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  • Post 3XBEP and a lung nodule

    Hi everyone,
    In the past year, I was always a spectator in this forum to look for answers and reassurance. This forum is amazing as members are chiming in all the time to support and help others.

    This is my first post so here we go:

    My primary tumor that was removed in June 2016 had 35% yolk sac, 35% teratoma, 10% EC and 20% seminoma. My tumor markers were always in the normal range after IO. Relapse was confirmed when a lung nodule has increased in size to 14mm in Feb 2017. Abdominal and pelvis scans were clear. 3XBEP was ordered.

    Today, I received my chest CT scan and the outcome was not what I expected. The questionable lung nodule did not shrink and stayed at 14mm. I am still waiting for the abdominal and pelvis scan results. This Friday, I will be meeting with my oncologist. Any advise based on everyone’s experience? Should I expect a lung dissection to remove the nodule (due to teratoma)? I am now very scared…..

    Also, will Bleomycin cause atelectasis and pneumonia to the lung? This is one of the comments from the chest CT scan on the lower left lobe.

    My journey so far:


    6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
    7/2016 - markers normal; confirmed Stage 1B; surveillance
    8/2016 - markers normal
    9/2016 - markers normal
    10/2016 - markers normal; CT scan revealed 3mm lung nodule
    12/2016 - markers normal
    2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
    3/2017 - 3xBEP
    5/2017 - finished 3xBEP
    6/2017 - markers normal; no size reduction in lung nodule

    Thanks and please help a fellow TC member.

    OneBallLeft
    Last edited by OneBallLeft; 06-13-17, 11:19 AM.
    6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
    7/2016 - markers normal; confirmed Stage 1B; surveillance
    8/2016 - markers normal
    9/2016 - markers normal
    10/2016 - markers normal; CT scan revealed 3mm lung nodule
    12/2016 - markers normal
    2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
    3/2017 - 3xBEP
    5/2017 - finished 3xBEP
    6/2017 - markers normal; no size reduction in lung nodule
    8/2017 - VATS and markers normal; continue to surveillance

  • #2
    For what I know its not much common teratoma spread. But your markers are normal and your tumor had seminoma.
    They did a biopsy of the lung module or a pet ct?
    They did a ultrassound of the remaining testis?
    -July 2016: diagnosed with mediastinal 100% yolk sac tumor (11x8cm) Afp 11300 -August: pet scan shows an 16x12cm tumor; started 4 x Bep -September: increase in tumor size 20x16 -November 2016: end of 4x Bep Afp 86; Pet Ct - decrease in tumor size (6,5x7,5cm) -December: Afp rising 86->257->376->880 -January: Moved to Ac. Camargo Cancer Center; supposed treatment: 4x Tip -> 2x HDCT (Carbo Etoposide) -> Surgery. -Jan-March: After 2xTip Afp ~45 - April: Afp 38 -> HDCT - May: Afp Rising 46->67->81 = HDC Failed; second round aborted; Pet ct shows stable disease; GemOx while waiting for salvage surgery.

    Comment


    • #3
      Rodrigo, thanks for the prompt response.

      ​For lung biopsy, it was one option discussed during the consultation meeting back in March (before 3XBEP). However, the oncologist stated that I would need chemo because of the risk of micro-metastatic disease elsewhere. He mentioned that I could have VATS if the lung nodule remains after chemo.

      ​For the remaining testis, I did not have an ultrasound. But I would mention to the oncologist in the next meeting.


      6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
      7/2016 - markers normal; confirmed Stage 1B; surveillance
      8/2016 - markers normal
      9/2016 - markers normal
      10/2016 - markers normal; CT scan revealed 3mm lung nodule
      12/2016 - markers normal
      2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
      3/2017 - 3xBEP
      5/2017 - finished 3xBEP
      6/2017 - markers normal; no size reduction in lung nodule
      8/2017 - VATS and markers normal; continue to surveillance

      Comment


      • #4
        As long as your markers are normal after the BEPx3, then I would think surgery would be the next option. You could get an opinion from a center of excellence if you haven't done so already. I don't think that they would just want to watch it but I do not have much experience with solitary lung nodules after BEP. With no reduction in size, teratoma would be an option. I would ask if given that it grew from 3 mm to 14 mm in 4 months if it would expected to be larger in size within the last 4 months if it was teratoma.

        Bleomycin can cause lung changes after BEPx3 and in fact it is fairly common. I would want an expert to give their opinion before I was to undergo further procedures, but I wouldn't delay those procedures.

        Mike
        Oct. 2005 felt lump but waited over 7 months.
        06.15.06 "You have Cancer"
        06.26.06 Left I/O
        06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
        06.30.06 It's Official - Stage I Seminoma
        Surveillance...
        Founded the Testicular Cancer Society
        6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

        Comment


        • #5
          I conccur with Mike- reach out to center of excellence for a 2nd opinion. Was your lung function normal before Bleo? Nothing was seen prior to BEP as far as the atelectasis and pneumonia?
          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


          • #6
            Thanks Mike and Trekga. I am currently being treated in a cancer research hospital.

            ​Prior to the BEP, there is no atelectasis and pneumonia in my lung. Lung function test was not performed before BEP. However, I am a healthy individual who hit the gym almost everyday.

