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  • Treatment options?

    Hi all,

    Just looking for some advice on treatment options. I had a 4.5cm pure seminoma, left testicle removed one year ago. We decided to do surveillance although the surgeon noted there were several "prominent" lymph nodes that were around 1.2cm. About four months later I started having abdominal pain/aching that would occasionally wake me up at night and was persistent throughout the day. More recent imaging found a single node that was over 3.5cm. There are still other nodes that are larger than 1 cm but I am not sure if they are of concern or not. There are also several spots on my lungs but the oncologist was not too concerned. I have only seen a radiation oncologist since the diagnosis, and he recommended treating with radiation from about t-10 down to and including the other testicle. I am not sure if you would be able to feel metastasis into the lungs but I had seen my GP about a week before I found out about the spots because of shortness of breath to up my asthma medication dose.

    I am wondering if I should be concerned about the other lymph nodes and my lungs and if I should also talk to a medical oncologist. If I have a choice should I go with chemo or rads? Any advice you can give is appreciated, this site has been a great resource already. Thanks all.

  • #2
    MXS,

    I would most definitely suggest seeing a medical oncologist, preferably one with TC experience/GU expertise.

    Originally posted by Mxs View Post
    There are also several spots on my lungs but the oncologist was not too concerned.
    On what basis is there no concern for lung nodes? The path of TC spread is pretty clear cut the majority of the time - testicle, RP nodes, lungs. You are stage IIb/III if the lung nodes are seminoma - did he give a reason for not thinking they are TC? Do you have a report on the size and location of the nodes?

    NCCN guidelines for IIB offer an option between radiation and chemo (3xBEP or 4xEP), and all stage III is chemo ... given the lungs, I would definitely suggest that second opinion.
    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

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    • #3
      Thanks so much for the reply, I was leaning towards seeing the medical onc but wasn't sure if I was just being paranoid. All I know about the lymph nodes is that there were several prominent para-aortic nodes on the left side, I am not sure what size would make them of concern though. As far as the lungs go, the spots were quite small and they thought they could be attributed to environmental causes like pollution etc. The abdominal pain was definitely in the same area as the nodes and I would recommend to anyone that if something doesn't feel right get it checked out.

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      • #4
        I would STRONGLY recommend that you see a medical oncologist. My understanding is that any node over 1.0 cm is something of concern. And I have never heard of any circumstance in which radiation would be intentionally directed to the remaining testicle. The radiation oncologist I met with (at the behest of my medical oncologist, who thought it was best for me to be as informed as possible) specifically explained that they place a clamshell-like device over the remaining testicle to minimize its exposure to radiation.

        I agree with Tracy that 3xBEP or 4xEP would be the preferred course of treatment at this point, given the lung nodes and the possibility that you are now Stage III.

        John
        JPM

        March 2011: Right I/O, Stage IA classic seminoma, 5.0 x 4.5 x 3.5 cm
        May 2011: Single-Agent Carboplatin
        Currently ALL CLEAR

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        • #5
          Thanks for the reply JPM. I had always heard that a shield was used to so I asked specifically about it but they said they were concerned about the other testicle and needed to include it in the target area for radiation. This would mean 100% chance of instant sterility after the first treatment, although they said testosterone production should come back after treatment. I haven't found anything else on this either.

          On a side note, I found an abstract for a study done on using lead shields to decrease scatter radiation to the testicles from routine diagnostic imaging - http://www.ajronline.org/content/184/1/128.full -
          Last edited by Mxs; 11-14-12, 02:52 PM.

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          • #6
            MXS,

            Not only would I strongly recommend you see a medical oncologist, I strongly recommend you see a different radiation oncologist.

            First, testicular cancer does not spread from one testicle to the other. If you get a second case of TC, it is a NEW primary, not a recurrence of your first primary cancer.

            Second, the NCCN Guidelines specifically state the following for radiation treatment: "All patients, with the exception of those who have undergone bilateral orchiectomy, should be treated with a scrotal shield." (Page TEST-A, 1 of 5) (page 20 of 55 in the PDF).

            I fear that this radiation oncologist has little or no experience dealing with testicular cancer patients. Again, given the prominence of nodes and the possibility of further spread to the lungs, I would think chemo is the only reasonable option. Please, please find yourself a medical oncologist.

            John
            JPM

            March 2011: Right I/O, Stage IA classic seminoma, 5.0 x 4.5 x 3.5 cm
            May 2011: Single-Agent Carboplatin
            Currently ALL CLEAR

            Comment


            • #7
              Thanks again for the info, John. I called to make an appt with the medical oncologist today and they think they can get me in to see him really soon. Really glad I didn't give the go ahead for radiation before looking into it, and I am extremely happy to have found this site. After reading lots of the other posts it seems like there are some really amazing people here.

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