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  • RPLND Post Chemo

    Hi everyone. I was diagnosed with stage II seminoma back in December '11. After surgery, I've been been going through chemo. I've finished my third week. The chemo has reduced the size of the tumor in my lymph node, but my tumor markers have been rising. My urologist thinks there is some non-seminoma in that area. She suggested RPLND, post-chemo.

    Is there anyone who had this done? I'm scared to death.
    Jan 2000 Left I/O
    Surveillance
    Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
    Pathology report 100% pure seminoma
    March 5 2012 started chemo 4xEP
    May 11, 2012 Finished Chemo.
    October 29, 2012 All Clear.

  • #2
    I had a post chemo RPLND done 3 weeks ago to treat Stage II- non-sem cancer. I spent a week in the hospital and have been home for 2 weeks. I haven't started driving yet, but I feel like I could drive. Appetite hasn't fully returned yet but I am slowly regaining my strength back.

    I personally don't know why your markers would be rising, but there are a lot more people on this site who know more about the subject than me.

    Comment


    • #3
      Originally posted by youngster View Post
      I had a post chemo RPLND done 3 weeks ago to treat Stage II- non-sem cancer. I spent a week in the hospital and have been home for 2 weeks. I haven't started driving yet, but I feel like I could drive. Appetite hasn't fully returned yet but I am slowly regaining my strength back.

      I personally don't know why your markers would be rising, but there are a lot more people on this site who know more about the subject than me.
      Thanks. They're not really 100% sure why they are either. They're going to do more tests. They've gone from 4 to 8 in about a month. All my other labs seem to be fine.

      I've read that this is a difficult procedure. It looks like you're recovering well.
      Jan 2000 Left I/O
      Surveillance
      Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
      Pathology report 100% pure seminoma
      March 5 2012 started chemo 4xEP
      May 11, 2012 Finished Chemo.
      October 29, 2012 All Clear.

      Comment


      • #4
        I had an RPLND post BEP because my markers had stabilized at above the normal range. If your makers (by the way which marker are you referring to, a specific one, or all of them?) start to rise it's usually indicative of some chemo-resistant cells that need to be surgically removed. The RPLND sucks, but after about two months or a little less you wont feel anymore discomfort, and you should be mobile in 2-3 weeks. I'd make sure you have a surgeon that has done it a few times with a good reputation. Best of luck, and you'll be out of the hospital and back to your life in no time
        Kick testicular cancer in the balls
        9/2010 Pure Embryonal Carcinoma
        10/2010 right orchiectomy
        6/2011 HCG up to 300 6/27/2011 3XBEP
        7/2011 HCG up to 1500
        8/2011 HCG down to 6
        8/25/2011 mass in abdomen
        9/23/2011 RPLND
        11/2011 HCG up to 37 masses in lungs and lymphnodes 11/2011 1X TIP
        12/2011 HCG up to 400
        12/2011-1/2012 2x HDC carbo/etopiside with Dr. Einhorn 3/2012-5/29/2012 50mg oral etopiside
        1/2012-present HCG >0.5

        Comment


        • #5
          Originally posted by zbot View Post
          I had an RPLND post BEP because my markers had stabilized at above the normal range. If your makers (by the way which marker are you referring to, a specific one, or all of them?) start to rise it's usually indicative of some chemo-resistant cells that need to be surgically removed. The RPLND sucks, but after about two months or a little less you wont feel anymore discomfort, and you should be mobile in 2-3 weeks. I'd make sure you have a surgeon that has done it a few times with a good reputation. Best of luck, and you'll be out of the hospital and back to your life in no time
          Thanks. It's good to know that there are quite a few that have had it, and have moved on. My Urologist referred me to a doctor in San Antonio, named Dr. Perekh. From what she says, he's an outstanding surgeon.
          Jan 2000 Left I/O
          Surveillance
          Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
          Pathology report 100% pure seminoma
          March 5 2012 started chemo 4xEP
          May 11, 2012 Finished Chemo.
          October 29, 2012 All Clear.

