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First CT scan and I got a conflicting evaluation

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  • First CT scan and I got a conflicting evaluation

    17 days ago I had a right side I/O that proved to be 1.2 seminoma with rete teste invasion but nothing else. 2 weeks after had my CT Scan in the morning and saw my urologist that afternoon. Radiology report came back clear and he recommended surveillance. 2 days later he calls me to say that he also looked at the scan and had a concern that a lymph node was enlarged but not more than 10mm which is what radiology looks for. He says he also showed it to an oncologist who said it doesn’t look right. I asked him the size and he said he didn’t have the info in front of him but that it was under 10mm. He recommends a CT scan in 3 months too see if it grows but also says I could start Chemo now if I wanted to, which surprised me. I have a friend who is a radiologist and we reviewed the scan together. He mention that by appearance the node looks a little plump but has a normal shape. He said if it is slightly enlarged that it could be drainage from the surgery. However he also felt that the size was relatively normal as he measured the short cross axis at 5mm and the long cross axis at 8mm. He says for evaluation purpose you always use the short cross. According to online information for TC its at 8mm in diameter you would be suspicious and sitting at 5mm he would not consider this to be enlarged and that the scan is clear. I am going to follow up with my Dr. but I also feel a bit concerned that he put chemo on the table despite what appears to be a very questionable situation, unless he had some other reasons to be concerned outside of the size. Not sure if anyone has any additional info that could shed light on this.

  • #2
    Basically what your doctor is doing is covering his/her ass just incase it is cancerous. Reality is that the margins are to close for them to say it is or is not csncerous
    Jan 2012- U/S mass in Left testicle
    Feb 2012- I/O performed to remove cancer
    Mar 1,2012- pathology pure seminoma
    Mar 7, 2012 PET SCAN stage IIa
    April 2012 Mayo clinic carbolite.
    May 2012 carbolite failed, started BEP x3
    August 7th 2012- BEP complete
    April 2013 CT/PET show relapse
    May 2013 RPLND
    Aug 2013 Relapse again Started VIeP x2
    Dec 2013 HDC completed CT/PETSCAN 1.1 cm x .8 cm right lower lung lobe
    Feb 2014 confirmed false positive all clear FINALLY !
    Jan 2015 1 year cancer free Pet/CT scan
    Jan 2016 2 years cancer free "Pet/CT scan


    • #3
      With the CT scan post-orchiectomy it is not unusual that nodes can be even larger than 10 mm and be a result of post-operative changes as your friend mentioned. Do you have any information on which node is enlarged (for example, is it in a typical landing zone for testicular cancer)?

      If it is less than 10 mm and your tumor markers are normal, I have seen experts re-do a CT within 6 weeks just to evaluate if it is cancer related or not. I would avoid starting chemotherapy if you do not need it and waiting to re-evaluate (if your markers are normal) would have no impact on your outcome even if it is related, so I am a bit surprised by the "you can start now" remark.

      Are you being treated in an experienced hospital? I would request the CT results and the tumor marker results from my medical record if it were me.

      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
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary


      • #4
        Thanks for your comments Mike, I am at a top 10 urology department and until this issue everything has been good. The node they are concerned with is the primary landing site for right side TC, however my radiologist friend also said how that would be a primary drainage site for surgery as well. Overall I am very surprised as to why my Dr put chemo on the table as an option now, although he was recommending the 3 month scan. Oddly prior to this he spoke fairly specifically against over treatment options when he thought the scan was clear, but this made me think that he thought something was really there. However based on what I read and from my radiologist friend, it is really all about size when it comes to lymph nodes and this node is not even close to 10mm. I will have to ask my Dr. what size he was measuring it at, in a worst case scenario he actually might have miss measured. Either way I won’t be doing the chemo as my Dr said in 3 months if they confirm it grew it would be the same chemo treatment.


        • #5
          They should definitely rescan as Mike suggested. BTW, there is a difference between top Urological hospital and TC Center of Excellence.I come from a family of Urologists who rarely saw TC.
          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.


          • #6
            Just to follow up l, I spoke with my urologist today and he clarified from his previous remark to say that it is not just the size of the lymph node but that when you have TC and we can see that lymph node at all on a scan, even if it is small, it is still considered very suspicious. He is still recommending to do the scan in 3 months to see if there is a change and that is what I am going to do. However I have never read anything online that made a reference to this type of analysis, most things still reference size as an important factor in nodal staging although location is important for TC. On this forum, I am not sure if I have seen anyone mention being diagnosed with a node measuring under 10mm and mine is 5mm by 8mm. My urologist did also mention that he did not think that the node would be affected by any post surgery drainage. I did also once again consult with my friend who is a radiologist who felt that the idea that the concern is based on that the node was visible alone is a big leap as he sees random nodes all the time in CT scans. He understands the nature of TC that makes this a concern, but again the suggestion that chemo is an option now still seems so odd. Was thinking of getting a second opinion from MSK but realistically I need the next scan to really have any definitive information to move forward. Any insight other have, please let me know.


            • #7
              I wouldn't read too much into him offering chemo, he's probably just aware that some guys are uncomfortable with surveillance alone and want to hit it with the big guns right away.
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP


              • #8
                From what I know it should be larger than 10mm for them to consider treatment or removal