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Surveillance after adjuvant

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  • Surveillance after adjuvant

    My boyfriend had stage 1b non-sem with a high EC content (~70%) and just completed 2xBEP as adjuvant therapy. Importantly, he has never shown any blood markers, even before his orchi. I’m super proud of him and pleased we can start to move on... but now comes my fears about surveillance.

    He’s had a CT scan a month after finishing chemo which was all clear, but the surveillance schedule now only gives him another CT at 18 months and no chest x rays (apparently these are now deemed not particularly helpful for non-sem relapse detection based on research). There are still regular bloods (every 3-4 months as I recall), but my feeling is that this might be a bit useless for detecting relapse if he never showed any markers to begin with (but correct me if I’m wrong!).

    I discussed my concerns with our oncologist and he reiterated that the risk of relapse after adjuvant is small and the risk of too many CT scans with its radiation dose is something to be limited as much as poss. He also mentioned that for the majority of patients relapse comes with some sort of symptom (eg. Back pain), and if any such symptom came up we could immediately book in a CT scan. We are based in the U.K. so there is no insurance issue...

    Would appreciate any advice/insight/reassurance that any of you may have!

  • #2
    Hi Rach,

    My partner was diagnosed in 2017 also stage 1b non seminoma (minus the ec component)

    We did 1x round of BEP as his lymph nodes looked a little larger than normal and it was deemed after the 1x round that this hadnt spread , he just has slightly larger lymph nodes in general.

    We are in Australia and for the first year he had CT scans , chest xrays and bloods every 3 months.

    Year 2 I believe it was every 6 months CT and bloods and 1x chest xray.

    3rd year was just annual CT , xray and bloods which we got the all clear.

    Next year 4 years is just a annual blood test

    Year 5 is again 1x chest xray Ct and bloods.

    Relapse is rare we were told even more so having the 1 round of BEP but is more likely to happen in the first 2 years as told by his oncology team, so I would not have felt comfortable waiting 18 months for a Ct scan as my partners bloods have always come back ok even when he was first diagnosed so I wouldnt have felt comfortable with just having bloods in the first year.
    We were happy to be ontop of it and have regular check ups especially in the first year .

    There are alot more knowledgable people on here than myself so I'm sure they will be able to help further.

    Wish you and your partner all the best.

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    • #3
      The updated NCCN Guidelines https://www.nccn.org/professionals/p...testicular.pdf (you can register for free access) do have chest X-rays every 6 months for year one and then once in year two and have a CT scan annually for year one and two. Although, the surveillance schedules do vary from place to place. BEPx2 should be sufficient at keeping things from coming back and many guys only get BEPx1. The utility of the markers would be of concern to me if they were not elevated previously but regardless I would do them.

      I think I would disagree that most guys that relapse are diagnosed by physical symptoms, or at least I would hope that they are not so. For clinical stage I nonseminoma from: https://ascopubs.org/doi/full/10.1200/JCO.2014.56.2116

      "Relapses in LVI-positive patients were more likely to be diagnosed first by TM elevation as compared with relapses in LVI-negative patients (61% v 41%; P < .05), while LVI-negative relapses were significantly more likely diagnosed first by CT scan (48% v 38%; P < .05). Chest CT scan, CXR, or physical examination rarely detected relapses in either group (LVI-positive < 1%/LVI-negative group < 3%)."

      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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