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Post Chemo Advice Regarding Active Surveilance/RPLND

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  • Post Chemo Advice Regarding Active Surveilance/RPLND

    Hey all

    I am 29 year old, who was diagnosed with TC in February, below is my exact diagnosis. On May 10th I finished 3x BEP, and just had my first scan post Chemo last week. As you can see from the CT scans it has been shrinking, but isnt the magic number <1CM? Would RPLND be something that I would have to do, and or has anyone had instances where it takes some time for it to shrink all the way to that magic number? Secondly, my concern is if it takes time to shrink or doctor suggests surveillance, could it spread to other areas during that time? Lastly, I had a lung nodule, which hasn’t changed, and doctors most likely say it could be from an infection, any concerns there?

    Diagnosis
    - Mixed germ cell tumor, stage IIB - Mixed germ cell tumor‐ 90% seminoma, 10% embryonal ﴾pT1b N2 M0 S0 possible IIIA 5 mm lung nodule

    CT Scan on Lymphnodes
    - Pre Chemo: 5.0 x 2.4 CM
    - After Cycle 1: 3.8 x 1.6cm
    - First Post Chemo Scan: 3.2 x 1.4cm


    AFP
    - 2/25: 2.1, 3/3: 2.3, 3/22: 5.5, 3/29: 7.9, 4/5: 3.7, 4/12: 11.7, 4/15: 7.6, 4/22: 7.1, 4/22: 7.1, 5/3: 20.7, 5/10: 10, 5/17: 6.8

    LDH
    - 2/25: 192, 3/3: 181, 3/22: 166, 3/29: 252, 4/5: 222, 4/12: 229, 4/15: 120, 4/22: 241, 5/3: 197, 5/10: 143, 5/17: 187

    HCG
    - 2/25: <0.6, 5/3: 6.5, 5/10: 0.8, 5/17: 0.6







  • #2
    Well, it is not unusual to still have some tumor visible that close to ending chemo ( I did at my 1st scan, & it disappeared by the next scan), yours is a bit larger than I'd expect, so certainly something to keep an eye on. It might just take a bit longer than most to shrink. Unless your markers start rising, I wouldn't think surgery would be needed at this point.

    Lung nodules are quite common, if it stays stable, I would not be con concerned.
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

    Comment


    • #3
      I noticed the blip in the APF/beta-hCG on 5/3. That seemed a bit unusual, although appears resolved, did they mention it or think it was a lab error or just cell lysis at the start of the third cycle? Just curious.

      Seminoma can take a bit of time to shrink but given the embryonal component and the still significant size (even for a pure seminoma cutoff of 3 cm), I would anticipate being told I may need an RPLND. Perhaps the doctors may decide to watch it but I am thinking RPLND may be, unfortunately, most likely.

      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.

      Comment


      • #4
        Hi @Mke & @Dave,

        Thanks for your quick response, and input on this. Obviously, I am super nervous, and it helps to have a space like this to be able to learn and get support from folks who have gone through this. So after my first appointment post-scan, the Oncologist is going to get the advice of the surgeon, but also the Tumor Board, which will provide better guidance. He said that the textbook answer is RPLND but his gut feeling is similar to @Dave, that it would shrink and possibly just dead cells (necrotic). I will find out more, probably next week. My fear with active surveillance is having that in my body. @Dave how big were your lymph nodes after the first post-chemo scan?

        @Mike - I asked them about the HCG, and it seems the explanation was the start of the 3rd cycle, and the body was shocked by the Chemo.

        If RPLND is in the future, do either of you recommend any great surgeons? I am thinking about getting a second opinion on my case regardless of what my Onco says, from Memorial Sloan Kettering.

        Comment


        • #5
          Sorry, rpk, I don't recall the size, but I think my original tumor was smaller than 3cm so it wouldn't really be useful.


          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #6
            If you are at MSKCC, then Dr. Joel Sheinfeld is about as good as they get and one of the handful of surgeons I would allow to perform an RPLND on me, if I needed it.

            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.

            Comment

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