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Post Chemo - RPLND - Encasing Aorta & Artery

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  • Post Chemo - RPLND - Encasing Aorta & Artery

    Hello, I have recently finished 3xBEP and had my final CT scan and unfortunately the mass in my abdomen is still large, 4.7cm. It started out at 18cm, so it is significantly smaller after chemo. My oncologist has ordered a PET scan that will be at 6 weeks after completion of my chemo. He had mentioned that a mass of that size probably will require RPLND. My concern is that my CT scan states the mass is encasing the abdominal aorta circumferentially, left renal artery and probably the proximal left ureter. It measures 4.7cm from the known seminoma. I know the RPLND surgery is going to be difficult, however the encased aorta and artery have me very concerned. How common of a surgery is it with the aorta involved? Thank you.

  • #2
    Hi BetterOnABoat, I am very happy to hear BEP worked out for you. Have you already checked the testicular cancer experts in your area? https://www.testicularcancerawarenes...cancer-experts

    I am sure more experienced users here can draw your attention on some resources. Even only for peace of mind, it might be a good idea to discuss your case with the surgeons experienced in RPLND.

    I am not a medical expert, but being familiar to posts here, I didn't get how 4.7cm is associated with seminoma? Could it be teratoma? Also, by experience I know CT scan is more preferred in TC.

    I didn't of course want to bombard you with questions but perhaps those details might help others to comment better to your post.
    March-April 2018: Lump and discomfort.
    May 2018: Right I/O
    Pre-surgery \: AFP: 560, b-HCG: 109.69, and LDH 317
    Post-surgery: AFP: 164 then 17.29 / b-HCG- 10.13 then <1.2/ LDH: 220 to 173.
    Pre-chemo: No retroperitoneum lymph node, small pulmonary lesion of 3mm in question.
    Pathology: 60% teratoma, 25%EC, 10% seminoma, 5% yolk sac No LVI / Pathology revised in the US in 2019 LVI +
    June-August 2018: BEPx3 micro metastasis? good risk low volume metastatic NSGCT.
    Post-chemo: Markers normal, scans clean. Moving to US.
    September 2018-May 2020: Markers and scans clean
    May 2020: Markers negative, AFP 3.9 to 5. CT: one gonadal lymph node measure 1.2x1.1cm. No significant change compared to 2019 but increase compared to post-chemo scans. Teratoma?
    June 2020: RPLND - 2 teratomas - 2.2cm and 1.0cm

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    • #3
      RPLNDs are more difficult after chemotherapy for seminoma due to the desmoplastic reaction that occurs with the tissues, where the tissues kind of melt together. I am not sure where you are located, but if it were me, I would be looking for a very experienced team/surgeon. Having additional procedures such as the need to graft the aorta is not uncommon so an experienced team would be able to handle this and have additional surgeons on the case during the day, i.e. a vascular surgeon.

      Mike
      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Surveillance...
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

      For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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