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4xEP done... now on to RPLND.

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  • 4xEP done... now on to RPLND.

    Ok, so my 4xEP is done. My oncologist and my urologist agree to proceed with the RPLND surgery to be sure it's all gone. I'm a 100% Embryonal Carcinoma, stage 2 in lymph nodes, no markers. They said there is a chance a that teratoma could set up in the lymph nodes later, and the EC could still be there. My last treatment was Dec 30th and my surgery is February 13th. My enlarged lymph nodes were down to 1 cm to 1.5 cm I think. That's why they're concerned. They say the chemo worked but I'm hating the surgery is still needed. Hating I'm going to be away from my work for another period of time.

    I have heart issues and blood sugar issues, so I'm nervous about this surgery, especially after chemo and my body is still feeling tired from the chemo and the general loss of some strength from sitting on my fanny for 3 months. Any advice for my situation? Anyone know if the RPLND isn't necessary? I'm 42, and will be 43 in a month so I ain't a spring chicken of 25 getting this surgery. Any wisdom would be appreciated!

    Chris <><
    September 9 Right Orchiectomy
    Pathology 100% pure Embryonal Carcinoma T2N2S0.
    Stage IIB
    Treatment RPLND deferred due to health. 4xEP

  • #2
    Getting the RPLND done is the standard of care post chemo for non-seminomas if you have residual masses >1cm. But..... between 1-2 cm is a sort of grey area also. Surveillance is certainly also a viable option. Were any of your makers elevated prior to starting chemo? If they were and they're all normal now then that's a great sign. What was the size of the masses before, and how much have they shrunk? Teratoma is indeed a danger, but in most cases it's benign, and if a change is size is seen in these residual masses the RPLND can always be done later, even over a year later, and after you've had a chance to recover. In most cases, the residual masses seen after chemo with mostly or pure EC are just necrotic (dead) tissue, but the risk is that there could still be some active cancer present. It's not very common, but it happens. Doing the RPLND now would get rid of something like that surgically, whereas it would require more chemo later without.

    I'm guessing you're already cured, though. I had a post chemo residual mass of 1.4cm after EPx4 also and had the RPLND done, and it was just dead tissue.
    StevePake.com | @K2xxSteve on Gab
    (Social Media with actual privacy, cancer support groups, encrypted secure chat & more)

    Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
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    • #3
      I also have heart issues (heart failure caused by chronic A-Fib, I am 34 years old) and I have 100% embryonal carcinoma.

      I am going to MSKCC. There was no sign of spread to the lymph nodes but the tumor did spread to the blood vessel in the testicle.

      I chose to do nothing, no chemo (since I would have to be hospitalized for it because the fluid with my heart). Just surveillance.

      From what I know about TC, there isn't as much of a problem of it being "too late" as there is with other cancers. Meaning, if it spreads you deal with it. Because of that, I think surveillance is a wise choice.

      Personally, I wouldn't do a RPLND unless I knew I definitely HAD to do it. It's way to invasive of a surgery. Listening to doctors is important, but we are the final decision makers.

      I'm not a doctor and I don't mean to scare you, I am just giving my opinion from a similar viewpoint as your own.

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