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How fast does teratoma cells grow?

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  • How fast does teratoma cells grow?

    Dear Forum members: My son (age 30) was diagosed with Stage IIB, nonseminoma, 80% EC, 19% ES, and 1% chorio. Just finished three cycles of BEP and anxiously waiting to do the CT-scan. He has one lymph node that was 3.2cm before starting chemo, and we of course don't know the pathology of that node. In case it has teratoma that does not respond to chemo, does anyone here know how fast teratoma grows? Just very worried that my son might need to go through RPLND...

  • #2
    Hi Samantha, my husband went through BEP and RPLND 3 years ago just like many other survivors. It has been very difficult for me also to see him suffer. But there is a light at the end of this tunnel, we have been in remission for 3 years now. RPLND is not an easy operation but a great way to increase survival chances if its necessary.

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    • #3
      Thank you for your response! That is great to know. Do you happen to know whether "nerve-saving" RPLND is the same as robotic, minimally-invasive RPLND? Or is it another variation of RPLND?

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      • #4
        Hi Samantha, its nice to meet you. I was diagnosed with stage 3b testicular cancer, I had an orchidectomy on May 28th of last year and that was followed by 4xBEP from June the 28th. It was found that the mass didn't shrink after chemotherapy, my last session of chemo was on the 13th of September. My initial cancer was mixed germ cell tumor(non-seminoma) which was 95% embryonal, 5%chorio and yok sac. They decided to book me for an RPLND, this surgery occurred on the 22nd of February this year and the pathology found that the masses were teratoma. Now they scanned me prior to having my surgery and remember my last session of chemo was on the 13th of September, now I am not a doctor and I am not quoting any studies here but my mass did not grow much in that time, its just my experience. Thought I'd share with you, wishing your son all the best with his care and hopes he has a speedy recovery. For me the RPLND wasn't so bad no complications but the first month after surgery was difficult, it took me 6 days to leave the hospital but because they removed my intestines for a 6 hour surgery, it took a while before I felt normal, the pain would be so bad and I wouldn't know why and then all of a sudden I'd be vomiting 15-22 times. I think the pain leading up to the vomiting was the worst, I think I was eating fatty foods so my diet had to be a little restricted to foods without spice and fat, just something to think on. After a month things settled down but I couldn't lift anything till 3 months had passed and it did take a while before the residual pain from the surgery resided. Overall though it wasn't so bad. I'm also very close to your son's age by the way. I really hope the best for him. I can try to answer your question for TC Fight above. Typically if there is spread from non-seminoma the path of spread is easily predictable now where they operate really depends on the results of the scans, however in general masses tend to run close to two major blood vessels which is why they have vascular surgeons present to make sure you don't bleed out, there is a major vein and artery in the retroperitoneum. There are also lymph channels that can be knicked and the nerves involved in erections and ejaculation, now worst case scenario is erectile dysfunction,but more commonly if the nerves are knicked it can cause dry ejaculation where the sperm doesn't come out, it passes out through your urine. Nerve sparing techniques try to avoid damage, but its hard because nerves are near invisible. RPLND is a complex surgery and most success is found with open RPLND, the traditional way of doing it, now if robotic options are available its less invasive but you need to go with someone that has major experience with it.
        Last edited by J0N3; 09-30-22, 03:29 PM.

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        • #5
          I agree with what J0N3 posted.

          Most experts I know prefer an open RPLND vs. minimally-invasive, which is preferred to be robot-assisted vs just laparoscopic, especially after chemotherapy. Nerve sparing is a technique to try to avoid cutting nerves responsible for ejaculation. When a bilateral template is used and after chemotherapy, this can be more difficult. An experienced surgeon should be able to give you their impression on if they will be able to do it or what the odds are that they can do it. However, many experts also say that a proper excision for optimal oncological outcomes should never be jeopardized in order to preserve the nerves.

          There is no standard rate of teratoma growth that I am aware of.

          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 [email protected] if you would like to chat privately so as to avoid any delays.

