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Chemo for Stage IS Non-seminoma

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  • Chemo for Stage IS Non-seminoma

    Just having worried second thoughts about planned chemo (3xBEP) starting in April.

    I got a right I/O a month ago, pathology was 50% embryonal, 40% yolk sac, 10% seminoma, no vascular invasion.

    In terms of markers, two weeks after the surgery my AFP decreased only slightly to 55 ug/L and HCG rose slightly to 16 IU/L. But nothing showed up on subsequent CT scans.

    Is immediate chemo such as 3xBEP the only treatment for a case like this? It was presented to me as if that was the only viable treatment option, nothing else was even really discussed. Now I'm feeling like I was rushed into something and I'm not sure if I should have had options. I tried searching online but had trouble understanding what is done for cases like this.

  • #2
    Hi Jbent ,

    Sorry to hear you probably need further treatment.

    Base on my knowledge, after I/O if Tumor markers are dipping down( not one time testing, at least two times or more testing in a month), then next step will base on CTs results. If tumor markers are not dropping or shortly dropped then raising again, Chemotherapy is MUST. Because tumor markers mean that in your body there are still active tumors are producing markers, and Chemothreapy is the only way to kill them.

    But, again I am not a TC expert, you better to consult your urologist und oncologist.

    Good luck!

    Amy, Ran’s mom
    Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary Pathology report: one lymph node from 57 is Teretoma .Back to surveillance 05/02/19 Blood work all normal

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    • #3
      jbent,

      Welcome to the forum.

      Please give us the entire picture. Did any CT scan show spread? What were the pre-surgery marker levels? Might be worth an email to Dr Einhorn, be sure to include all your test results, as well as everything you've posted here.

      Dave
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP

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      • #4
        Thanks for the response Amy.

        Hi Dave, neither dye CT scan before nor after I/O revealed anything. 10 days before surgery AFP was at 60 and bhcg was at 10. Marker levels were taken day of the surgery and one week ago (three weeks after surgery) as well but unfortunately I don't know what those numbers were, aside from knowing that bhcg was still elevated.

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        • #5
          This is a tough one for me to gauge, for sure, and you should definitely e-mail Dr. Einhorn for his opinion - (leinhorn@iu.edu)

          What were your AFP and HCG numbers at first diagnosis?

          With 50% embryonal carcinoma and 40% yolk sac (aggressive components), rising HCG (albeit slightly), if I were in your shoes, I would definitely choose chemo as well. Reading your post, I thought to myself (surely some chemo is next, just because AFP isn't decreasing at expected rate, and HCG slowly rising). The question I was thinking to myself was 'how much chemo?'- If your markers normalized, I think it would've been either surveillance or 2xBEP if you chose adjuvant chemo. The markers not normalizing is the concerning thing (this is assuming a non false-positive blood test). I chose surveillance and relapsed after a year, doing RPLND, and chemo after, and it wasn't as bad for me as I thought it would be, based on other stories I've read. I'm 5 years out and now and all-clear.

          The good news is that it looks like you caught it very early, and chemo will almost surely destroy whatever might be lingering. All of your components are highly sensitive to BEP, and should obliterated by this chemo alone.

          Keep us updated!
          6/28/13 - Diagnosed with TC
          7/02/13 - Left I/O
          Pre-I/O - AFP 232 | b-Hcg 276
          7/09/13 - CT scan CLEAN - negative for mets/lymph node enlargement
          7/28/13 - AFP 7 | b-Hcg <2
          7/30/13 - Pathology Result : pT1 NSGCT (15% EC , 10% Yolk Sac , 75% Immature Teratoma) no LVI/Epididymis/S.Cord involvement
          7/30/13 - Surveillance - Next CT + Blood in October 2013
          10/22/13 - AFP/HCG normal | CT Scan normal | 3-months all clear
          --Next Check-Up in February--

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          • #6
            Originally posted by jbent View Post
            Thanks for the response Amy.

            Hi Dave, neither dye CT scan before nor after I/O revealed anything. 10 days before surgery AFP was at 60 and bhcg was at 10. Marker levels were taken day of the surgery and one week ago (three weeks after surgery) as well but unfortunately I don't know what those numbers were, aside from knowing that bhcg was still elevated.
            You need to get the most recent marker numbers, were the numbers you posted from the test done on the day of surgery,? I'm having some difficulty figuring out which test results gowith what dates. Could you post the results with the dates tests were taken & the date of surgery?

            Get that sorted out & than contact Doc E, but given that EC can spread via bloodstream, it seems likely that chemo may be needed.

            Dave
            Jan, 1975: Right I/O, followed by RPLND
            Dec, 2009: Left I/O, followed by 3xBEP

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