          Comment


          • #6
            My husband had a post 4*BEP chemo, RPLND. He was in surgery for about 8 hours. His tumor was mixed germ cell and not a text book case. They woke him up the next day. He was in the hospital only a few days. I have a picture of him on here at home after his RPLND, he had staples put in. We got a hospital bed and a shower stool from the cancer society for him to sleep on when he got home from the hospital. It was hard for him to move around for awhile and he had to cover his staples when he took a shower, no baths. Make sure the doctor you have doing it, is the one who does it the most. This is a very rarely performed surgery. Most people when we put it on his history have no clue what it is, but then again most of what he's gone through is not understood by the general public. If you have specific questions I will ask him for you.
            Diagnosed Mixed Germ Cell tumor Carcinoma and classic seminoma StageIIC 6*8cmbulky June 26-08
            Left I/O June 26-08 4*BEP July-08-Sept-08
            Mets to Abdomin/chest,
            Stage III, , 6*8 cm Jul 08
            Markers normalized Nov08, residual tumor 3*2cm in abd. 13mm in chest. Spinal Stenosis,Neuropathy RPLND feb 09
            Found all three: Cancer, teratoma and scar tissue
            10/09 B-HCG up to 39.90, recurrent TC, 2*VIP 12/09, TI started 05/11/2010, stem cell infusion 5/18/2010 day of rebirth
            08/10 all clear

            Comment


            • #7
              Originally posted by starjayroman View Post
              My husband had a post 4*BEP chemo, RPLND. He was in surgery for about 8 hours. His tumor was mixed germ cell and not a text book case. They woke him up the next day. He was in the hospital only a few days. I have a picture of him on here at home after his RPLND, he had staples put in. We got a hospital bed and a shower stool from the cancer society for him to sleep on when he got home from the hospital. It was hard for him to move around for awhile and he had to cover his staples when he took a shower, no baths. Make sure the doctor you have doing it, is the one who does it the most. This is a very rarely performed surgery. Most people when we put it on his history have no clue what it is, but then again most of what he's gone through is not understood by the general public. If you have specific questions I will ask him for you.
              Thank you. I'm still hoping and praying, I won't have to go through with it. But, if I do, then I do. This too, shall pass. My oncologist is still trying to get a PET scan approved, so that we can get an idea why the AFP is rising. The insurance intially denied the PET.
              Jan 2000 Left I/O
              Surveillance
              Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
              Pathology report 100% pure seminoma
              March 5 2012 started chemo 4xEP
              May 11, 2012 Finished Chemo.
              October 29, 2012 All Clear.

              Comment


              • #8
                Originally posted by zbot View Post
                If your makers (by the way which marker are you referring to, a specific one, or all of them?) start to rise it's usually indicative of some chemo-resistant cells that need to be surgically removed.
                By markers, I was referring to Alpha-fetoprotein.
                Jan 2000 Left I/O
                Surveillance
                Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
                Pathology report 100% pure seminoma
                March 5 2012 started chemo 4xEP
                May 11, 2012 Finished Chemo.
                October 29, 2012 All Clear.

                Comment


                • #9
                  I think you should get a second oncology opinion and maybe see if you can fly up to Indiana University and see Dr. Einhorn. AFP rising from 2 or 4 to 8 is suspicious, but I don't think that means you need to jump right in with the RPLND. An RPLND surgery on seminoma is extremely rare because it's an incredibly difficult surgery because of how hard seminoma is. I'd suggest a second oncology opinion because they'll get a second read on your original pathology slides to see if it's really pure 100% seminoma that you're dealing with. If the 2nd op "discovers" some non-seminoma then yes, an RPLND might be warranted, but more chemo might be another option first. Seminoma will never elevate your AFP so your oncologist is right to suspect maybe there could be some non-seminoma, but that's what a second opinion at a center of excellence is for. Do that before jumping right in with a surgery which might not even be the best and correct course of action.
                  Steve
                  My CaringBridge Site
                  February 2011 - DX Stage IIB, 90% Embryonal Carcinoma, 10% Yolk Sac
                  Mar-May 2011 - EPx4 per Dr. Bosl at MSKCC, administered locally in DC
                  22-Jun 2011 - RPLND with Dr. Sheinfeld at MSKCC, all 51 nodes removed negative incl 1.4cm post chemo node
                  Dec 2013 - 2.5 YEARS ALL CLEAR!

