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  • Lymph node growth rate

    Hello everyone,

    I've been looking around the net for a while but found little information about lymph nodes growth rate, so I thought I'd post my doubts here.

    Here is my situation:
    -42 year old
    -Had cryptorchidism, and no clue that it could increase the risk of TC.
    -After beeing unable to get pregnant for a long while, last year me and my wife underwent some screenings and they found cancer in my left testis; the urologist mentioned seminoma or mature teratoma.
    -Got the left testis removed right away. Histology confirmed it was seminoma, 1.8 cm, non invasion of blood vessels, epididymis, tunica vaginalis and spermatic cord.
    -I was proposed to follow up without treatment (which sounded like a good idea to me)
    -CT after 6 month was ok.
    -MRI after 12 month showed a para-aortic lymph node that was 40x20 mm in size. Blood markers are normal. I was proposed BEP or radiotherapy.
    -I started with homeopathy and a radical lifestyle change (but I'm going for traditional therapy as well - this was just supplementary as it won't probably do any harm).
    -Had a CT 3 weeks after the MRI to assess the situation before therapy, and it showed that the limph node remained 40x20 mm. Nothing else around. This was yesterday.

    So now I have 2 questions:

    -The only study I found shows that the max growth rate of seminoma in the limph nodes is 4.6 mm per month. So how is it possible that mine got up to 40 mm in 6 month? This would be at least 6 mm per month (or more, depending on when it started). Everyone is sure it is seminoma, but I'm concerned it might be non seminoma (which as far as I understand grows faster and requires different therapies). Can anyone share their experience on lymph nodes growth rate in seminoma?

    -The fact that it grew pretty quick and then it stopped might have something to do with my lifestyle change, or they just stop and go randomly? (Btw homeopathy was started after CT so it did not contribute).

    I'm confused right now, so I will be grateful for any experience you can share on that topic!

    Thank you,

    Alf

  • #2
    ALF~ hopefully someone will respond with experience with seminoma. I know that lymph nodes can remain stable.
    17 year old son Grant dx 12/21/16
    pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
    pre/o CT Scan 12/22/16 normal
    r/o 12/22/16
    Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
    PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

    -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
    2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
    BEP x 3 1/27/17
    Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
    2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
    Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

    Comment


    • #3
      Homeopathy may help your mind, but it won't help testicular cancer.

      Radiation won't help with non-seminoma.

      BEP kills seminoma and nonseminoma (except teratoma) pretty equally.

      You are looking at 3xBEP (assuming markers not highly elevated), or MAYBE an RPLND, although RPLND is not an established pre-chemotherapy treatment method for seminoma.
      6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
      6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
      7/7/15: bHCG 56, AFP 42, LDH 322
      7/13/15 - 9/18/15: 4xEP
      10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
      10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
      4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
      4/20/16: RPLND @ IU - teratoma only!
      9/18/2017 all clears up to this date!

      Comment


      • #4
        Given your age and the pathology it most likely isn't non-seminoma.

        A lymph node could already be 10mm in the first place without being a concern, so a growth of 30mm over 6 months = 5mm which isn't far off, but these are all rules of thumb.

        I'm not sure what the best advice is really, I think 3xBEP would be your course of action, but for a singular enlarged lymph node with no marker raises (also a sign of seminoma), it might be worth waiting a bit, but maybe not.

        Hopefully someone else can chime in.
        24 year old diagnosed 6/11/16
        Pre/o markers 9/11/16 - HCG 15, AFP 210, LDH 539
        Pre/o CT Clear
        Non-seminoma (80% embryonal carcinoma, 10% yolk sac tumour, 5% chorea carcinoma, 5% seminoma)
        Post-op markers - 14/12/16 - HCG 35, AFP 1050, LDH 430
        Post-op CT with one enlarged lymph node - 1.5x1cm
        Borderline stage 2B/3B
        BEPx3 started 15/12/16 (Borderline BEPx4 - Advise of Dr. E to only do 3 rounds)
        CT and markers clear - in remission - 28/2/16

        Comment


        • #5
          I was in a similar situation like you, although mine was originally >95% seminoma and <5%EC (my age 40). When it was discovered through CT scan last November, it measures 40mmX30mm, so pretty similar to your situation. I had the same question you had, since I could not understand how it grew so fast since the previous scan was done in April (6 months earlier) and I was told i. In my case, looking back at the images of April, it turned out that the enlarged lymphonode was already visible (about 12 mm in size) but it was completely overlooked by the doctors (and I changed hospital because of that). I did 3XBEP and since the lymphonode after chemo was still about 30 mm, I had also the RPNLD.

          Comment


          • #6
            Unfortunately homeotherapy is not going to help your lymph node if it is indeed cancer. You didnt mention your tumor markers though. What were they prior to orchiectomy? Did they return to normal after surgery? And how about now?

