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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!
    10/22/19: all clears up to this date!

    Comment


    • #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

        Comment


        • #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.

          Comment


          • #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

              Comment


              • #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.

                  Comment


                  • #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

                      Comment


                      • #12
                        Originally posted by Josh's Mom View Post
                        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.
                        Great to hear things are working. I would definitely be prepared for surgery after chemo is complete. Tumors that large often don't shrink enough to be safely considered all dead cancer. chemo+surgery does have a high chance of being the 1,2, punch to get rid of this forever though!
                        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!
                        10/22/19: all clears up to this date!

                        Comment


                        • #13
                          Thank you everyone for your kind responses. Good news and bad news coming back from a full set of contrast CT scans today at the 6 week mark of BEP x 4. The good news is that our tumor markers are doing great and trending in the right direction. His bhcg is 1.4, his ldh is 239 and his AFP that was 40,440 4 weeks ago is down to 4,035 (90% reduction in 4 weeks).

                          Lung scans show all smaller nodules gone, medium sized ones reduced. Largest being 1cm by 1cm. Doctor says that anything that size would not need to be operated on post chemo. Agree?

                          Liver still shows 3 lesions at 2mm (same size as before) and one lesion reduced from 11m down to 5m. Doctor says those are also all too small for post chemo surgery. Agree?

                          Chest lymph nodes are all still involved, as well as one clavicle node. Nodes have reduced between 10-20%. Largest chest lymph node measures 2.2 by 1.7cm. Clavicle node is still wuite large at 5.7x2.4cm.

                          Bad news of the day was the main abdominal mass. Previously, an ultrasound at the end thr 14th day of treatment showed 30% reduction. Turns out that was wrong. Mass is virtually the same size at 16.4 x 7.9 x 13.5 cm. All his main arteries run through the center of the mass. Previously, all were compressed. The compression in the aorta and retroperitnal arteries has diminished, but the compression on his intravenous cava remains. The doctor says though the tumor is unchanged in size, it doesn't look like "healthy" tumor matter any longer; many shades of grey and marbling and spider webbing. Not sure what to make of that.

                          After seeing these scans, it's clear we are not getting out of this without surgery. My concern is will the mass shrink enough to be operable. I asked her what the next course of action would be. She says way too soon to say. Options could include anything from radiation, to surgery, to a combination. She didn't seem to keen on the idea of further chemo. Am I correct to think that more chemo would be useless if all his tumor markers normalize anyway?

                          My husband wants me to request she consult with Dr. Einhorn now. My thoughts are he will just say to complete current protocol and then re-evaluate for next game plan.

                          I have ZERO knowledge on how these tumors respond, whether they die first and then reduce as they dissolve or if they shrink at a steady rate, when surgeries are done post chemo, what makes a mass operable or not, what tumors are small enough to be left behind (i.e. the ones in his lungs and liver), when additional rounds of chemo are suggested. So any thoughts or knowledge you can offer is appreciated.

                          I will finish by saying that this boy is doing AMAZING. Zero side effects other than hair loss and some reduction of hearing (still falls in normal ranges at half way mark, but is showing decline). His lowest WBC has been 8,000. His blood work numbers look great. He has a great appetite, tastes buds are fully intact, good energy levels, daily walks. His body Iis handling the protocol extremely well. Hoping this all helps to make him good candidate for any further necessary treatment plans. Thanks all for any help you can offer.

                          Comment


                          • #14
                            Thank you everyone for your kind responses. Good news and bad news coming back from a full set of contrast CT scans today at the 6 week mark of BEP x 4. The good news is that our tumor markers are doing great and trending in the right direction. His bhcg is 1.4, his ldh is 239 and his AFP that was 40,440 4 weeks ago is down to 4,035 (90% reduction in 4 weeks).

                            Lung scans show all smaller nodules gone, medium sized ones reduced. Largest being 1cm by 1cm. Doctor says that anything that size would not need to be operated on post chemo. Agree?

                            Liver still shows 3 lesions at 2mm (same size as before) and one lesion reduced from 11m down to 5m. Doctor says those are also all too small for post chemo surgery. Agree?

                            Chest lymph nodes are all still involved, as well as one clavicle node. Nodes have reduced between 10-20%. Largest chest lymph node measures 2.2 by 1.7cm. Clavicle node is still wuite large at 5.7x2.4cm.

                            Bad news of the day was the main abdominal mass. Previously, an ultrasound at the end thr 14th day of treatment showed 30% reduction. Turns out that was wrong. Mass is virtually the same size at 16.4 x 7.9 x 13.5 cm. All his main arteries run through the center of the mass. Previously, all were compressed. The compression in the aorta and retroperitnal arteries has diminished, but the compression on his intravenous cava remains. The doctor says though the tumor is unchanged in size, it doesn't look like "healthy" tumor matter any longer; many shades of grey and marbling and spider webbing. Not sure what to make of that.

                            After seeing these scans, it's clear we are not getting out of this without surgery. My concern is will the mass shrink enough to be operable. I asked her what the next course of action would be. She says way too soon to say. Options could include anything from radiation, to surgery, to a combination. She didn't seem to keen on the idea of further chemo. Am I correct to think that more chemo would be useless if all his tumor markers normalize anyway?

                            My husband wants me to request she consult with Dr. Einhorn now. My thoughts are he will just say to complete current protocol and then re-evaluate for next game plan.

                            I have ZERO knowledge on how these tumors respond, whether they die first and then reduce as they dissolve or if they shrink at a steady rate, when surgeries are done post chemo, what makes a mass operable or not, what tumors are small enough to be left behind (i.e. the ones in his lungs and liver), when additional rounds of chemo are suggested. So any thoughts or knowledge you can offer is appreciated.

                            I will finish by saying that this boy is doing AMAZING. Zero side effects other than hair loss and some reduction of hearing (still falls in normal ranges at half way mark, but is showing decline). His lowest WBC has been 8,000. His blood work numbers look great. He has a great appetite, tastes buds are fully intact, good energy levels, daily walks. His body Iis handling the protocol extremely well. Hoping this all helps to make him good candidate for any further necessary treatment plans. Thanks all for any help you can offer.

                            Comment


                            • #15
                              Yup, stay the course, complete the 4xBEP, then evaluate and definitely consult with Dr. Einhorn or another TC expert. With expert help you have a good chance at this. I definitely would expect surgery to be required post chemo, and the experts can help determine if any further treatment is needed to make the surgery easier as well.
                              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!
                              10/22/19: all clears up to this date!

                              Comment

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