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Advice on treatment - 2a Seminoma

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  • Advice on treatment - 2a Seminoma

    Hi,

    I'm 35 years old and am at stage 2a seminoma. I have 3 affected lymph nodes in my abdomen. They are 8mm 10.8 mm 1.2 cm. I was wondering if 3 lymph nodes is to many for radiation and would be better to do chemo. Or if I could still use radiation.

    Thanks

  • #2
    I don't believe your doc would be offering radiation if it were too many nodes. The advantage I see with chemo is that it will kill any TC cells anywhere,so if you have some nodes that have TC in them that just hasn't gotten large enough to show up on scans yet, they will be taken care of as well.

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

    Comment


    • #3
      Hi...I had a singular 1 cm node and got 20 days of radiation in 2009...doing well with no issues at 58 years of age. Wishing you the best... Raincrow

      Aug 07 - Stage 1 - Pure seminoma - Right orchidectomy + surveillance
      May 09 - Stage 2a - 1 cm node in para-aortic region
      June 09 - 20 X RT (25Gy to full lymphs, extra 10 Gy to node)
      Sept 09 - All Clear
      Mar 10 - All Clear
      Jul 10 - All Clear
      Nov 10 - All Clear
      Aug 11 - All Clear
      Feb 12 - All Clear
      Dec 12 - All Clear
      Dec 13 - All Clear

      Comment


      • #4
        sounds like a clear choice of chemo as it will work for all of your 3 lymph nodes.

        Comment


        • #5
          I still say rplnd
          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

          Comment


          • #6
            Raincrow - Thanks for the kind words and chiming in - your post is very encouraging.

            JoesMum - My doctors said chemo works with Seminoma too. I guess there's not really a wrong choice??

            Comment


            • #7
              I have a final consultation with my doctors this week. I'll definitely ask about RPLND and see what they say. I don't think my medical facility offers that. They seem to be by the book. Thing is I think I'm limited on other facilities too because of the healthcare plan I choose. I've had my plan for a long time and it's worked well but I didn't expect to be dealing with cancer. I'm just glad I have a plan, I can't imagine what it's like for people who don't have one and need one.

              Comment


              • #8
                Hi Mister, I understand that BEPx3 works well for Seminoma. My son has just finished it and got good results - thanks G-d. My son was also given a choice of chemo or Radio and we believe that chemo was the correct choice. He also had stage 2 seminoma. Good luck with the treatment. Your lymph nodes are only slightly enlarged so chemo should help.

                Comment


                • #9
                  Originally posted by MisterT2828 View Post
                  Raincrow - Thanks for the kind words and chiming in - your post is very encouraging.

                  JoesMum - My doctors said chemo works with Seminoma too. I guess there's not really a wrong choice??

                  They won't do RPLND even though it will likely be effective. No doctor will treat you outside the guidelines. There are currently studies being done using RPLND for patients like yourself. Personally, if I could get into a trial where they are doing the RPLND, I would do that. Chemo and radiation both work for seminoma, it's just that their side effects can be a lot more serious compared to an RPLND (which rarely has serious side effects).
                  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


                  • #10
                    I talked to both oncologist today. When I was expressing my concerns over second malignancies, he said if you do have one it would be sarcoma. I said what does that mean. He said that sarcoma cancer would be caused by something else - not related to the radiation. Then he went over the doses with me. Like the amount to the field and the amount to my nodes. Hesaid these were fairly low amounts of radiation. He also said said the abdominal aorta can take a lot more radiation than I would be receiving and didn't express any concerns over that.

                    Is this guy downplaying these side effects?

                    Comment


                    • #11
                      Originally posted by MisterT2828 View Post
                      I talked to both oncologist today. When I was expressing my concerns over second malignancies, he said if you do have one it would be sarcoma. I said what does that mean. He said that sarcoma cancer would be caused by something else - not related to the radiation. Then he went over the doses with me. Like the amount to the field and the amount to my nodes. Hesaid these were fairly low amounts of radiation. He also said said the abdominal aorta can take a lot more radiation than I would be receiving and didn't express any concerns over that.

                      Is this guy downplaying these side effects?

                      I will say from my experience speaking to different oncologists that Rad Oncs will tend to downplay the side effects of radiation, medical oncologists will tend to downplay the effects of chemo, and urologists will tend to downplay the side effects from an RPLND.
                      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
                        Can someone verify the BEP schedule. Is it Mon - BEP. T-F EP. Day ,8 & 15. B. ???

                        Comment


                        • #13
                          ...and those that do open RPLND will talk badly about robotic RPLND, etc. I just had a conversation with a robotic RPLND expert here in Columbus. He said he felt it was a good way to locate and dissect the lymph nodes, but he did point out that we don't have good studies on it yet. He so happened to train under Sheinfeld at Sloan. When we were talking about Sheinfeld he said "Sheinfeld would HATE that I'm doing the RPLND robotically!". I tell you this story because it shows how hard it is to make a decision when each medical expert has strong opinions and they disagree with one another.

                          If I was choosing between radiation or 3 x BEP, I would pick radiation. The relapse rate is super low, the treatment is more tolerable than 3 x BEP. This paper shows limited fields used with a super low relapse rate.
                          http://ascopubs.org/doi/full/10.1200/jco.2003.06.065
                          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
                            Originally posted by MisterT2828 View Post
                            Can someone verify the BEP schedule. Is it Mon - BEP. T-F EP. Day ,8 & 15. B. ???

                            You have the schedule down correctly.
                            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


                            • #15
                              Good article: http://www.medpagetoday.com/meetingc...meetings/57739
                              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

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