            If it was me, I would choose radiation if it is 100% seminoma. 40x20mm is getting up there in size. Anything >1 cm is considered suspicious. Either way you will more than likely need treatment. You could ask about a biopsy, but that could spread cancer cells.
            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! 6/26/17 Finished 3x bep!

            Comment


            • #7
              Thanks everyone for the very valuable inputs.

              Just to be clear, I'm not planning to rely on homeopathy alone (nor the homeopath advised me on doing so); this is just to support me during and after the traditional treatments.

              Originally posted by singa76 View Post
              I was in a similar situation like you, although mine was originally >95% seminoma and <5%EC (my age 40). When it was discovered through CT scan last November, it measures 40mmX30mm, so pretty similar to your situation. I had the same question you had, since I could not understand how it grew so fast since the previous scan was done in April (6 months earlier) and I was told i. In my case, looking back at the images of April, it turned out that the enlarged lymphonode was already visible (about 12 mm in size) but it was completely overlooked by the doctors (and I changed hospital because of that). I did 3XBEP and since the lymphonode after chemo was still about 30 mm, I had also the RPNLD.
              OK this is not good: putting you through all the exams, and then overlooking the results... how did find out about the lymphonode already been enlarged in April? Did they admit it or you got to have someone else look at April scan?

              Originally posted by Joe.shupe22 View Post
              Unfortunately homeotherapy is not going to help your lymph node if it is indeed cancer. You didnt mention your tumor markers though. What were they prior to orchiectomy? Did they return to normal after surgery? And how about now?

              If it was me, I would choose radiation if it is 100% seminoma. 40x20mm is getting up there in size. Anything >1 cm is considered suspicious. Either way you will more than likely need treatment. You could ask about a biopsy, but that could spread cancer cells.
              Markers have always been normal, prior and after surgery, and now as well. I'd choose radiation as well, but I'm just not sure about the fact that it's pure seminoma (since it grew fast), so I fear I'd do it for nothing and then still have to go through BEP.

              Comment


              • #8
                Just as a follow up, I asked to have RPLND but the doctors said they won't do it because it is too dangerous.
                I've been offered a treatment with one carboplatin run followed by local irradiation of the swollen lymph node. In some studies it has proven to have the same effectiveness as radio and BEP, but with less side effects. On the negative side, there are no long term results yet. I think I will choose this way.

                Thank you guys for your comments!

                Comment


                • #9
                  Originally posted by Alf View Post
                  Just as a follow up, I asked to have RPLND but the doctors said they won't do it because it is too dangerous.
                  I've been offered a treatment with one carboplatin run followed by local irradiation of the swollen lymph node. In some studies it has proven to have the same effectiveness as radio and BEP, but with less side effects. On the negative side, there are no long term results yet. I think I will choose this way.

                  Thank you guys for your comments!

                  I'm not sure where you live, but an RPLND under an experienced surgeon is not a dangerous surgery. All surgeries have their risks, mostly due to the existing comorbidities of the patients. However, most men with TC are young men. That is why the mortality rate listed in the literature of a primary RPLND is zero. Nobody dies. Most worrisome risk is a small bowel obstruction, < 2% will experience it. I'll take that any day over the risks of radiation or 3 x BEP (which can be far worse and not really more rare).

                  However, an RPLND is not a treatment for seminoma in the guidelines at this time. But wait a few years, and it'll be there.
                  Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

                  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
                    Originally posted by RJKD View Post


                    I'm not sure where you live, but an RPLND under an experienced surgeon is not a dangerous surgery. All surgeries have their risks, mostly due to the existing comorbidities of the patients. However, most men with TC are young men. That is why the mortality rate listed in the literature of a primary RPLND is zero. Nobody dies. Most worrisome risk is a small bowel obstruction, < 2% will experience it. I'll take that any day over the risks of radiation or 3 x BEP (which can be far worse and not really more rare).

                    However, an RPLND is not a treatment for seminoma in the guidelines at this time. But wait a few years, and it'll be there.
                    Switzerland here. They mentioned the risk of damaging the aorta, and also the risk of developing a lymphedema. So they won't do that.
                    Ironically they don't see any problem with chemo, their mayor concern is that I might loose my hair (which obviously is the minor of my concerns)...

                    Comment


                    • #11
                      Hi, during my second cycle of BEP I was asking myself how it was possible that my lymphnode grew that fast since my previous scan was clear. I therefore decided to look at the images myself (with the help of google) and they immediately looked suspicious. I brought that up with my oncologist at the first meeting, and after insisting she decided to bring that up with the radiologist that originally signed the report. After few days she send me an email apologising for the mistake!

                      Regarding your treatment option, I am not sure what stage you are but I would suggest you to check the EU guidelines (http://uroweb.org/guideline/testicular-cancer/#7), at point 7.3.2 you have your treatment options. Certainly I would not do an RPLND with an urologist that is not confident with the procedure.

                      Comment

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