
          Hey, thanks for this. Yes, having my post-op blood work done on 2/13 (the day before my appt with the medical oncologist.)
          Patrick
          29 years old

          U/s on 1/23/12, I/O on 2/1/12

          Stage IB
          Classical seminoma, 4.5cm, RT invasion, LVI, no spermatic cord margin invasion.
          CT scans clear
          pre op bHCG: 57, post op: 2.4
          On surveillance:
          Clear: 5/17/12, 8/23/12
          11/29/12 -- CT scan shows 1 enlarged retroperitoneal lymph node 20mmx15mm, stage changed to IIA
          12/17/12 - 3/17/13 -- EPx4 @ MSKCC
          Clear: 3/7/13, 3/28/13, 5/2/13, 5/30/13, 6/27/13, 7/25/13, 9/5/13, 10/10/13, 11/7/13, 12/16/13, 2/19/14, more to come...

          Comment


          • #6
            Hi all,

            Just an update on this -- I saw the medical oncologist on Tuesday and really liked him. I am still going to see a radiation oncologist next week to hear what he has to say, but the medical oncologist has recommended the surveillance route.

            He had the results of my blood work and said that my bHCG is at 2.4 post op. Does that sound right? Again, still not sure what a normal range is supposed to be... I know it was 57 before the surgery. He was happy with this number but I guess I thought it was supposed to be at 0.

            Anyway, we'll see what the radiation oncologist says next week but I was already in favor of doing surveillance so I think that's the way I'm leaning.

            Thanks again for all -

            Patrick
            Patrick
            29 years old

            U/s on 1/23/12, I/O on 2/1/12

            Stage IB
            Classical seminoma, 4.5cm, RT invasion, LVI, no spermatic cord margin invasion.
            CT scans clear
            pre op bHCG: 57, post op: 2.4
            On surveillance:
            Clear: 5/17/12, 8/23/12
            11/29/12 -- CT scan shows 1 enlarged retroperitoneal lymph node 20mmx15mm, stage changed to IIA
            12/17/12 - 3/17/13 -- EPx4 @ MSKCC
            Clear: 3/7/13, 3/28/13, 5/2/13, 5/30/13, 6/27/13, 7/25/13, 9/5/13, 10/10/13, 11/7/13, 12/16/13, 2/19/14, more to come...

            Comment


            • #7
              By our lab <4 is normal.

              The 1/2-life of hCG is 3 days, so since the first you would have gone through 5 half-lives, and your # is perfectly in line with that, so you can definitely breath easy. Assuming you go with surveillance (based on your stated preference) - when is your followup - 3 months?
              Tracy
              Cancer pharmacologist, caregiver blog here

              Wife to Kel, dx 12/30/11 Stage IIIc (poor) embyronal, AFP 13700, 10x11 cm retroperitoneal mass, 1 cm^2 lung met
              Left I/O 12/31/10.
              4xBEP 1-4/11, AFP=22, 5*7 RP mass, tx failed
              1.5 x VeIP 5-6/11; tx failed, AFP/b-hCG rising
              Salvage RPLND @Indy 6/29/11, metastatic mixed germ cell tumor with yolk sac, seminoma and teratoma
              Remission! AFP steady since 9/2011; 2+ years ALL CLEAR

              Comment


              • #8
                Yes, first follow up would be in 3 months (so first week of May).

                Thanks for the info on the bHCG -- breathing easier now!!
                Patrick
                29 years old

                U/s on 1/23/12, I/O on 2/1/12

                Stage IB
                Classical seminoma, 4.5cm, RT invasion, LVI, no spermatic cord margin invasion.
                CT scans clear
                pre op bHCG: 57, post op: 2.4
                On surveillance:
                Clear: 5/17/12, 8/23/12
                11/29/12 -- CT scan shows 1 enlarged retroperitoneal lymph node 20mmx15mm, stage changed to IIA
                12/17/12 - 3/17/13 -- EPx4 @ MSKCC
                Clear: 3/7/13, 3/28/13, 5/2/13, 5/30/13, 6/27/13, 7/25/13, 9/5/13, 10/10/13, 11/7/13, 12/16/13, 2/19/14, more to come...

                Comment

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