First CT scan after I/O: What's normal?

[tc2006]

Hi,
let me start our by saying how fortunate I feel to have found this great forum, and all the wonderful people that make it such an encouraging place to visit. I hung out in the forum reading people's stories many times after my I/O, and started posting myself last week.

I have been diagnosed stage I seminoma about 5 weeks ago, and one thing that's kept bugging me - and has also made my decision more difficult as to the most appropriate therapy - are the results of my first CT scan which was done three days after the I/O. While the report is mostly positive according to my doctors, it does mention "non-specific, sub-centimeter paraaortic and iliac nodes" on the right side, the side where my tumor was. The prevailing medical opinion I was given has been that these are not to worry about (i.e. not metastasis,) but I am wondering if anyone else on this forum had scans showing nodes <1cm, and what the interpretation of their urologist or radiologist was. The second thing that's bugging me about my report is that it mentions "tiny, low density foci" in the right kidney, the liver and the pancreatic tail; the report suggests these are either cysts or "focal ectatic ducts" (?). When I asked my general physician, I was told that these are very common things that pretty much everybody's scans show, sort of like 'birthmarks within our body'. - Has anybody else on this forum had these supposedly harmless results in his CT scan, or should I be concerned ? Would radiation therapy likely make things worse if these spots are not cysts?

[jsburton]

My experience

I also had the same diagnosis as you. Stage I Seminoma with no vascular invasion. I chose to do the 'preventative' radiation to help keep my mind at ease, I couldn't/didn't want to wonder if it was gone.

When I got my first CT after my surgery, they saw some 'cysts' on my kidney and said that was normal. The one thing that made me nervous in the radiology report was a couple of 'questionable' lymph nodes on the same side as the surgery. They had grown (I don't remember the measurement) since the pre-op CT, but as it turned out it was related to my body reacting to the surgery. The next CT scan I got 4 months later revealed they had returned to normal.

Hope this helps!

[tc2006]

Thanks for you reply, your comments do help. Were the cysts in your kidney still visible (unchanged) in the CT after 4 months?

By the way, as I am still trying to decide between radiation and surveillance, do you remember how large your tumor was? Also, what was the dose they irradiated you with, and did they do what's referred to as the 'hockeystick' field ? Thanks.

[jsburton]

The cysts still remain unchanged. Boy how soon you forget, I don't recall the measurement of the tumor, I think I still have all my reports somewhere buried in a box since my move. I know my tumor pretty much took the whole testicle ,the ultrasound was pretty much a black mass.

The total dose of radiation I got was 2500 rads over 4 weeks. They did the "hockey stick" field on me, staying inside the kidneys. Also don't forget the wonderful "nut cup" as the nurses referred to. Every treatment they put a lead ball around the remaining testicle to keep it protected. Talk about pain when they 'missed'

I personally had NO problem with the radiation. I didn't change my diet that much, I still ate spicy food etc... The only side effect I had was I would get tired an hour or two later after the treatment. Toward the end however my skin was getting a bit sensitive in the radiated areas, but all is well now. Your results may vary!

[tc2006]

wow, your info sounds a lot like mine - the cysts, the tumor taking over most part of the testicle, even the radiation therapy sounds the same as the one that was described to me as the most 'standard' treatment option. Were you offered surveillance as an alternative, or did you not even consider it? What about Carboplatin, was that mentioned?

[cbuysse]

My C/T scan showed cysts on the Kidney as well. My Urologists said they were very common and not to worry about them.

[rjs]

Similar Situation

TC2006 -
My diagnosis and reports were very similar to yours. I also opted to go with radiation to give myself peace of mind and avoid the monthly follow-ups that would be required for surveillence. No matter your choice there will still be regular follow-ups that you will need to stick to. But with radiation (or carboplatin) they are less frequent than with surveillence.

I was given the option of surveillance, but in the end went with the radiation. The dosage is relatively small and the schedule followed what you have been told. My side effects were relatively mild compared to some others, but I did have constant nausea and extreme fatigue over the 4 weeks of treatment. I think the fatigue fully subsided about 2 weeks after treatments ended.

