Husband has non-seminoma embryonal carcinoma

[Angela]

Hi,

My husband had a right radical orchiectomy on 4-14-06. His tumor markers, chest x-ray and CT scan all came back normal. I got the pathology report yesterday and I have no idea how to interpret it. It says that the final pathologic diagnosis is embryonal carcinoma, but it doesn't say what percent. Do I assume it's 100% Is that a bad thing? It also says the following:

Testis confined with focal extension into but not through tunica albuginea.
The tumor measures 1.2 x 1.0 x 0.9 cm.
No involvement of the epidiymis or rete testis.
Spermatic cord margin free of neoplasia.
Sections of the spermatic cord margin show benign vascular tissue and skeletal muscle with no evidence of malignancy.
No lymphovascular space infiltrative tumor is seen.
The tumor has a relatively uniform appearance with no evidence of seminomatous tumor or choriocarcinoma present.

Sounds like the tumor was confined to the testicle right? The surgeon who performed the orchiectomy is recommending RPLND. He is referring us to a specialist in Milwaukee so we'll see what he says.

My only concern is the type of tumor is was (embryonal carcinoma) and that there was no percentage given.

Can anybody shed some light on this? If you need more info, please let me know.

Thanks, and I am so glad I found this site!

[MRM]

You will need the tumor percentages before determining what his next treatment should be. Were his tumor markers normal before surgery as well?

If it is pure EC, it does have a higher chance of spread, but he may still be able to pick surveillance if that's what he wants to do. I think pure EC also has a higher risk of skipping the lymph nodes and going to the chest, which would mean chemo if it happened.

[Angela]

Ok, I'll find out the percentages. I thought that was kind of strange it didn't have it in there.

Yes, his tumor markers were normal before the surgery too. And from what I have read it means that if it should spread then we won't be able to tell by the tumor marker. Am I understanding that correctly?

[MRM]

It makes them less reliable, but they'll still use them. A person can be marker-negative at original diagnosis and marker-positive at relapse or vice-versa.

[Scott]

Welcome, Angela! Be sure to explore both surveillance and RPLND, and the pros and cons of each.

[Apache]

definitely find the percentages, they could help you sort out the probabilities and such on which step to take next. read and learn as much as possible, and question the heck out of the doctors. get a 2nd opinion also, if needed.

[petep]

hello -

see my signature...almost the same case....

and this link...

https://www.moffitt.usf.edu/pubs/ccj/v6n6/article1.htm

this was the doc I saw...

I also saw einhorn...both suggested surveillance - why...80% chance of cure with surgery alone...RPLND not bad choice, but with embryonal both said there is a recurrence possibility with rplnd....then need chemo...

I did have a recurrence, had the 3xBEP, just completed a couple weeks back.

The recurrence occurs, because at some point a microscopic cell or cells got out, they get caught up in the lower lymph nodes and begin growing...

another choice if you do not think you can handle surveillance is 2 x BEP just after the surgery, even though no tumors in lymph nodes...but they both said this is viable, but on average 80% of the people getting chemo would be treated unnecessarily.

hope this helps.

[BeachTech]

Angela,
I had the same pathology report (see signature). I don't mean to scare you, but my doctor told me that it is "a fast-moving type of tumor" (thanks a lot, doc).

I would say there is a good chance that he is beyond Stage I (travelled beyond the testicle). However, from what I have read, this type of tumor responds very well to chemo. I was Stage 2a, and they skipped the RPLND and went strait to chemo. I was in remission after the third cycle of chemo, but my doctor gave me the fourth round for free

I know it is very stressful waiting for the test results, etc. Just remember this cancer has a very high cure rate. The way I thought about it...what if there was a lotto where your chances of winning are 90-95%, would you buy a ticket? I would.
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