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          • #6
            Dear Jon and Mike: Thank you both for your responses. I am sorry Jon for everything you had to go through. Young people are not supposed to get cancer, so it must have been extremely difficult time for you. You are a warrior to have come through with this and have the heart to help others on this forum. Your case is very, very similar to my son's.

            Based on your answers, I am not sure how many KINDS of RPLNDs are there? Is nerve-sparing the same as robotic? Are there three kinds of surgeries or basically just two, open and robotic?

            It's good to know from you, Jon, that teratoma did not seem to have grown that fast. The inflamed lymph node my son has grew from 1.7cm to 3.2cm in 6 weeks, so that is a fast growing kind, though it might have a percentage of teratoma. We are anxiously awaiting first post-chemo CT-result. I will update here later.

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            • #7
              RPLNDs are either open or minimally-invasive (which is laparoscopic and usually robot assisted nowadays).

              Nerve-sparing is a surgical technique to try to avoid severing the nerves. There are also differences in the surgical fields or templates (bilateral template, modified unilateral templates) and places like USC differ a bit in their approach as they have a midline extraperitoneal approach.

              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 [email protected] if you would like to chat privately so as to avoid any delays.

              Comment


              • #8
                Dear Mike: Thanks again for your well-informed response! Is nerve-sparing used for both open or minimally invasive? Now you have introduced these other categories which I haven't heard of before. So much to learn! It's amazing how you have become such an expert. i am assuming, from your response, that the midline approach is a superior one?

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                • #9
                  Yes, a nerve sparing technique can be deployed with with open or minimally invasive. If a bilateral template is used, then this reduces the chances of maintaining proper ejaculation where if a modified unilateral template is used the nerves on the opposite side are not touched at all and so almost all patient maintain proper ejaculation.

                  The RPLND is done for a therapeutic purpose, to remove any potential cancer from the abdomen so preserving the nerves at the risk of not properly removing any cancer is not really the goal. Not that they want to disturb the nerves but left over cancer is much more dangerous.

                  The midline approach is just a different technique so I'm not advocating it is better or worse than others.

                  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 [email protected] if you would like to chat privately so as to avoid any delays.

                  Comment


                  • #10
                    Makes sense, thanks. Sounds like modified unilateral template is the way to go. Looks like we now have to wait for further CT scan, as the reduction of the problematic lymph node to 1.2cm is good after chemo, but it is still not under 1cm. His oncologist claims that the CT was done too early after chemo (one week after), although that was the recommendation by Dr. Danashmand. Anyway, doing a CT scan again in a few weeks.

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                    • #11
                      A modified unilateral template is done in selected patients, many post-chemo RPLNDs are bilateral.

                      If Dr. Daneshmand would be doing the RPLND and is OK with the CT timing then why would the oncologist be intervening saying that it is too early? If it were me, I would defer to the RPLND surgeon at this point.

                      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 [email protected] if you would like to chat privately so as to avoid any delays.

                      Comment


                      • #12
                        The oncologist wants to determine whether the node may shrink further. I guess it is good to wait and see if it means my son can avoid the surgery. There seems to be some confusion as to whether one should follow up with the urologist or the oncologist after chemo. The oncologist seems to think that it is her job until surgery is confirmed.

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                        • #13
                          I would be asking my oncologist why there isn't an interdisciplinary team assessing my case and not just one discipline/specialty. In my opinion, the more eyes on me, that have experience with testis cancer, the better.

                          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 [email protected] if you would like to chat privately so as to avoid any delays.

                          Comment


                          • #14
                            I should definitely ask for that. What a great idea. Thank you!

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                            • #15
                              My son's second post-chemo CT came back and we got the bad news that there is no further shrinkage, so the bad lymph node is currently at 1.2 cm. We are finally going to see Dr. Daneshmand today, and i fear that he will recommend RPLND. The question would be which kind. AT UCLA, they suggested minimally invasive and robot-assisted. We will see what Dr. Daneshmand suggests. I read about mid-line RPLND, which seems to involve less incision than the traditional RPLND. Do you have any more insights on this? And i will ask about what waiting for a further while might mean in terms of more chemo or RPLND later.

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