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Please help! Confused about conflicting tumor markers

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  • Please help! Confused about conflicting tumor markers

    My 16yo son was diagnosed last week with stage 3c mixed germ cell non-seminomous testicular cancer with mets to liver and lungs and tumors in abdomen. His initial tumor markers were HCG 250, LDH 756, AFP 37,000. He had an orchiectomy and then his tumor markers were re-run before chemo treatment began. Those numbers were HCG 214, LDH 696, AFP 36,600. His treatment plan is 5 days of etopiside and cisplatin every 21 days and bleomycin 1x a week. A total of 12wks of treatment. He completed his first 5 day treatment Tuesday and went today to the oncology clinic for 2nd bleo. While there, they ran his markers. AFP will take 5-6 days to come back, his LDH did well and dropped by 50% to 336, but his HCG tripled to 725! What the heck! Our oncologist is out, so we saw an associate who isn't very familiar with germ cell tumors and said we will just have to wait for the AFP to come back and we shouldn't worry. That's like telling a mother not to breath. Can anyone comment on why the contradictory markers, one dropping greatly and the other rising greatly?

  • #2
    Chemo causes cancer cell death. So sometimes the chemicals within the cancerous cells come out at a faster rate when they are destroyed. As I understand it, markers bouncing around or increasing some sometimes happens during chemo treatment.

    Sounds like he is receiving 4xBEP, which sounds correct for stage 3c.

    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: begin 4xEP, end 9/18/15
    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!
    4/15/19: all clears up to this date!

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    • #3
      Agree with Biwi, makers will be moving up and down during treatment. Your son needs to continue with the treatment.
      6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
      7/2016 - markers normal; confirmed Stage 1B; surveillance
      8/2016 - markers normal
      9/2016 - markers normal
      10/2016 - markers normal; CT scan revealed 3mm lung nodule
      12/2016 - markers normal
      2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
      3/2017 - 3xBEP
      5/2017 - finished 3xBEP
      6/2017 - markers normal; no size reduction in lung nodule
      8/2017 - VATS and markers normal; continue to surveillance
      12/2017 - all clear
      ​3/2018 - all clear
      6/2018 - all clear

      Comment


      • #4
        It's actually pretty odd to check markers after only one week of treatment. What biwi described is called cell lysis, & it's pretty common at this stage. One might even infer that the increase in hcg is a sign of the treatment is working.That is likely why they don't normally test markers this early in treatment.

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

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        • #5
          Thank you all for your response. It helps my anxiety levels a lot. May I ask how long to see a reduction in tumor size once treatment has started? He has a large cervical lymph node tumor that is about 1.75 inches by 3 inches. I haven't seen any change in the node (possibly even slightly bigger) since treatments began. He has a bleo this Friday that will complete the first cycle.

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          • #6
            It depends. I had teratoma and required surgery to remove after 3XBEP.
            6/2016 - Right I/O; 35% Yolk Sac, 35% Teratoma, 10%EC, 20% Seminoma with LVI; AFP elevated; CT scan clean
            7/2016 - markers normal; confirmed Stage 1B; surveillance
            8/2016 - markers normal
            9/2016 - markers normal
            10/2016 - markers normal; CT scan revealed 3mm lung nodule
            12/2016 - markers normal
            2/2017- markers normal; CT scan confirmed lung nodule grew to 14mm; confirmed relapse
            3/2017 - 3xBEP
            5/2017 - finished 3xBEP
            6/2017 - markers normal; no size reduction in lung nodule
            8/2017 - VATS and markers normal; continue to surveillance
            12/2017 - all clear
            ​3/2018 - all clear
            6/2018 - all clear

            Comment


            • #7
              Tumor size reduction is very individual, but often isn't even finished untlll weeks after the last dose of chemo. It is not common to even scan after one week of treatment, as it won't normally show anything useful.
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

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              • #8
                Tumor size reduction is very individual, but often isn't even finished untlll weeks after the last dose of chemo. It is not common to even scan after one week of treatment, as it won't normally show anything useful.
                Jan, 1975: Right I/O, followed by RPLND
                Dec, 2009: Left I/O, followed by 3xBEP

                Comment


                • #9
                  Thank everyone for helping this scared mamma. The good news was they did an ultrasound of my sons abdominal tumor before his 3rd bleo and the scan showed a 30% reduction in size already! He went from 16.6 cm x 13.4cm to 10.8cm x 9cm. His HCG dropped from the 700s to 154 and his ld went from 363 to 284. We won't have AFP until Wednesday. The chair of the research committee oversees (Australia? Or maybe New Zealand?) Confirmed probably tumor lysis as cause for drastic increase in markers last week. We are headed in the right direction.

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                  • #10
                    Thank everyone for helping this scared mamma. The good news was they did an ultrasound of my sons abdominal tumor before his 3rd bleo and the scan showed a 30% reduction in size already! He went from 16.6 cm x 13.4cm to 10.8cm x 9cm. His HCG dropped from the 700s to 154 and his ld went from 363 to 284. We won't have AFP until Wednesday. The chair of the research committee oversees (Australia? Or maybe New Zealand?) Confirmed probably tumor lysis as cause for drastic increase in markers last week. We are headed in the right direction.

                    Comment


                    • #11
                      Hey, i had stage 3c three years ago. (ßHCG 225.000, LDH ~1.250, AFP 27)
                      4x BEP and RPLND did it!
                      So the treatment is correct

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