What should I do? Seminoma pT2

[Aleksandrze]

Hallo guys I'm Alex and I'd like to shere with you my case.

Pathomorphological diagnosis:
1. Seminoma pT2 tumor in the center of a testicular in size 2,0cm x 1,5 x 1,7cm occupied about 10% of the testicular.
2. The epididymis, tunica vaginalis, spermatic cord - unchanged.
3. There were no signs of angioinvasion.

CT:
1. A single aortic lymph node with the transverse size 12x7mm.
2. Everything else is clear.

Bloodtest results:
Before orchiectomy: LDH 157 AFP 2.96 B-HCG 1.0 (normal)
After orchiectomy: LDH 150 AFP 3.19 B-HCIG 1.0 (normal)

I think it's a stage IIA pT2 N1 M0 S0 and I'm not sure why should I do now. The lymph node is really small and everything other seems to be normal. I'm not sure if chemio is good in my case. One doctor said to me that I'm "healthy" but it's better to me to take 2x carboplatine just in case. I'm not convinced about it because I'm affraid of the aftermaths. What do you guys think?

[billandtuna]

Hi Alex, and welcome aboard!

I know this is a confusing time when you have to make a lot of decisions quickly, and you're learning everything you an as fast as you can.

Given that you have some doubts, I think it would be a good idea to check in with a second oncologist or urologist to review your options and help you make a final decision that you feel comfortable with. Make sure that your insurance covers a second opinion (they almost all do, but you don't want to get caught short on that if you can avoid it).
Your first oncologist will welcome a second opinion (or at least they had better!). You may come to the same conclusion, or you may get new information that takes you down a different path.

I myself had a 1A seminoma that was 4.5cm, and also rete testis involvement, so it's a different circumstance. I had 2xcarboplatin, but if I knew then what I know now, I probably would have gone with surveillance. As chemo goes, it's a pretty easy one, but chemo is never a party.

So it really comes down to what risks you want to balance. All your options at this point have superb outcomes, so it's a matter of deciding what's most important to you.

[Aleksandrze]

Thank you billandtuna for the quick answer. I want to take opinions from more people than just me. I also don't really trust doctors in Poland. I think they don't really know much about TC because it's really rare cancer and they also don't really care and give you BEP just in case because this is what they do in cancer right? But I guess it is more things to consider in my case. There's only one place I can take carboplatine and this is the capital of Poland 500km from me. :/ As you can see I must be sure what sould I do now. Carbo is not so destructive as BEP. I don't even know if should I take any chemo or maybe just observe. Btw I'm gay too

[billandtuna]

Hi Alex,
I hope you get answers from people with more similar experience here.

My mother's mother's father's mother came from Krakow in the early 1900's when my grandfather (her son) was only 1 year old, so I have a soft spot for Poland!

Even if seeing another oncologist in Poland may be difficult, you should be able to reach out to one by e-mail to make sure that the options you're being offered are the best for you.

Testicular cancer may be rare, but it is also pretty simple to treat, with extremely high survival. But you should feel confident about your next steps.

Good luck, and let us know how things are going for you.

[Aleksandrze]

So I was by my oncologist and we agreed that I don't need chemo right now. I must do CT and bloodtest to check if everything is normal.

[testicles001]

12x7mm already skipped threshold for 10mm normal lymp node. What you can do, is do another scan in 1 month time. If that lymph node gets further enlarge, than do radiation. Seminoma are very radio senstivie and its best choice treatment for stage 2a

[billandtuna]

Good luck Alex, it sounds like things are well in hand!

[Mike]

Hi Alex,

I've had the pleasure to lecture in Krakow in 2012 and loved my visit.

Was it your left or right testicle that had the cancer?

Was the CT done before or after the orchiectomy?

With normal markers and a node at just 12 mm, I think my choice too would be to wait and see what the node does. There is probably a 40% chance that chemotherapy can be avoided as the node may shrink back down. On the other hand if the node increases then the full BEPx3/EPx4 or even radiation would be needed, however, you would know more for certain that it is needed. Plus, in this situation, having the carboplatin up front (which would be an undertreatment if you really have a metastasis) could just confuse things.

Keep us posted on the follow up CT and I would probably want it done within a month or two of the first CT, just so you are nor waiting 3 or 6 months to have it done.

I am not familiar with testicular cancer specialists in Poland, there are some great doctors in Germany, however there have been a few kinf of recent recent articles that may help you in finding more experienced testicular cancer doctors if you ask around. The articles are: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829749/ (these authors seem to be more epidemiologists but they may have connections) and https://www.ncbi.nlm.nih.gov/pubmed/26843846 is another that has authors contact information.

Mike

[Harxxony]

Hallo guys I'm Alex and I'd like to shere with you my case.

Pathomorphological diagnosis:
1. Seminoma pT2 tumor in the center of a testicular in size 2,0cm x 1,5 x 1,7cm occupied about 10% of the testicular.
2. The epididymis, tunica vaginalis, spermatic cord - unchanged.
3. There were no signs of angioinvasion.

CT:
1. A single aortic lymph node with the transverse size 12x7mm.
2. Everything else is clear.

Bloodtest results:
Before orchiectomy: LDH 157 AFP 2.96 B-HCG 1.0 (normal)
After orchiectomy: LDH 150 AFP 3.19 B-HCIG 1.0 (normal)

I think it's a stage IIA pT2 N1 M0 S0 and I'm not sure why should I do now. The lymph node is really small and everything other seems to be normal. I'm not sure if chemio is good in my case. One doctor said to me that I'm "healthy" but it's better to me to take 2x carboplatine just in case. I'm not convinced about it because I'm affraid of the aftermaths. What do you guys think?

Hi Alex, sorry for you to join us. Didn't really get this pT2 dygnosis, as there is no evidence of any local spreading. About 12x7 mm node, I had 14x10 mm node, but went to surveillance, so far I'm good (16 months). I'd say you have just 15% of chance that you are not cured yet on the basis of local pT diagnosis. I think that 2xcarbo is to much.

[Davepet]

I'm with Mike, I'd be afraid 2x carbo would be under treatment if this is a metastasis.