Thoughts on Treatment?

[NightTrain]

Hi Everyone!

I had a right I/O on October 9th. We got the pathology report late last week. 95% classic seminoma, 4% EC, and 1 yolk sac. The original chest xray was clean and if I remember right I believe my urlogist said the only elavated tumor marker was BHCG at 6, which I believe is only slighted elevated, right? I was hoping for 100% seminoma so was a little disappointed when it came back with 5% nonseminoma. The other problem is the presence of V/I. This puts me in the 50% chance the cancer has spread. I called my urologists office today to see if the results of my first c/t scan were in. The nurse called me back at the end of the day and said it looked good and that she didn't see any issues but would make sure my urologist would get it soon. I was a little surprised that a nurse called so I am going to wait until I hear from the urologist before I fully believe it is clean.

My question. My urologist said last week that if the c/t scan came back clean the recommended treatment would be RPLND or possibly surveillance. I really do not like the option of surgery. The more reseach I do the more I think that 2, or possibly even 1 cycle of chemo may be a good solution. Because of the V/I it seems to me it puts me in a category of enough risk that the cancer will show up down the road that it may be good to just treat it now. I am curious what everyone's thoughts and or experiences are....? There is some pretty good data out there that says in this case that 1 X BEP may be just as effective of 2 X BEP. I am 31 and single and am hoping to have a family one day.... that is my only concern with doing chemo, possible infertility. However, if cancer shows up down the road after surveillance and I have to go through 3 or 4 cycles of chemo I may regret not having done less cycles of chemo originally. From what I have read it sounds like every additional cycle of chemo increases the negative impacts of chemo.

Aside from the fact I have cancer, its great to have the support of this forum. I wish everyone the best!

[Aegean]

Due to the high seminoma content, I think that the 50% relapse number is a bit large. RPLND is more of a diagnostic tool and is being used more and more after chemo as opposed to before because it will not get rid of any micromets that may have gotten in the blood. Due to the vascular invasion, you would be staged 1B (uness something else appears that you have not yet mentioned) and most likely 2xBEP would be the road you would go down.

[NightTrain]

I had my first ct scan post I/O two weeks ago. The nurse told me the results were in last Tuesday. I called every day last week and never heard anything from my doctor. So I have been stressing for over a week now if the cancer has spread. Finally on Friday I called and got an appointment with an oncologist. I have been working with a urologist so far. I think I made her mad cause I told her I was much more interested in surveillance than an RPLND. Is this normal?

[NightTrain]

btw.... If I end up being stage 1 I am really thinking 2BEP is the way to go. With the VI that puts me in the 50% chance it has spread. I know that having any nonseminoma that it should be treated as nonseminoma. However, my pathology only said 5% nonseminoma with 95% seminoma.... I haven't been able to research anything with this kind of makeup. My tumor was almost 5cm which tells me that even though it was 5% nonseminoma that is pretty significant.

[Elliott]

As the wife of a man who had 100% pure seminoma with no v/i and choose radiation and survelliance but is now doing 4XBEP I would say do the two rounds of BEP and cut your relaspe percentage to what is it like 1%.

[NightTrain]

To make things worse my father died of colon cancer at the age of 38. My mom is getting the worst part of all of this. I agree with you, I would rather over treat now just to make things better on my poor mother.

[Karen]

Originally Posted by NightTrain

btw.... If I end up being stage 1 I am really thinking 2BEP is the way to go. With the VI that puts me in the 50% chance it has spread. I know that having any nonseminoma that it should be treated as nonseminoma. However, my pathology only said 5% nonseminoma with 95% seminoma.... I haven't been able to research anything with this kind of makeup. My tumor was almost 5cm which tells me that even though it was 5% nonseminoma that is pretty significant.

You really shouldn't get hung up on the numbers here. Different tumor cell types grow at different rates and can spread by different pathways. A pathology of 99% seminoma will still be treated as a non-seminoma. Your CT and post-I/O markers are needed to figure out the best treatment, which for stage 1 can include surveillance, althought with LVI and yolk cell I'l lean heavily towards chemo.


Condolences on the loss of your Dad. I agree that the emotional stress you and you mom must have over this may need you to be aggressive with treatment so you can both put this behind you. Post your final pathology, markers and CT when you get them.

[NightTrain]

The CT scan came back clean. The blood test I took just prior to my I/O only showed one elevated marker. HCG was a 5. I saw an oncologist today for the first time and we talked about 2BEP or surveillance as my options. Even though I have VI he thought that everything else pointed to a 'less than 50%' chance of spreading. We drew some more blood just to see what the post I/O levels show. Unless they are up which I am not expecting them to be (wasn't expecting to get TC either so you never know!) than I am probably going to go with surveillance. My doc seemed to feel pretty strong that surveillance appears to be a very good option for us. It's a tough decision... part of me just wants to blast the hell out of it with chemo!

[Elliott]

Survelliance is a good option, just make sure you have follow up ct scans and blood draws and that you go to them. Also if you get the feeling that something is just not right, make sure you go to the doctor right away to address your concerns.
Best of luck on the marker numbers!

[BAK]

Remember, that if the surveillance schedule is properly followed, the long term survival rate is essentially unchanged between adjuvant chemo and salvage chemo after failing surveillance. While this is a personal decision that has many factors to consider, the really important difference at the end is pretty much a wash between whatever you choose. Therefore, don't go crazy deciding, discuss all of your options frankly with your doctor, and whatever decision you make, accept it as the correct one and don't look back. Either way you will come out victorious in the end.

[Aegean]

Originally Posted by NightTrain

The CT scan came back clean. The blood test I took just prior to my I/O only showed one elevated marker. HCG was a 5. I saw an oncologist today for the first time and we talked about 2BEP or surveillance as my options. Even though I have VI he thought that everything else pointed to a 'less than 50%' chance of spreading. We drew some more blood just to see what the post I/O levels show. Unless they are up which I am not expecting them to be (wasn't expecting to get TC either so you never know!) than I am probably going to go with surveillance. My doc seemed to feel pretty strong that surveillance appears to be a very good option for us. It's a tough decision... part of me just wants to blast the hell out of it with chemo!

As long as you can commit to the surveillance schedule and deal with the reality of a possible relapse, it is a good option. The difference between 3xBEP or 2xBEP is not enough to dissuade me from surveillance but the possibility of avoiding it altogether is great, in my opinion. As the others have said, though, once you make your choice it's full throttles ahead and no looking back!!!