Finally got the full pathology report - opinions?

[Lee359]

Mixed type, 45x35x35mm occupying most of testis. Tumour is limited to testis, reaching the tunica but not through it.
Consisting of immature teratoma 70%, Yolk sac 20-25%, seminoma <5%, Chorio<1% (only noted as possible not definite)
Path report notes AFP 229 others normal

No LV, Epididymis and cord clear.
CT scan clear

pT1 Nx Mx
Blood test for markers today and currently awaiting further oncology consult.

Lee

[Jules]

Lee did you have a CT scan yet, when will you see your oncoligist?

[Lee359]

Hi Jules, had a CT scan couple of days before I/O, Oncologist appt next week, don't know what day yet.

[Jules]

OK, Lee keep us posted.

[frank1980]

Mixed type, 45x35x35mm occupying most of testis. Tumour is limited to testis, reaching the tunica but not through it.
Consisting of immature teratoma 70%, Yolk sac 20-25%, seminoma <5%, Chorio<1% (only noted as possible not definite)
Path report notes AFP 229 others normal

No LV, Epididymis and cord clear.
CT scan clear

pT1 Nx Mx
Blood test for markers today and currently awaiting further oncology consult.

Lee

This is almost my same situation my friend, even if I'm sorry to read that you have a non seminoma cancerous form. Anyway, if there is no LV, if your epididymis and your spermatic cord are clear, and also the CT scan is clear you are in a good position. Very probably, your tumor was classified as "pt1,Nx,Mx" because the doctors didn't find enlarged lympho nodes so they didn't send them to the histologic unit to explore them. If you want to put your mind in rest, you can ask to your doctor also for a Pet scan before starting any type of treatment. For example, in my case, with the Pet scan the state of my tumor was changed and was classified as "pT1,N0,M0" (from "pt1,Nx,Mx" like your case) since there were no mets found in the whole body and now I'm feeling more relaxed. The CT scan is an accurate exam, but unfortunately it doesn't see the metabolic activity of the cells, while the Pet scan can do it and can offer you more safety (the oncologist explained to me that the CT scan sees the 95% of the situation, while the Pet scan sees the 99,9%).. Nowadays there is also the opportunity, with the new medical equipments, to have a complete Pet and CT scan at the same time, it will reveal you everything. I'm not a doctor, but very probably your oncologist will suggest you to have a radiotherapy treatment or a single carboplatin chemo round in order to have stronger safety, anyway, if you do a Pet scan and it won't show anything abnormal, you can avoid them and you can be put on surveillance. And I think it's the best way to be!

[Nut of Mordor]

but very probably your oncologist will suggest you to have a radiotherapy treatment or a single carboplatin chemo round in order to have stronger safety,

Carboplatin and radio work only for pure seminoma, so it's not is case.

If the scan is clear and markers will go down to normal he's a good candidate for surveillance, but - just my two cents - with that big amount of immature teratoma (chemo resistant and it can turn into nasty kinds of non testicular cancers, like PNET) I would at least discuss the RPLND option with the doctor.

[frank1980]

Carboplatin and radio work only for pure seminoma, so it's not is case.

Ops, this is true, I'm sorry!

Anyway, I think he will be put first on surveillance before having RPLND. Let's hope so...

[Lee359]

Blood results today, AFP 25, (taken 26 days after I/O and down from 229).
Was hoping for it to be much lower than that by now
Lets see what the oncologist says next week.

Edit: Just a thought,the initial blood test was 7th march (AFP=229) which was 21 days before the I/O and although the Path report states afp=229, I don't know if it was retested on the day of the I/O or not.
If it had risen in the interval then the expected results today would be different - guess that's a rather important question to ask

[frank1980]

My friend, I think that 25 is a good result (most if had decreased from a higher value like yours!) My oncologist said that there is no need to worry until 30 units, so, if I can express to you my point of view, even if your value is unfortunately officially in the "red zone" you can feel a little bit more relaxed. Probably it will need also some time to decrease and to become normal. Don't think if it had risen or not in this interval, Afp level (like some other blood markers values) is subjected to fluctuations, it's normal. Enjoy your today's good news, because this one that you have received today is a very good step. I cross my fingers for you and wish to you good luck at the next test!

Sincerely!

[davidhanson90]

As far as I know, AFP half life is around 5-7 days. So if we take 7 and your numbers we get

26 days / 7 = 3.7 (Lets say 4)

Week 1 = 114
Week 2 = 57
Week 3 = 28
Week 4 = 14

Your around 3.5 weeks right so 26 seems ok to me.

You just need to watch for rises in afp.

[Lee359]

Updating this here, because it makes more sense than a new thread

Saw Oncologist today, he was OK with the AFP at 25 last week and am now officially on surveillance with fortnightly blood tests. Next blood tuesday, next CT scheduled for June.

Did say he would have liked to see the AFP a little lower, but agreed with me that since they didn't do a marker draw on the day of the I/O, we don't know exactly what number we are counting down from. But as long it goes down and stabilises he is happy.
Also said that the clear CT along with the histology was very encouraging.

Waiting for the next marker result before relaxing, but still in a positive mood today

Edit: Should point out that Oncologist has been part of the team since the start, but this was the first visit/meeting.

[Jules]

That's good news lee, I'm really pleased for you.