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  • Second month surveillance show elevated HCG

    Hey guys, this is my first post. I will try to make it brief. I hope someone knows of a similar case and can point me to some helpful articles or just give their advice/opinion.

    I was diagnosed with TC on July 10th, 2013 and had an orchiectomy of my right testicle on the 15th of the same month. The mass was large at 4.5cm and the biospy came back Seminoma (70%); embryonal (20%); yolk sac tumor (5%); teratoma (5%). I was lucky, as the cancer was only found in the testicle (no other involvement and the CT-Scans came back negative).

    I was good candidate for surveillance and felt relieved to have that option, so I took it. During my second month check up, my beta HCG came up high, at 3.4. My pre-op beta HCG was 4.8 and my post op and first month beta HCG was below 3 (the results were not more specific). My pre op AFT was 8.2, post op 4.3, first month 1.8, and currently they are 1.7. My chest X-ray remains clear.

    I understand that the HCG is an excellent tumor marker, but is it possible that it fluctuates to 3.4 for benign reasons? That's probably wishful thinking, but I would like to know what the evidence is on patients that relapse during surveillance, specifically with respect to the HCG and it's reliability.

    I'm still waiting to hear from my oncologist. My urologist said that the oncologist will most likely want CT-Scans done in order to decide about the next course of action.

    Thank you everyone, this is such a great forum.

  • #2
    Originally posted by BoilerMaker View Post
    Hey guys, this is my first post. I will try to make it brief. I hope someone knows of a similar case and can point me to some helpful articles or just give their advice/opinion.

    I was diagnosed with TC on July 10th, 2013 and had an orchiectomy of my right testicle on the 15th of the same month. The mass was large at 4.5cm and the biospy came back Seminoma (70%); embryonal (20%); yolk sac tumor (5%); teratoma (5%). I was lucky, as the cancer was only found in the testicle (no other involvement and the CT-Scans came back negative).

    I was good candidate for surveillance and felt relieved to have that option, so I took it. During my second month check up, my beta HCG came up high, at 3.4. My pre-op beta HCG was 4.8 and my post op and first month beta HCG was below 3 (the results were not more specific). My pre op AFT was 8.2, post op 4.3, first month 1.8, and currently they are 1.7. My chest X-ray remains clear.

    I understand that the HCG is an excellent tumor marker, but is it possible that it fluctuates to 3.4 for benign reasons? That's probably wishful thinking, but I would like to know what the evidence is on patients that relapse during surveillance, specifically with respect to the HCG and it's reliability.

    I'm still waiting to hear from my oncologist. My urologist said that the oncologist will most likely want CT-Scans done in order to decide about the next course of action.

    Thank you everyone, this is such a great forum.
    Mine was 100% EC, with VI. Preop, HCG was clear, AFP was slightly elevated. Postop, HCG remained clear, AFP dropped within norms.

    Fast forward three weeks, HCG was slightly elevated. Docs are 80% sure I'll end up with 3xBEP because of it. There's about a 10% chance that the fluctuation was due to other reasons.

    All that said, I went to my GP yesterday for a cough and came out with a chest xray that isn't good.

    Comment


    • #3
      bHCG of 3.4 is still really low. I personally would wait a couple of weeks and have it checked again to check for a trend.
      Tony

      Diagnosed 4/12/12
      AFP 31, HCG 32
      I/O 4/25/12
      Nonseminoma Stage 1S
      Embryonal Carcinoma 95%, Yolk Sac 5%
      Lymphatic Invasion, Markers did not normalize
      BEPx3 Finished 8/5/12
      Post Chemo APF 2 HCG Undetectable

      Comment


      • #4
        CT Scans came back negative. Bit of very good news. I am surprised how high the highs can be and how low the lows can be.
        I am still scheduled to see my oncologist on Friday.

        Comment


        • #5
          If it is a relapse, a B-HCG of 3.4 is low, and I cannot imagine that a CT scan would show anything.

          The key is: is there an upward trend? They should retest you a couple of weeks after the last test, and see if it was a fluke reading, or if the B-HCG is trending upward.

