what to do

[docabear]

my labs seem to be low compared to others that i seen
AFP 22.2 LDH 157 HCG QN 37 and my BHCG hasn't came back yet and i haven't had any labs since my surgery 20 mar 06 i'm scheduled to go on the 19 apr 06 to get them should i be getting them sooner? I have already had a ct scan and it came back negitive and my path says i have 65%embryonal carcinoma, 20% teratoma and 15% yolk sac tumor. and i have vascular and intra and extra testicular lymphatic invasion along with a few other things should i be having test done sooner or is my doctor doing the right thing. i'm not questioning his abilities it just seems to be taking a long time to get started with the treatment.


Dx 20 Mar 2006 R I/O 20 Mar 2006

[Scott]

Welcome, docabear! It sounds as though you're getting all the normal tests. Did you have a chest x-ray, or did the CT scan include your chest as well as your abdomen? Any word yet on treatment from here? Has your doctor explained surveillance, RPLND surgery, and chemotherapy possibilities?

[docabear]

My doctor explained surveillance, RPLND surgery and he is going to refer me off post to a civilian oncologist for the chemo. my ct scan included chest and abdomen. i was just wondering about the time span. it will probaly be another month to month and a half before treatment begins if i chose to do the RPLND or Chemo because of the referal to a civilian is this too long or should i request something sooner if possible.

[Scott]

RPLND surgery is considered most effective within six weeks of the orchiectomy, so if that's an option you are considering, you should get an earlier appointment.

[Jens]

65%embryonal carcinoma (EC), vascular and intra and extra testicular lymphatic invasion

Hi docabear.

From you pathology alone you have an slightly increased risk of spreading and because of a predominance of EC and presence of vascular invasion, RPLND may not be the optimal choice. Chemo should be considered.

Best wishes
Jens

[mikeygti]

I agree with Jens that chemo should be considered if treatment is required.
E/C has been known to skip the lymph nodes,and end up in the lungs....

Good luck !

[docabear]

thank you jens and mikeygti

i haven't seen an oncologist yet. and i don't know if my doctor knew that EC tends to skip the abd lymph nodes. I'll be sure to bring it up next time i talk with him.
I just really don't want chemo with all it's side effects. the only good thing is it will be a good diet plan
thanks again
docabear

[Jens]

I just really don't want chemo with all it's side effects. the only good thing is it will be a good diet plan

Hmmm... I gained a few pounds and they stayed on I'm afraid.

Have you seen you onco?

Best wishes.
Jens

[docabear]

well i decided to take the surgery. i've done a lot of research and in my mind this is the best option right now. my surgery is sched. for the 15th of may.
i look this way i'm taking the lesser of two evils now if i have to get chemo later i'll deal with it then. hopefully i don't have to get chemo i really don't want my kids to see me that sick. so far i've handled this pretty well and if my kids were to see my really sick i don't think i could handle it as well as i have.

[dadmo]

Where are you having your RPLND done? If the doc cannot do the nerve sparing type you may want to bank sperm. Retrograde ejaculation is a potential problem even when you have a surgeon who is highly skilled in this operation.

[docabear]

i'm having my surgery here at the air force base here in alaska. the surgeron used to work at walter reed army medical center he said he has done quite a few rplnd with the nerve sparing. i'm not to concerned with sperm banking i already had a vas. a couple of years ago.

[docabear]

just had rplnd

i had my rplnd surgery on 15 may 06 and it went very well. it's not as bad as i thought it was going to be. i'm moving very and planning on going deep sea fishing in a few days although i won't be able to reel any fish in it will still be fun.

the first part of my path report came in and they found an enlarged node 2.5 X 1.1 X 1.1 so my doc sent it to the experts in the armed forces for further eval still waiting on that to come back. he also refered me to an oncologist to see if i need chemo and if so how many cycles.
if anyone has any thoughts please let me know

[dadmo]

docabear:
Congratulations on getting that RPLND out of the way. If the pathology from the node is positive for cancer the standard protocol would be two rounds of chemo.

[Scott]

I agree that if you have chemotherapy now, it will probably be two cycles, but the NCCN guidelines say that "if the resected lymph nodes involve a tumor, the decision about whether to use adjuvant chemotherapy is based upon the degree of nodal involvement and the ability of the patient to comply with follow-up." Surveillance might be an option.

[dadmo]

docabear:
Everyone is going to heave to forgive me here but I’m going to think out loud. I think the two cycles are a prophylactic measure. If you choose surveillance and have a recurrence you will move directly to 3BEP (I’m picking BEP because of the embryonal carcinoma).
If you choose surveillance and don’t have a recurrence you win big, really big. All you have are a few physical and mental scars. You have avoided all of the life threatening and shortening effects of the chemo. If you go directly to chemo I think you would get 2EP, since it’s being give as a preventive (I could be wrong on this). It would seem that if the long-term effect of 2EP vs. 3BEP are about the same then why not try and completely avoid the chemo? I am really not trying to push you either way but if it were me I would wait on the chemo. At least that’s my position today. I’m sure if you look at other post I have advocated the chemo, I guess that’s why this is such a hard decision.