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  • New here - New to tc - have some questions

    Hello,

    I was recently diagnosed with stage 2a seminoma. Oncologist say treatment options are radiation 30 Gy dog leg or 3x BEP. Both oncologists gave me the run down but they didn't really say what they recommend. Before doing research I would have just assumed radiation would be more toxic but researching BEP it appears it's just as bad or worse. I guess I was just wanting to get suggestions or advice on what you guys think the appropriate treatment for me would be.

    The r oncologist seem to be pushing radiation. The m oncologist was neutral saying the chemo would be backup. I think I'm leaning towards the radiation but when I asked my detailed questions to the r oncologist - he kind of avoided the question. So I thought I'd shoot some questions to you guys so I can try to get to the point where I feel confident of my treatment.

    1. I think the biggest thing holding me up on radiation is that I don't quite understand like at at what direction the beam(s) hits my body. Like is it multiple beams hitting my body from all different angles. And do those beams just shoot through me hitting everything in their path. Meaning if a beam coming from above - will that beam hit my skin on my stomach then my intestines then my liver then whatevers behind the organs then eventually hitting my nodes then hit the skin on my back - hitting all of that with the same dose intesity.

    I guess I just am scared of those major organs being in the radiation field. Which leads me to my next question.

    2. Does anybody know how much radiation the major organs receive. ie liver pancreas stomach kidneys colon bladder. Or better yet - anyone have a dose volume histogram for dog leg. Hard time finding that online. When I asked the onc he blew it off and mention 30 Gy is lower than other doses for other cancers. I told him ya but aren't those just shooting the tumor directly and not a field. When I persisted they did say they can review my simulation plan with me. They also said nobody's really asked to see the sim plan before. I was shocked.

    Anyways just thought I'd see what you guys think. Advice comments thoughts welcome Thanks

    35 yrs old slim build
    Stage 2a seminoma
    3 nodes in abdomen - 8mm 10.8 mm 1.2 cm
    ct ab picked up the 10.8 and 1.2
    PET picked up the 8 mm - I believe all 3 lit up
    ct chest - pick up a small nodule - Dr said doesn't look like tc...
    Markers appear normal

  • #2
    Was anything about RPLND mentioned as an option? That would be my first choice as long as the nodule in your chest doesnt change.
    11/16- Pain/lump in R testicle 11/16- US finds multiple masses 11/16- Right I/O path multifocal largest nodule 2.1cm 100% EC with LVI/rete testis invasion. 12/16- Ct/markers normal stage 1b 12/16- Ct/markers normal 1/17- rplnd pN1 2 nodes 1.8/1.4 cm EC Stage IIA 2/20 ct/markers clear! 3/1/17 started androgel for low T 4/27/17 Relapsed. Multiple lymph nodes in mesentary and few nodes in retriperitoneum. Start 3x bep. Ct after 2nd cycle revealed all masses already resolved! Continue last cycle!

    Comment


    • #3
      No they didn't mention RPLND. I believe that's for non seminoma. They just said radio or chemo.

      ​They set up another chest scan in like 3 months. I wonder if I should wait for that scan result before starting treatment. Although that kinda scares me waiting that long to do anything. Doctor said it's not that unusual for people to have a nodule on their lung. He said a lot people just don't know because they have no reason to do a chest scan.

      Comment


      • #4
        RPLND isnt just for non-seminoma. Typically it is not used as primary treatment, but it can be a very curative procedure by itself. Some dont like the idea of surgery, while others (like myself) dont like the idea of chemo. It seems like you're very concerned with the toxicity of each treatment, figured I would mention another.

        I had non-seminoma, but I probably still would have sought an rplnd if it would have been 2A seminoma. I also had a nodule on my lung. I believe it wasnt even noted in my latest scan. So your doctor is correct, many people have unknown nodules (not just in the lung) that are harmless. I would not wait to start treatment as those lymph nodes are not going to magically disappear though.

        I did see that for stage 2A seminoma the typical treatment is radiation. That would be my choice if rplnd was not on the table
        11/16- Pain/lump in R testicle 11/16- US finds multiple masses 11/16- Right I/O path multifocal largest nodule 2.1cm 100% EC with LVI/rete testis invasion. 12/16- Ct/markers normal stage 1b 12/16- Ct/markers normal 1/17- rplnd pN1 2 nodes 1.8/1.4 cm EC Stage IIA 2/20 ct/markers clear! 3/1/17 started androgel for low T 4/27/17 Relapsed. Multiple lymph nodes in mesentary and few nodes in retriperitoneum. Start 3x bep. Ct after 2nd cycle revealed all masses already resolved! Continue last cycle!

        Comment


        • #5
          Oh really - I didn't know that about RPLND. Wonder why they didn't mention that?

          Thanks for the information.

          Comment


          • #6
            Its not something they use as primary treatment for seminoma. In fact, if you do any research on primary rplnd for seminoma, there isnt a whole ton of information, not that I could find anyways. But I see no reason why it couldnt be done. I could be totally off, but its something to mention if the procedure doesnt scare you off. My opinion on treatment tends to fall heavily on surgery first if it is an option.
            11/16- Pain/lump in R testicle 11/16- US finds multiple masses 11/16- Right I/O path multifocal largest nodule 2.1cm 100% EC with LVI/rete testis invasion. 12/16- Ct/markers normal stage 1b 12/16- Ct/markers normal 1/17- rplnd pN1 2 nodes 1.8/1.4 cm EC Stage IIA 2/20 ct/markers clear! 3/1/17 started androgel for low T 4/27/17 Relapsed. Multiple lymph nodes in mesentary and few nodes in retriperitoneum. Start 3x bep. Ct after 2nd cycle revealed all masses already resolved! Continue last cycle!

