2 year tests show high HCB and lymph node

[HalfSac]

It's been awhile since I've been on here. I just went yesterday for my 2 year check up, blood tests and CT. Today I met with my oncologist and he said he was a little concerned. My AFP and LDH were normal, have been for the last 2 years. My HCG was 9 (up to 5 is normal). That was the first time it's been over 2 since my surgery. He also said that a lymph node near my pelvis was slightly enlarged since the last scan. I'm scared it may be early signs of a relapse, does anyone have a similar experience? He's order more blood tests next week, and I'm suppose to be scheduled for a biopsy of the lymph node soon. Sucks because I thought I was almost out of the relapse woods.

[Davepet]

Please define "slightly enlarged", numbers matter. Also, what type of TC was noted in the path report? Unfortunately, we are never 100% out of the "relapse woods" it's just that the odds get better & better every year.

Dave

[HalfSac]

Sorry, pathology was 2.6x2.6x2.5 and composition of 25% embryonal carcinoma; 25% yolk sac tumor; 20% seminoma, and 30% teratoma. The node was 1.1 x 1.0 cm six months ago, now it's 1.7 x 1.2cm. I had surgery and followup with oncology at home in Cincinnati, but initially I met with Dr. Einhorn in Indy. I just emailed him and his thought was the odd spread pattern to the pelvis could be caused by a hernia I had years ago. He also suggested that surgery on the one node might be an option instead of chemo. Something my oncologist never even mentioned.

[Mike]

I am glad that they are re-doing the labs to see if there was any error. I would wait to see what they have to say. May even be worth making sure that low testosterone isn't interfering with the beta-hCG level (at 9 it is still really low, just an FYI). If the node is definitively thought to be a relapse, then I would defer to Dr. Einhorn of if a biopsy is necessary/needed or if surgical or chemo intervention can be started without the biopsy. The vast majority of relapses for nonseminoma are within the first 2 years so you may be able to avoid the biopsy discomfort but I would let Dr. Einhorn decide that. Was your check up with oncology or urology?

Mike

[HalfSac]

Yeah good point, I was reading tonight about low testosterone and sent my Oncologist a message asking if that could be it. I had that tested over a year ago and it was in the normal range, but that could have changed. I'm going to send my last couple scans and bloods tests to Dr Einhorn tomorrow so he can get a good picture of what's going on. My checkup was with my Oncologist.

[Mike]

Yeah, see what Dr. Einhorn thinks before getting too worried as you will be in good hands there. Isolated pelvic relapses, while possible, are not all that common so it may take a bit to figure out the best approach to avoid jumping the gun with treatments but taking a bit of time would not be expected to affect your outcome for a cure, if needed.

Mike

[HalfSac]

Just to update, I had my biopsy at the hospital yesterday. Wasn't too bad, in some pain but tylenol helps. I should have those results Tuesday, repeating blood on Monday. Dr Einhorn mentioned that removing the node itself might be okay instead of chemo. My oncologist said possibly, but he felt the risk of relapse would be high. Obviously Einhorn is the expert, but I really do like my oncologist and academically he's a rock star. Also have to give him credit, he never gets offended when I say "but Dr. Einhorn said....." He even said that I would have time after the biopsy results to drive up and see Einhorn about surgery instead of chemo. What are your thoughts? With the enlarged node and HCG at 9, do you all think it's TC or a fluke coincidence?

[Trekga]

Hopefully your results will shed some light on your situation, along with new Tumor Markers. Glad you are consulting via Dr. E, no one knows TC like him, we are blessed to have him willing to reach out to patients and Oncologists.

[Davepet]

I'm curious, does anyone know if a pelvic node requires a full RPLND or is it a less intensive surgery? If it's less invasive, I'd personally be inclined to get the surgery first & hold off on chemo until it is obviously needed.JMHO.

Dave

[HalfSac]

I'm not sure, that's one of my questions for Dr. E. He should have my scans and tests any day now. My oncologist said it may be difficult to get to, he wasn't even sure at first we could biopsy it. His other concern was higher likelihood of spreading. I kind of agree with you, as much as I would hate another surgery, long term effects of 3xBEP scares me alot. Has anyone else had pelvic lymph nodes removed?