Inquiring answers for a few questions?

[sjsamgolf]

Am wondering if anyone can help? Is that true that chemo does work for immature teratoma? My pathology report is as follows 50% immature teratoma, 50% yolk sac, less than 1% embroynal carcinoma. No VI or LI. AFB was 350 prior to surgery coming down accordingly. Dr. said yolk sac is why AFB was high at 350. Any questions or comments would be greatly appreciated.

[matthias]

Immature teratoma can be treated by combination chemotherapy; this is in contrast to mature teratoma that does not respond. And yes, your AFP (alpha fetal protein) was high due to the yolk sac component (ec can also raise your AFP).

Not much else to report: it's your usual boring non-seminoma. More people get killed by the flu each year, both in absolute and relative terms.

[sjsamgolf]

Matthias

Just wondering if with my tumor content, that if I go the watchful waiting mode. Doctors will be able to catch in time in case of spread. My question is if you make all your appts. there is no way it will spread out of control? I'm still worrying about if I should wait, 2 rounds of BEP or RPLND. Thanks

[nzsteve]

Hi,

It would be unlikly to spread out of control in the couple of months between follow up appointments. Just make sure you attend them and dont get complacent after a couple of all clears. Generally, if your abdomin and lung CT is clear with blood markers dropping after the orchiectomy theres a 70% chance youre cured, and will need no other treatment. Flip side of that is the 30% chance that you will need some chemo and/or RPLND in the future. If you choose surveillance and it does come back then its almost always curable.

I fell into the 30% that needed some more, but based on the odds I still think I made the right decision to go with surveillance. 2 rounds of chemo is 2 rounds of poison that you might not need, and RPLND is major surgery. I wouldnt recommend going through them unless you have to. 2 cycles of BEP is a 'touchy' issue aswell. Im pretty sure its not generally recommended as there is not enough evidence that it is enough to kill off what might in you, and pre-exposure at this stage could reduce the effectiveness later on if you relapse. 3 cycles of BEP would be standard firstline treatment for a relapse, and has a very high success rate.

Hope that helps,

Steve

[Rune]

Like nzsteve said, 2xBEP is something a lot of people object against. 3xBEP is really the 'gold standard' as far as chemo goes.

But I don't see any reason why you shouldn't be able to go on surveillance - if you keep ALL the checkup appointment, seeing as there's no VI/LI and the percentage of embryonal carcinoma is so small.The way I see it, when following a well-planned surveillance schedule, the chance of a cure (in the case of a recurrence) is the same as it would be if you did chemo now.. so why not avoid the chemo if you can?

[sjsamgolf]

Rplnd

How about an rplnd? If I were to do that isn't that a better chance of catching it. The rplnd gives you 2 chances doesn't it, you do the surgery and if they find anything they remove it plus all your lymph nodes. If you wait you are just banking on chemotherapy, right? I am really going nuts trying to fiqure out what to do. First, though my tumor marker afp has to normalize before I can do anything.

[Rune]

You're correct that a recurrence on surveillance would lead to chemo therapy.

Unfortunately there's no obvoius choice. In the end, it all comes down to what you think is best.

The problem with getting the RPLND is, that while it lowers the risk of recurrence to just a couple of percent if they don't find any or only microscopic cancer, you might still face adjuvant chemo if there's a more substantial amount of cancer found.

I know that a potential problem with chemo is that elements of the tumor (namely embryonal carcinoma) might turn into teratoma which would require a post-chemo RPLND to remove. But I don't know if this applies to immature teratoma as well.. maybe someone here does?

The problem with both approaches is that they potentially overtreat 70% of stage I patients, which are cured already from the orchiectomy.

As for getting two chances with the RPLND - the cure rate for 3xBEP is around 98-99%, so there should be no need for a second chance. I can only say what I would choose in your situation - and in my humble opinion surveillance seems like the better option. But this all depends on the AFP-levels. When are the markers expected to normalize?

I hope this helps. Please ask away if you have further questions.. it's important that you make an informed decision. I would also discuss this with your doctors.

[matthias]

First, you can have chemo and then still do an RPLND afterwards, if required. Secondly, you can have chemo (BEP/EP), and then more chemo (TIP, VIP), and then even more (stem-cell transplant, high-dose chemo).

So it's really not like you have only RPLND and BEP chemo, and if you don't do the RPLND now, you can never have it or must totally rely on BEP chemo alone. Far from it...

Also, ever noticed how at your workplace the quiet guys that hardly anyone knows about, do a tremendous amount of work? Same for lymph nodes; I'd try to keep them. Look up Scott's thread on his RPLND adventures...

How about an rplnd? If I were to do that isn't that a better chance of catching it. The rplnd gives you 2 chances doesn't it, you do the surgery and if they find anything they remove it plus all your lymph nodes. If you wait you are just banking on chemotherapy, right? I am really going nuts trying to fiqure out what to do. First, though my tumor marker afp has to normalize before I can do anything.

[sjsamgolf]

AFP Levels

My AFP started at 350 before surgery. That was 2/1. Tested on 2/15 it was 82. So good signs so far. I know I won't have to worry about a decision till it drops to normal level. Should be in a few weeks. Thanks for the responses. I'm going on vacation next week and really need a break from the stress. I know I have to lead a normal life!!!!

[Scott]

I know I have to lead a normal life!!!!

Well, yes, but it isn't likely to be the same "normal" as before cancer. It changes us. Fortunately, some of those changes can be for the better.

[matthias]

As a final and parting thought to this discussion: Yes, it's the Big C!

However, these days, in many instances the Big C is a manageable, chronic disease. It's really not like 30 yrs ago when it was a death sentence! To add insult to injury: you'll soon discover, that many fellow cancer survivors do not take TC afflicts seriously due to the extraordinarily high cure rate.

Just another stigma to live with!

My AFP started at 350 before surgery. That was 2/1. Tested on 2/15 it was 82. So good signs so far. I know I won't have to worry about a decision till it drops to normal level. Should be in a few weeks. Thanks for the responses. I'm going on vacation next week and really need a break from the stress. I know I have to lead a normal life!!!!

[Scott]

To add insult to injury: you'll soon discover, that many fellow cancer survivors do not take TC afflicts seriously due to the extraordinarily high cure rate.

Have you really run into that?

[amorgan74]

Scott, We have seen something similar to that, It's like sometimes at the doctor's office I got tired of hearing how lucky Wesley was. I am thinking okay we know the odds are pretty good he will not only survive, recover and more than likely be cured but it's still cancer. Don't get me wrong the doctors were great and I guess part of this is looking at TC through their mindset of the doctor and how easy it is to treat in most patients rather than looking at it from the mindset of the cancer patient going through treatment and recovery. The put the shoe on the other foot thing. I am glad the outcome is so good for just about everyone that goes through treatment but agree with Matthias that I have sometimes felt what he is talking about too.
April