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Right orchiectomy done, 80% yolk sac, 20% embryonal carcinoma. What next?

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  • Right orchiectomy done, 80% yolk sac, 20% embryonal carcinoma. What next?

    Hello,

    My name is Cristian, I'm 27 y/o.

    Was suspected of TC so I had a right orchiectomy last month. Results are 80% yolk sac, 20% embryonal carcinoma. No evidence of lymphvascular invasion and from the IRM it seems that the cancer has not spread anywhere else (post operation exam shows: pT1).

    I've discussed with several oncologists so far and some recommend chemo while others recommend a 'wait and see' alternative. I've been reading for the few weeks on the internet, on forums and I wanted to see what others are saying too, so this is the reason I am posting here.

    Personally, I would not want to do chemo, I would prefer to wait and see, check everything once 2-3 months in this first year.

    My AFP prior to the orchiectomy was 33. Now, 4 weeks after the operation it is at 9.90 (so it is normal). LDH and BCG were both normal/low prior and after operation.

    I hope I provided all the necessary details to get some opinions on how to proceed. Please let me know if there are any details that will allow for a more accurate opinion.

    Sorry if my English is not very good.
    Thank you in advance,
    Cristian

  • #2
    Given for info, you can do either chemo or surveillance. You still have a risk of relapse, around 30% i believe. But if you can keep toa schedule and are ok with the regularctscans, surveillance is a good choice.
    7/15/11 Right I/O
    90% EC, 10% Seminoma, LVI, CT scan and Chest x-rays clear
    8/22/11 RPLND, all clean

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    • #3
      Sorry for not posting in so long. I opted for surveillance and 2 years have passed, all clear.

      At that time I talked to several other doctors, I did a lot of research and I decided to go with surveillance. I don't know if I was lucky or I took a correct decision, but it ended up well so far.

      Great forum, great info, if anyone is in a position similar to that in my first post, do not hesitate to contact me, send me a PM, and I will help how I can.

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      • #4
        Originally posted by ChrisRO View Post
        I don't know if I was lucky or I took a correct decision, but it ended up well so far.
        Well, you made the same decision the leading experts are now leaning towards more & more. That is to treat as little as possible, knowing that in the event of a recurrence , the odds of survival are exactly the same as treating early. I would say you made the correct decision, you were already cured & were able to avoid the unpleasant & sometimes permanent effects of further treatment. The odds were strongly in your favor.

        Thanks for posting an update!

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

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        • #5
          Yeah as time goes on more and more experts are recommending surveillance, at least for Stage I that isn't choriocarcinoma or matured teratoma.

          When I was trying to make that decision I had emailed some with Dr. Einhorn who said something like "Surveillance is never a bad decision".

          Surveillance is what I, too, opted for - unfortunately I was in the group of people who's cancer did recur in the lymph nodes. But still, it was treatable. I'd still choose surveillance in the same circumstance, there's just no way to know if it will recur or not.

          Glad you're doing well!
          Jan. 3rd 2011 - Right I/O. May 2011, recurrence; RPLND, 2xBEP.

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          • #6
            Originally posted by zak0691 View Post
            Surveillance is what I, too, opted for - unfortunately I was in the group of people who's cancer did recur in the lymph nodes. But still, it was treatable.
            Your case is exactly the point, Zak. There was probably a 70% or better chance you were already cured when you chose surveillance, but even though it did come back. there was further treatment available to take it out. While some chemo lite may have eliminated that problem, it also might not have done so & you gave yourself the best chances by avoiding treatment you might not have needed.

            I think we should all feel fortunate that we have these options, most cancer patients have no options that include long term survival. With TC, most of us can survive & have pretty much normal lives. I think that is something to celebrate.
            Jan, 1975: Right I/O, followed by RPLND
            Dec, 2009: Left I/O, followed by 3xBEP

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