          Good luck!
          Heidi

          Husband - age 51
          10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
          11/1/10 4X BEP
          12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
          2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
          6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
          Surveillance since 6/11

          Comment


          • #6
            Here's what the Testicular Cancer Resource center dictionary has to say about hCG:
            Human Chorionic Gonadotropin (hCG), beta subunit - In adults, significant elevation of levels of beta HCG occurs only during pregnancy and in patients with trophoblastic neoplasms or nonseminomatous germ cell tumors. As a result, it is used as a tumor marker. Essentially, 100 per cent of patients with trophoblastic tumors and 40-60 per cent of patients with nonseminomatous germ cell tumors, including all patients with choriocarcinoma, 80% of patients with embryonal carcinoma, and 10-25% of patients with pure seminoma are diagnosed with elevated levels of beta HCG. The serum half life of beta hCG is 24 to 36 hours, which implies that elevated concentrations should return to normal within 5 to 7.5 days after surgery if all tumor is removed. Please note that the normal HCG level is usually less than 5 miu/ml. Also note that the HCG level can become elevated (falsely positive) due to abnormally low levels of testosterone or because of marijuana use.
            With levels that close to normal, I'd expect the docs to retest & see if a upward trend is developing before going to aggressive treatment. You might want to email Dr Einhorn to get his thoughts.

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

            Comment


            • #7
              Beta HCG UP again...

              Just retested (3rd month surveillance) and my Beta-HCG levels are up to 15. Last month the results were 3.4 and Dr. Foster of IU decided it was nothing to worry about. I emailed to ask him what he thinks about my current rise in marker levels.
              My local urologist is worried and has recommended I get in touch with a medical oncologist.
              Anyone have a similar case or experience?
              Hoping for the best. Preparing for RPLND and/or Chemo.
              Thanks everyone

              Comment


              • #8
                Originally posted by BoilerMaker View Post
                Just retested (3rd month surveillance) and my Beta-HCG levels are up to 15. Last month the results were 3.4 and Dr. Foster of IU decided it was nothing to worry about. I emailed to ask him what he thinks about my current rise in marker levels.
                My local urologist is worried and has recommended I get in touch with a medical oncologist.
                Anyone have a similar case or experience?
                Hoping for the best. Preparing for RPLND and/or Chemo.
                Thanks everyone
                That's where I was. First month my HCG was 6, second I was at 20 with lung mets. Even with my HCG as low as 20, there was clear lung and lymphatic system involvement.

                Dr Nichols is my medical oncologist and he had me on chemo pretty quickly. My case was a little more urgent since it went to the lungs so gosh darn fast.

                I'm on inpatient VIP due to the lung mets, but I'm guessing you're probably a candidate for the standard 3xBEP. Round three for me starts next week, and I'm looking at possibly four rounds total.

                Comment


                • #9
                  Originally posted by jeremy75 View Post
                  That's where I was. First month my HCG was 6, second I was at 20 with lung mets. Even with my HCG as low as 20, there was clear lung and lymphatic system involvement.

                  Dr Nichols is my medical oncologist and he had me on chemo pretty quickly. My case was a little more urgent since it went to the lungs so gosh darn fast.

                  I'm on inpatient VIP due to the lung mets, but I'm guessing you're probably a candidate for the standard 3xBEP. Round three for me starts next week, and I'm looking at possibly four rounds total.
                  Good luck Jeremy. We can still count ourselves lucky among cancer sufferers. TC is the poster child for curable cancer.
                  I hope everything goes as well as possible for both of us.

                  Comment


                  • #10
                    Originally posted by BoilerMaker View Post
                    Just retested (3rd month surveillance) and my Beta-HCG levels are up to 15. Last month the results were 3.4 and Dr. Foster of IU decided it was nothing to worry about. I emailed to ask him what he thinks about my current rise in marker levels.
                    My local urologist is worried and has recommended I get in touch with a medical oncologist.
                    Anyone have a similar case or experience?
                    Hoping for the best. Preparing for RPLND and/or Chemo.
                    Thanks everyone
                    A BHCG of 15 is clear indication that you are headed for further treatment, unless it was an anomaly. Men without a germ cell tumor should not have elevated BHCG (sometimes marijuana or low T can raise it a bit). Can you get a recommendation for an oncologist? Hang in there.
                    Heidi

                    Husband - age 51
                    10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
                    11/1/10 4X BEP
                    12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
                    2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
                    6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
                    Surveillance since 6/11

                    Comment


                    • #11
                      I have an appointment with Dr. Einhorn on Wednesday morning. I am lucky to have ended up at Purdue for my grad school placement and am 1 hour from IU.

                      Comment


                      • #12
                        Originally posted by BoilerMaker View Post
                        I have an appointment with Dr. Einhorn on Wednesday morning. I am lucky to have ended up at Purdue for my grad school placement and am 1 hour from IU.
                        Excellent choice.
                        Heidi

                        Husband - age 51
                        10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
                        11/1/10 4X BEP
                        12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
                        2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
                        6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
                        Surveillance since 6/11

                        Comment

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