Carboplatin was not provided as an option by my doctors. I did discuss it with them and initially wanted to go this route since everything I read indicated the outcome was the same as radiation and the side effects were less. But the doctors wanted to avoid chemo at this point and felt like the findings on carbo were to "early" to replace what is a proven course of treatment with the radiation. I think in Europe they are moving to Carbo more often than in the US.

As someone else here posted, if you opt for radiation make sure you get the "lead cup". Its awkward, you will need help placing it and the techs may tell you its not necessary, but at this point its always better to be safe. You can not reverse sterility if your body reacts different to the radiation. Besides, at this point so many people have seen, touched, moved, and checked out your package there really is nothing to be embarrassed about. You should also consider sperm banking. Talk to your Urologist about where this might be done in your area. Its a little costly,but again a good preventive measure in the event your counts are low. It is a good idea that you get your sperm counts done anyway prior to treatment so you know if there are any pre-exisitng issues. Some TC patients already have low counts or are sterile so knowing this prior to radiation (or carbo) might help you decide if you need to bank any sperm.

WOW! Thats alot of information. Keep asking questions, take one day at a time, and make the decisions that are best for YOU.

-rs

[rjs]

One More Thing

The cysts found around the kidney and cords are indeed typical. I also have the same situation and was freaked out initially. The cysts still show up on my CT follow-up scans, but they are unchanged and not growing. So the doctors are correct when they tell you they are typical and not anything to worry about.

[Fish]

TC2006:

I also have a cyst on my left kidney. It was first noted in 1988 and was about 1 cm.

In my most recent scan it is 6 cm, so it has grown over the last 18 years. Solitary or simple renal cysts can grow fairly large, but rarely cause any problems. As with my case, most are found incidentily during x-rays or CT scans for some other problem

[Karen]

TC2006,
My husband is also Stage I seminoma. He had his first CAT less than 72 hrs after his I/O and the results showed lymph nodes on his left side (same side as the I/O) of <1cm and be "to be noted". At his 3 month post radiation CAT they were not noted, so that suggests they were a little swollen as a response to the surgery. He did 15 days of RT for a total of 25Gy. Just paraaortic region, not the dog-leg. I asked Dr Sheinfeld if PA vs dog leg made a difference and he said either would be fine. Like jsburton, my husband wanted to do all he could up front to lessen the odds of a recurrence without the higher anxiety of surveillance. It is so much a personal choice and no decision is wrong, so whatever you do, don't second guess yourself. He did not want to deal with more frequent check ups, and his radiation oncologist is a leader in the gamma knife procedure, so we were confident in his advice. I believe the jury is still out on single dose carboplatin. It's a relatively new approach and in 15 years the data will be in! You will be fine, and we are here for you!

[tc2006]

Karen, thanks for your encouraging words. Sometimes I think I shouldn't worry so much about the treatment decision, as both surveillance and radiation are said to have good outcomes. But then again I think it is quite an important decision, and while my inner voice tells me not lo let any radiation into my body unless it is 100% clear that there are still cancer cells somewhere, somehow I cannot seem to get 100% comfortable with the idea to "not try and do everything in my power" to stop it - even if it means undergoing radiation. Oh well. - In your husband's case, I guess it is not clear whether the nodes disappeared in the CT scan after 3 months b/c they were just swollen, or b/c the radiation destroyed any cancer cells. Or was there any evidence either way? As far as the radiation field goes, my radiation onc. recommended the "dog leg" - I guess it may have to do with the fact that I have had an undescended testis as a child, and several hernia surgeries ever since; so my pelvis seems more vulnerable - I guess - to host any cancer cells. However, I do realize this also means more tissue will be hit with radiation, and possibly without it being justified ...

[Karen]

tc2006,
No way to know what happened with his nodes, but even through they were "noted" nobody seemed too concerned with them, so I assume they were thinking it was from the surgery. Unfortunately, with micrometastesis, even a few cells making it to the nodes will, over time, grow. Seminoma is very slow growing which is why recurrences are seen further out than for non-seminomas. Do you have the final pathology report? The tumor size, and degree of invasion can help you in your decision as well.

[tc2006]

Yes, I have the pathology report: The tumor was on the large side with 6cm, but there was no vascular or lymphatic invasion or infiltration of the rete testis noted. It also said it was an anaplastic seminoma, but I was told that wouldn't make a difference for the treatment.