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Is chest X-ray enough?

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  • Is chest X-ray enough?

    Hello,

    I have been following this forum from January and changed some private messages here. Now I would like to get your opinion on my case.

    I had my right testicle removed in late December 2016 and diagnosed with seminoma. Tumor size was about 4 cm, microscopic LV invasion (blood vessel). Bhcg was slightly elevated (1.2) before operation but dropped to < 1 and has remained normal.

    After the operation I got a pretty nasty infection in the incision point and was in hospital for 2 weeks - the incision had to be opened in order to get bacteria out and I got a good deal of antibiotics, too.

    A CT 2 weeks after this (February) showed mildly prominent lymph nodes but they did not appear malignant. After discussing with an oncologist I opted for surveillance and accepted that the relapse rate would be about 20%.

    The next CT in June showed that lymph nodes have remained the same, no changes. According to the CT report they are not malignant rather they suspect that they are just normal in my case or it is because of the severe incision infection: The incision took 3 months to heel and scar tissue is quite thick.

    The local (Finnish) seminoma surveillance protocol states that my next surveillance in mid-September will be blood work and chest X-ray only, no CT. I have spoken with two oncologists and they both stated that if I relapsed my bhcg level would rise because I had a raised bhcg and because it would be the same cancer which was present in my testicle.

    I spoke with my TC nurse and she said that because there were no changes from February to June and because seminoma grows very slowly they would not find anything in a September CT. However I am not feeling very confident about this. I have understood that missing blood markers cannot be trusted on their own and I think that having only a chest X-ray is not enough in my case. The next CT would be only in January 2018. I suppose that the surveillance protocol tries to reduce the amount of total radiation and there is also some cost factor.

    I've tried to push for a CT instead of only chest X-ray but have not yet had a success. How do you see this? Am I overly concerned or should I still try to have a talk with my oncologist?

  • #2
    Hoping some can answer, I do not know about Seminoma post treatment protocol out of the US. Sorry you had an infected surgical site. What size were the nodes?
    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.

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    • #3
      Hi, the surveillance protocol according to the European TC guidelines (http://uroweb.org/guideline/testicular-cancer/#8) suggests 2 xCT scan and 2xMarkers in the first years (and no X-rays) in case of pure Seminoma. I would rely on the markers in your case since they were elevated the first time, as suggested by your doctors. Perhaps (but I am not an expert), if you are particularly worry, you can try to have an US of the abdomen instead of a CT scan?

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      • #4
        In Scotland there are no CT scans in the surveillance protocols. I'm seminoma (6.3cm), RT & LVI. I opted for Carboplatin X1.

        I'm still in year 1. I had a staging CT. Thereafter, 3 monthly f/u with twice yearly CXR and annual abdo & pelvis MRI.

        I'm not surprised they don't want to radiate you again. I think a CXR will be ok here. Of the top of my head, if I hadn't had Carboplatin I'd have 2 CXRs & 2 MRIs in year 1 (3 monthly intervals) - it sounds like you will be pretty similar though substituting CT for MRI.

        Best wishes
        Steve.

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        • #5
          Thank you guys. I'll have my markers tested and CXR next week. Should be enough for surveillance based on your replies and European TC guidelines.

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