                  Comment


                  • #10
                    I had post bep. Had rplnd by respect dr. He wasn't worried about doing post rplnd.

                    Comment


                    • #11
                      Originally posted by S P View Post
                      I think you should get a second oncology opinion and maybe see if you can fly up to Indiana University and see Dr. Einhorn. AFP rising from 2 or 4 to 8 is suspicious, but I don't think that means you need to jump right in with the RPLND. An RPLND surgery on seminoma is extremely rare because it's an incredibly difficult surgery because of how hard seminoma is. I'd suggest a second oncology opinion because they'll get a second read on your original pathology slides to see if it's really pure 100% seminoma that you're dealing with. If the 2nd op "discovers" some non-seminoma then yes, an RPLND might be warranted, but more chemo might be another option first. Seminoma will never elevate your AFP so your oncologist is right to suspect maybe there could be some non-seminoma, but that's what a second opinion at a center of excellence is for. Do that before jumping right in with a surgery which might not even be the best and correct course of action.
                      Thanks. I'll definately get a second opinion. I had a PET scan in January, and it didn't show anything out of the ordinary, other than the tumor that is in my lymph node, The CT scan that I had a couple of weeks ago, showed no signs of the tumor spreading, and the tumor in my lymph node has shrunk in half. So, if there is any cancer there, it has to be pretty small. So, yeah, I'm not going to jump into getting an RPLND, because it's not something I want to do. Being laid up all summer, isn't my idea of fun. I'm still confused as to why my oncologist referred me back to my urologist, because she knows less than he does, when it comes to cancer. Right away she suggested RPLND, but made it clear she wasn't going to perform it, because of the difficulty.
                      Jan 2000 Left I/O
                      Surveillance
                      Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
                      Pathology report 100% pure seminoma
                      March 5 2012 started chemo 4xEP
                      May 11, 2012 Finished Chemo.
                      October 29, 2012 All Clear.

                      Comment


                      • #12
                        Originally posted by Rush67 View Post
                        Thanks. I'll definately get a second opinion. I had a PET scan in January, and it didn't show anything out of the ordinary, other than the tumor that is in my lymph node, The CT scan that I had a couple of weeks ago, showed no signs of the tumor spreading, and the tumor in my lymph node has shrunk in half. So, if there is any cancer there, it has to be pretty small. So, yeah, I'm not going to jump into getting an RPLND, because it's not something I want to do. Being laid up all summer, isn't my idea of fun. I'm still confused as to why my oncologist referred me back to my urologist, because she knows less than he does, when it comes to cancer. Right away she suggested RPLND, but made it clear she wasn't going to perform it, because of the difficulty.
                        I had one post 3xBEP and its not fun, but certainly something you can deal with if its needed. however I would side with many of the people who have already made the comment that you should get a second opinion. I would recommend Dr. E and Dr. Foster @ IU. If you are going to travel and get it done, you might as well get it done with the best (or the people at Sloan not putting them down either!).
                        11/21 Diagnosis
                        - EC 45%, Yolk Sac 40%, Teratoma 14%, Sematoma 1% w/ LVI
                        - CT no remote mets, RPLNs largest 4.2cm, few <1cm, Liver/Kidneys/Lungs/Brain CLEAR!

                        11/25 - Left I/O AFP:2715,HCG:503,LDH:289
                        12/8 - Post I/O AFP:855,HCG:304,LDH:NORMAL!
                        2/20 - 3xBEP DONE! AFP:5.8 HCG:<1
                        4/15 - RPLND Residual Necrosis/Teratoma removed
                        http://takingcancerdownoneballatatime.blogspot.com/

                        Comment


                        • #13
                          Monday I'm going to San Antonio to see Dr. Parekh. Hopefully, all my questions will be answered, and he'll decide whether I should get the RPLND, or not. Hopefully not. At that time I'll request we get a second opinion on the pathology report.
                          Jan 2000 Left I/O
                          Surveillance
                          Dec 2011 cancer diagnosed in right testicle, and lymph node, followed by I/O
                          Pathology report 100% pure seminoma
                          March 5 2012 started chemo 4xEP
                          May 11, 2012 Finished Chemo.
                          October 29, 2012 All Clear.

                          Comment

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