            Comment


            • #7
              The NCCN guidelines which are written by all the TC experts don't mention RPLND as primary treatment for stage 2A seminoma. I'm not sure why, but likely a good reason, I doubt they just didn't consider it.
              Dx March 21 2016
              Right Orchiectomy march 25 2016
              60% embryonal 35% yolk sac 5% seminoma
              positive node on CT 1.4X1.3cm stage 2a markers rising, HCG 2300 AFP 25
              Started 4xEP april 2016
              Finished chemo July 2016, markers normal, complete radiographic remission
              RPLND MSKCC Aug 2016, removed something like 60 nodes all negative but one with teratoma
              Surveillance

              Comment


              • #8
                There are some studies investigating whether an RPLND would be effective. I see no reason why it wouldn't. In fact, it should be more effective than for non-seminoma as seminoma tends to have a more predictable path of spread. From what I know, it simply is not in the guidelines because radiation and chemo are super effective and RPLND is a major surgery (more so without robotic methods).

                I would without hesitation do an RPLND here if I had a choice.
                Canadian. Diagnosed at age 31. Treated in NYC. Now living in Columbus, OH.

                7/1/2015: felt tiny lump on side of R testicle
                7/30/2015: Ultrasound shows 2 intra-testicular masses.
                7/31/2015: tumor markers normal, CXR clear
                8/5/2015: R orchiectomy
                8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
                8/14/2015: CT abdomen/pelvis clear, Stage 1b
                8/24/2015: started 1 x BEP

                Comment


                • #9
                  I really don't know that much about radiation, but I would expect that it does go through skin and any organs on either side of the target area. As most nodes will be in the retroperitonial area, the intestines are the most likely to be in the path.
                  Dave
                  Jan, 1975: Right I/O, followed by RPLND
                  Dec, 2009: Left I/O, followed by 3xBEP

                  Comment


                  • #10
                    Ya that's what I would expect to - I guess everything gets hit with full power in field area. I would assume the major organs can take radiation or this wouldn't even be a treatment.

                    I also wonder if there are any side effects from the aorta - like higher blood pressure - higher cholesterol etc??

                    Didn't mention anything like that in the radiation information pack I got at doctors office.



                    Comment


                    • #11
                      Originally posted by MisterT2828 View Post
                      Ya that's what I would expect to - I guess everything gets hit with full power in field area. I would assume the major organs can take radiation or this wouldn't even be a treatment.

                      I also wonder if there are any side effects from the aorta - like higher blood pressure - higher cholesterol etc??

                      Didn't mention anything like that in the radiation information pack I got at doctors office.




                      Yes, you can have side effects to the major organs. In the old days they used to radiate even the chest area and there was a higher incidence of heart attacks. However, the doses used are lower now and the field applied is smaller.
                      Canadian. Diagnosed at age 31. Treated in NYC. Now living in Columbus, OH.

                      7/1/2015: felt tiny lump on side of R testicle
                      7/30/2015: Ultrasound shows 2 intra-testicular masses.
                      7/31/2015: tumor markers normal, CXR clear
                      8/5/2015: R orchiectomy
                      8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
                      8/14/2015: CT abdomen/pelvis clear, Stage 1b
                      8/24/2015: started 1 x BEP

                      Comment


                      • #12
                        Like in general - what do you guys think preferred treatment would be for a young man in 30s lIke myself if both radiation and 3x BEP were the options. I know everyone is a little different but just in general.

                        What do you think most doctors would recommend for young men. Or does age have anything to do with it.

                        Comment


                        • #13
                          The last decade has been shifting towards chemo. But some recent studies are bringing radiation back into the main treatment. I would recommend radiation. It's a much less harrowing experience and the side effects are more local to where the radiation hits. That said, the relapse rate is slightly higher with radiation. I think doctors would be split on which treatment they would recommend with a slight edge to radiation.
                          Canadian. Diagnosed at age 31. Treated in NYC. Now living in Columbus, OH.

                          7/1/2015: felt tiny lump on side of R testicle
                          7/30/2015: Ultrasound shows 2 intra-testicular masses.
                          7/31/2015: tumor markers normal, CXR clear
                          8/5/2015: R orchiectomy
                          8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
                          8/14/2015: CT abdomen/pelvis clear, Stage 1b
                          8/24/2015: started 1 x BEP

                          Comment


                          • #14
                            MisterT,
                            I've had both (radiation and chemo). I had 20Gy for my seminoma and 3 x BEP for my EC relapse. I got 20Gy and not 30 because the UK have adopted that for low-risk prophylactic/adjunctive treatment - which was my case. I think, these days if you have adjunctive treatment then most places opt for a short course of chemo. In your case, short course/reduced treatment is not the option.

                            In terms of side effects during / after treatment. For me radiation was _easier_. I had some stomach/sickness issues - because the RT can clip your gut. But the meds sorted that out for me. From what I recall, RT over time made me tired and feel like I was suffering some virus/man flu bug. I do remember one day, working and suddenly realised I didn't feel crap any more! I found 3 x BEP much harder, and my recovery period post treatment was also a lot longer, and I still have some (very minor, compared to others) nerve damage in my fingers and some mild tinitus.

                            There is, I guess, no single right answer. There is a wrong answer - which is to do nothing. But I'd say both treatments will lead to the same conclusion - your cancer will be killed.

                            Jan 2009: RHS (Seminoma) & RT
                            Mar 2010: LHS (Embryonal Carcinoma)
                            Sep 2010: Relapse & 3 x BEP
                            Mar 2015: Five years "nut free"
                            http://doublezeroami.blogspot.com

                            Comment


                            • #15
                              Do you remember how long after your radiation treatment that day was when you suddenly realized you didn't feel like crap?

                              Comment

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