Announcement

Announcement Module
Collapse
No announcement yet.

how strict is the 1cm magic number?

Page Title Module
Move Remove Collapse
X
Conversation Detail Module
Collapse
  • Filter
  • Time
  • Show
Clear All
new posts

  • how strict is the 1cm magic number?

    So I have my post-chemo CT coming up at the end of the year (Merry Christmas, right?) and I'm curious about how strict the 1cm target is on whether I'd proceed with RPLND? What's the effective difference between a 0.9cm and 1.1cm node? Is there documented precedence on leaving a greater-than-but-close-to-1cm node alone or even on proceeding with surgery on a less-than-but-close-to-1cm node?

  • #2
    I am not certain. With my son his nodes were all still over 2cm or 3cm post chemo so post chemo RPLND. I know IU says OVER 1cm. Goodluck.
    Son Grant
    dx 12/21/16 at age 17

    BEP x3
    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
      Shabby - We are in the same boat as you. My son is at his post chemo scans right now. We meet with the Doctor next Tuesday to discuss the results. It's the first time I can see the fear in my son's eyes. He is scared that they are going to tell him he will need the RPLND. When he was in cycle 2 of BEP ended up in hospital with blood clots in the lungs and one exploded. x-rays from that we know the node was smaller (PA said emergency room does not even mention node in their notes, and usually they only mention anything over 1cm). Hopeful it's gone after cycle 3. I'm adding your to my prayers shabby, that we both get our Christmas wish this year

      Comment


      • #4
        I am not sure that you are going to find detailed information in regard to 0.9 cm vs. 1.1 cm. I think one may take into consideration of the response of the node (how big it was before and after chemotherapy) and the timing of the CT (could the node continue to shrink). However, almost all the experts would agree that a post chemotherapy RPLND is recommended for nodes >1 cm with nonseminoma.

        There was this fairly recent article on sub-centimeter nodes after chemotherapy that may help put things in comparison on risks, etc. and be of use for you and your doctors. https://academic.oup.com/annonc/article/25/2/331/191333

        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

        For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

        Comment


        • #5
          Mike is right on, the rest of the details (pathology, staging, timing of scans and treatment, etc) matter when it is right on the border.

          FWIW, my signature has my details. I had a post-chemo 1.0cm lymph node. Went on surveillance on the recommendation of two oncologists. A few months later the node was enlarging. Quickly had an RPLND done once enlargement was confirmed, and it was determined to be teratoma. All clear since.
          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!
          3/29/2018 all clears up to this date!

          Comment


          • #6
            Thanks, everyone

            Comment


            • #7
              We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

              07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
              09/17 AFP 133.7 Start 3x BEP
              11/17 finish BEP AFP 5.9
              12/17 Recommended RPLND AFP 4.6

              Comment


              • #8
                The standard of care is to do the RPLND surgery for residual masses (lymph nodes) over >1cm, but like Mike said, it depends on pathology, the degree of shrinkage of the nodes, and whether markers have normalized or not. Sloan-Kettering is known to be more aggressive about doing the RPLND surgery. Indiana University is more likely to favor surveillance, but it very much depends on specifics of the case as well.
                Young Adult Cancer Survivorship by Steve Pake
                April is Testicular Cancer Awareness Month!
                www.stevepake.com
                Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                My Survivorship Thread | All of my Blogs
                C
                ONTACT ME ANYTIME!

                Comment


                • #9
                  Originally posted by Ann View Post
                  We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

                  07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
                  09/17 AFP 133.7 Start 3x BEP
                  11/17 finish BEP AFP 5.9
                  12/17 Recommended RPLND AFP 4.6
                  Surveillance is a perfectly viable option here. In another 3 months that residual mass might not even be there, and it's likely just necrotic (dead) tissue.
                  Young Adult Cancer Survivorship by Steve Pake
                  April is Testicular Cancer Awareness Month!
                  www.stevepake.com
                  Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                  My Survivorship Thread | All of my Blogs
                  C
                  ONTACT ME ANYTIME!

                  Comment


                  • #10
                    Originally posted by Ann View Post
                    We had our post Chemo apt today. Tumor markers normal. Lymph node is .7 cm. RPLND is recommend in about three months. It was stated that node could shrink further and very small possibility no surgery. Side note: My son did not take his lovenox shots for 4 or 5 days so ended up back in hospital with severe pain this past weekend and still has severe pain. The 3 month delay in surgery would give his lungs time to heal. Recommended surgeon Dr. Steven Campbell Cleveland Clinic. Does this sound like we are on the right path.

                    07/17 95% embryonal 5% yolk sac. rising markers. Stage 2A. Lymph node 2.1 x 2.0 cm.
                    09/17 AFP 133.7 Start 3x BEP
                    11/17 finish BEP AFP 5.9
                    12/17 Recommended RPLND AFP 4.6

                    I am not all that familiar with Dr. Campbell (not that mean that much) but if it was me, I would just ask what the options are as far as RPLND surgeons at Cleveland Clinic. I am not sure who is doing the most procedures now but know that Dr. Klein is there, Dr. Stephenson is there and there are probably others as well. Dr. Campbell may very well be the one doing most of the cases now, I just don't know.

                    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

                    For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

                    Comment


                    • #11
                      Is the 1cm rule for non-Seminoma only? I had my post chemo scans today and I have 2 nodes (seminoma) still about 1.5cm each, but was told if they are under 3cm with normal markers to only do surveillance. Does this sound right, or is my oncologist clueless?

                      Comment


                      • #12
                        2.9cm. Referred to urology. Oh well. =/

                        Comment

                        Working...
                        X