Another new guy

[Agent23]

Hi everyone, I'm Jeff. I had my left removed on the 21st of last month. The results came back mostly seminoma with a very small percentage non-seminoma. I was just hearing all this in the fifth person, so I didn't think to ask exactly what percentage. The cat scan follow up showed nothing, but the urologist still suggested that I get the RPLND in case it had spread microscopically into the lymph nodes, which I basically rejected outright, at the time. I am going to an Oncologist this Tuesday to talk about my options.

The Urologist said possibly chemo/surveillance or maybe just surveillance, but I think just surveillance is highly unlikely with the presence of nonseminoma. He also said that if chemo is done, then they had to do the RPLND it is much more difficult. It's just a big mess. Like I have seen written here in the last couple of weeks lurking on the boards, cancer sucks, big time.

Now I am beginning to think it may be better just to go ahead and get the RPLND done right away. It really seems like the best option.

I am 36 years old, the cancer was caught at stage one. I am glad I found this board. Reading posts from people going through the same thing, or have been through it in the past helps to give me the courage to get through this.

[Scott]

Welcome, Jeff. I wouldn't be so quick to rule out surveillance. As long as you stick to the follow-up schedule and are prepared for the possibility of chemotherapy later in case of a recurrence, it may be a good choice.

[Fish]

Wellcome Jeff:

Do as much reading as you can on TC. There has been some movement in recent years away from RPLND as a primary treatment for non-seminoma since some cell types, particularly embryonal cell, can bypass the retro-peritoneal lymphnodes and end up in the lungs. Even though your tumor was mostly seminoma, the presence of any other cell types means they will manage your case as a nonseminoma. Its great you're getting an opinion from an oncologist, and don't hesitate to get additional medical opinions if you think it's necessary. If you haven't visited the TCRC, here is the link:

http://tcrc.acor.org/

Great information and lists of experts in the field that you can contact if necessary.

If your xrays/CT scans/blood work are normal following orchiectomy, you should be a candidate for surveillence.

Best wishes,
Jim

[Karen]

Hey Jeff,
I suggest you get copies of all your labs and final pathology report. You should know all this for your own informaion, as well as if you go for a second opinion. The more you can tell us about your marker levels pre and post I/O and the final pathology, chances are there's someone here with a similar history that can support you and answer your questions. Welcome to the forum!

[DianeE]

Hi Jeff,

Did your pathology report indicate lymphatic or vascular invasion?
My son Brian did have "probable lymphatic invasion" and he did
opt for the RPLND. Good thing too, because there were traces of
cancer in five of the nodes that were removed. He is going through
two rounds of chemo now to make sure all the cancer is killed.

The RPLND was a breeze compared to what he is going through with
the chemo. He'll start the second round tomorrow if his tooth problem
is cleared up. If he had chosen surveillance over the RPLND, the cancer
would have gotten worse and he would have been looking at four
rounds of chemo. And there would have been the possibility of
a post chemo RPLND, which is a bit trickier than if done before chemo.

I think it depends on your path report. Either way, you'll be cured.

Diane

[Agent23]

Thanks for the replies. I do have to get copies of my lab reports. All I know is that when I did the Cat scan a week after the orchiectomy nothing showed up. The doctor (urologist) said that there could be a microscopic spread.
If the cancer could bypass the lymph nodes entirely, thats a horse of a different color. Now I am not so set on going ahead with the RPLND.
I have an appointment with the oncologist Tuesday, I will update the situation then.

[Scott]

It would help to have your pathology report. Most types of testicular cancer spread through a predictable path through the retroperitoneal lymph nodes first, but choriocarcinoma and embryonal carcinoma in particular may spread more quickly through the blood directly to the lungs.