First Post-Chemo CT and what's next

[pc84]

I recently had my first post –chemo abdominal CT scan one week after my fourth cycle of Etoposide-Cisplatin.

Original pathology report showed 70% EC, 25% Seminoma, and 5% yolk sac tumor.One enlarged lymph node on pre-orchiectomy scan at 3.9 centimeters, then at 2.9 centimeters after orchiectomy.Tumor markers all normalized by third cycle of EPx4.

Post chemo CT scan showed reduction of lymph node to 1.4 centimeters. My follow up with onco isn’t for another 12 days and I want to be better prepared to have an informative discussion about whether further treatment is necessary. Personally, I would like to avoid the RPLND and know that if I was being treated in New York, I would likely be advised to go ahead with it. I have seen Dr. Einhorn before I started chemo, who said that the magic number was 1 cm for node diameter to avoid surgery.

I am thinking that since the scan was only one week after the last chemo cycle, another scan would be appropriate to check if the node size has normalized further.

Any helpful input is greatly appreciated. Keep fighting.

[Fed]

Yeah, 1 cm is typically the cut-off for a suspicious node. I am fairly certain your oncologist will bring it up and mention the possibility of an RPLND. It is not unreasonable to wait for a few weeks to see if the node resolves. Even if you needed surgery you wouldn't be able to have it done so soon after chemo anyways.

[AustinsMom]

Hi Pete,

My son just had his first post chemo CT Scan last week, exactly one week after his final Bleo. Like you, all of his markers normalized after the first round and continued through the end of his BEP. Initially, we were just told his CT Scan was clear, but he had one enlarged node when he relapsed 4 months after his I/O. Our Oncologist sent me the comparative CT Scan images so we could see for ourselves what it looked like. His node measured 1.38 x .57 at diagnosis ( which was apparently considered normal). At relapse it grew to 1.85 x 1.05. Last week the node measured 1.36 x.55.

When we were initially given the post chemo news, I was sick at the thought this meant an RPLND. However, our Oncologist and the " Johns Hopkins Tumor Team" are all in agreement Austin is in complete remission and should be back on surveillance. This is due to the normalization of his markers and what they feel is a node within the normal range. What he said was that the node could possibly enlarge due to a pelvic infection or something of that sort and there is also a possibility it could still shrink some, but it will never disappear as it is there to serve a purpose. He reassured us they would certainly be keeping an eye on it though in future scans. He went on to site some of Dr. Einhorns recent studies, which basically conclude that , while there is a chance Austin will need a RPLND, it is not significant enough to warrant surgery at this point. Of course, he knows we will be diligent about bringing Austin in for his scheduled check ups as well.

So.... I am assuming that there must be some leeway with that 1 cm. cut off that I have always read about. This information was all relayed in a very lengthy email ( on the 4th of July , no less) because we couldn't wait to get the results, so I did not question it. However, when we go in for our next appointment in a couple of weeks, I am curious to know why the size (over 1 cm.) was considered normal in the first place.

In any case, our Oncologist sent me a couple of recent studies that back up the surveillance decision in our situation. If you are interested and would like to read them, you can P.M. me and I will attempt to forward them to you.

Wishing you the best,
Diane

[Davepet]

I am thinking that since the scan was only one week after the last chemo cycle, another scan would be appropriate to check if the node size has normalized further.

My first post chemo scan showed that my enlarged node had reduced but not gone back to normal. The next scan didn't mention any abnormal nodes & that has held for 2+ years now.

It can take some time to go down & my doc was unconcerned at the first scan & said he expected it would reduce going forward.

Dave

[pc84]

Thank you so much Dave and Austin's mom for the replies. I couldn't wait, so I e-mailed Dr. Einhorn.

He responded that since it is only 4mm above normal, it would be prudent to get another scan in 6-8 months. If the node is still enlarged at that point, then he would recommend RPLND at Indiana.

By the way, Austin and I were diagnosed and went through treatment at similar times. I have followed his treatment closely through your posts. I admit it, I cried at some times, but I am so pleased he is done and had a good outcome. He is much too young to have gone through this.

Also, has Austin began regrowing his hair yet? I am two weeks after my last cycle and have some sprouts on the back part of my head.

All the best.

[AustinsMom]

Hi Pete,

The advice Dr. Einhorn gave you sounds pretty much like what our Oncologist was trying to tell us, although I sensed he was fairly optimistic that the node would remain stable, based on %'s. I know I will be nervous as all get out when its time for the next scan, but I just have to keep reminding myself, even if it is enlarged, there is still a treatment that will take care of the problem, albeit a tough one.

While I have not noticed any sprouts of hair on Austin's head, I can feel the stubble when I touch it. I also have noticed his facial hair reappearing. I am so anxious to see what his "new hair" will look like. I know other people who have been through chemo say it can change color or become curly. Just hoping it doesn't look like he bleached it and then got a bad perm. Does your new growth look any different?

More importantly, of course, Austin feels pretty darn good. He is still plagued by a lot of fatigue and "chemo brain", but I know he's in summer vacation mode and it's almost too hot and humid to enjoy being outside, which makes us all a bit lethargic. He is now cramming for all his finals later this week that were missed at the end of the year, which doesn't seem to bring out much energy or excitement in him either!! Luckily, he has a week in NYC followed by 3 weeks at the beach to look forward to, so life isn't all that bad.

Wishing you the best,
Diane

[coryswife]

We are sort of in the same boat. My husband just had his first post chemo scan after finishing 4xEP for stage II pure seminoma. He has one node still at 1.7 cm (down from 3.2 cm). We meet with the Oncologist Monday and markers should be in by then, although when taken after 2 rounds, all but LDH was normalized (HCG down to normal form 194).

I am interested to find out from Dave how big his residual node was and how long after was the second scan.

[Davepet]

I am interested to find out from Dave how big his residual node was and how long after was the second scan.

Afraid I cannot recall the size, it's probably on some paperwork somewhere.... It was not huge, even prior to chemo.
Dates however, I kept good records:
Last Bleo: 4-6-10
Pet scan: 4-20-10 Residual node showing
Pet scan: 7-6-10 No Nodes remarkable

So about 2 weeks post Bleo & 11 weeks after that.

Dave