            For the lung nodule, I am hoping that it is non-cancer related and non dangerous nodule.
            6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
            7/2016 - markers normal; confirmed Stage 1B; surveillance
            8/2016 - markers normal
            9/2016 - markers normal
            10/2016 - markers normal; CT scan revealed 3mm lung nodule
            12/2016 - markers normal
            2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
            3/2017 - 3xBEP
            5/2017 - finished 3xBEP
            6/2017 - markers normal; no size reduction in lung nodule
            8/2017 - VATS and markers normal; continue to surveillance

            Comment


            • #7
              Hi OBL

              Given the high amount of Teratoma and Y.S. it could be one of those guys in the lungs. I'm no doctor but I've read studies where people who have higher rates of Teratoma and Y.S. end up needing some kind of surgery to remove the tumor. Have they had you speak to a thoracic surgeon about the possible removal of the nodule?

              Comment


              • #8
                Thanks Daniel on the feedback. Tomorrow I will be seeing my oncologist to review the result and will request to speak to a thoracic surgeon on that lung nodule as well as atelectasis/pneumonia.

                ​Finally, I received the scan report on abdominal/pelvis and it came clean. Now, my focus will be the lung nodule and hoping that it is non-cancer related......
                6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
                7/2016 - markers normal; confirmed Stage 1B; surveillance
                8/2016 - markers normal
                9/2016 - markers normal
                10/2016 - markers normal; CT scan revealed 3mm lung nodule
                12/2016 - markers normal
                2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
                3/2017 - 3xBEP
                5/2017 - finished 3xBEP
                6/2017 - markers normal; no size reduction in lung nodule
                8/2017 - VATS and markers normal; continue to surveillance

                Comment


                • #9
                  Good luck with everything. Just having finished my 3xBEP course I can tell you that my lungs were affected. Not a whole lot but definitely a little. My Oncologist says that the function will come back over time. Also, I had a couple of lung nodules but they shrank back to normal size. Got my fingers crossed for ya.

                  Comment


                  • #10
                    Thanks Daniel_Eye and everyone who chimed in.

                    ​I just had an appointment with my oncologist and my case will be referred to a thoracic surgeon ​to remove the lung nodule.

                    ​The oncologist is very optimistic as he stated that this will be the one last hurdle to get the "all clear". He suspected that the remaining cancer cells in the lung nodule are mature Teratoma since there is zero growth after 3XBEP. The chemo has taken care the rapid growth cancer cells.

                    ​Also, he said that I was very lucky under this unfortunate situation where the lung nodule is very close to the chest wall. As such, VATS, which is the least invasive surgery, should be performed instead of a open chest.

                    ​After seeing my oncologist, I felt a lot better as many questions have been addressed. In the past week, I went insane with many "what if" questions popping in my head. Now, I am back in the waiting game to wait for the next available appointment.

                    Wish me luck!!!
                    ​OneBallLeft
                    6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
                    7/2016 - markers normal; confirmed Stage 1B; surveillance
                    8/2016 - markers normal
                    9/2016 - markers normal
                    10/2016 - markers normal; CT scan revealed 3mm lung nodule
                    12/2016 - markers normal
                    2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
                    3/2017 - 3xBEP
                    5/2017 - finished 3xBEP
                    6/2017 - markers normal; no size reduction in lung nodule
                    8/2017 - VATS and markers normal; continue to surveillance

                    Comment


                    • #11
                      Hi everyone, I wanted to provide an update on my progress.

                      ​I had a VATS surgery two weeks ago to remove the lung nodule and it went really well. I think it was done in record time as it was an hour and 15 minutes from end to end. I was shocked when I woke up in the recovery room and looked at the time. In the past two weeks, I slowly recovered my strength and was able to do a spinning class.

                      ​Today, I got the pathology report and was very nervous when opening the report online. The tone of the report is very promising that they only found mature teratoma and cannot identify any other Non-teratomatous germ cell elements, immature elements, or somatic malignancies.

                      ​Now, I can really take a break and enjoy my new normal. Next week, I will see my oncologist and review the report as well as to discuss the new surveillance protocol.

                      ​I am officially a cancer survivor!!!.

                      Thanks

                      ​OBL

                      6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
                      7/2016 - markers normal; confirmed Stage 1B; surveillance
                      8/2016 - markers normal
                      9/2016 - markers normal
                      10/2016 - markers normal; CT scan revealed 3mm lung nodule
                      12/2016 - markers normal
                      2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
                      3/2017 - 3xBEP
                      5/2017 - finished 3xBEP
                      6/2017 - markers normal; no size reduction in lung nodule
                      8/2017 - VATS and markers normal; continue to surveillance

                      Comment


                      • #12
                        Good to hear. Like you, I was relieved to hear I only had teratoma resected post-chemo! Dead tissue would have been even better, but mature teratoma with clear margins is a success as well!
                        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


                        • #13
                          Congrats!!
                          3/29/17 Diagnosed 100% Embryonal 4/10/17 Left I/O CT scan shows a few suspicious lymph (biggest 1.9 cm) 5/8/17 - 7/3/17 3xBEP 7/20/17 CT Scan Clear, AFP has uptick to 19 8/16/17 AFP Drops in half to 10, ALL CLEAR! 11/16/17 All Clear! AFP continues to drop!

                          Comment


                          • #14
                            Good news. Only Teratoma thankfully!!!
                            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


                            • #15
                              Good deal buddy good deal, welcome to the survivors club! Surveillance is super important now so make sure you're on top of your check-ups, blood work, and scans. Try to eat healthily and like you're doing now get your exercise. I started going back to the gym as well and I've lost 5 pounds. I just have to try and lay off the ice cream and in a couple of months, the Halloween candy! Everyone on here is very supportive so make sure that you pop in to share your stories, it helps to clear your mind as well as others that might have a situation similar to yours.

                              Cheers,
                              Daniel

                              Comment

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