Follow-up for seminoma after chemo

[TSX]

I finished 3xBEP chemo about two weeks ago and am now in follow-up mode. I am concerned that I will be getting too much radiation from the CT scans. Including yesterday's scan to assess the effectiveness of the chemo for me, I've had three pelvic scans, three abdominal scans and two chest scans.

Yesterday's scan showed that the enlarged lymph nodes in my abdomen decreased anywhere from 0 (ie, no change) to 30 percent in volume from one month pre-chemo to two weeks post-chemo. My doctor said it's typical for seminoma to leave behind some "structure", that is likely necrotic tissue that will go away over time (a couple of years or so). Since none of the enlarged nodes are greater than 2cm, I do not have to have the RPLND surgery at this time, but my doctor wants to follow me closely. I am worried that it is too closely, considering the large amount of radiation one receives in a single CT scan.

I am having another abdominal/pelvic CT scan in two months, and if no growth is seen compared to yesterday's scan, my doctor wants to put me into the following surveillance protocol:

Years 1&2: Tumor Markers and Abdominal/Pelvic CT scan every 3 months
Years 3-5: Tumor Markers and Abdominal/Pelvic CT scan every 6 months
Years 6-10: Tumor Markers and Abdominal/Pelvic CT scan every year

The recommended surveillance protocol on tcrc.acor.org is (OHSU protocol for stage IIb seminoma treated with chemo):

Year 1: Tumor Markers and Chest X-ray done every 2 months
Year 2: Tumor Markers and Chest X-ray done every 4 months
Years 3-5: Tumor Markers and Chest X-ray done every 6 months
After Year 5: Tumor Markers and Chest X-ray done once a year

However, there is a paragraph on the same page on tcrc.acor.org that is as follows:

When we talk about a CT scan, we are normally talking about an abdominal scan. Pelvic CT's are normally given as a part of the abdominal scan. They generally do not add much to the evaluation of testicular cancer patients, but occasionally they are useful for patients with odd areas of recurrence, especially those patients with a history of scrotal violation, prior pelvic surgery (i.e. hernia repair), undescended testicles, or prior pelvic recurrences. Additionally, there are certain individual situations where abdominal or chest CTs are used and are appropriate even if there isn't large volume teratoma (especially after chemo if the CT isn't quite normal).

So I guess my question is does my follow-up seem excessive in terms of CT scans? Has anyone else here had such a rigorous follow-up after seminoma treated with chemo?

Thanks.

-TSX

[Scott]

No, I don't think it's excessive.

[Eric]

I had 2 scans every year since RT in 2001. Now after chemo my onco wants me to do 1 last year of scan(maybe 2) and after i will do only Xray and bloodwork. I told to my onco about the protocol in tcrc.acor but he does not seem too concerned about it. He tell me that scan don't represent too much danger for an adult, it only can cause damage when a child is growing. He told me also to stop going on internet because i can see a lot of things that are not necessarily true

[TSX]

I had 2 scans every year since RT in 2001. Now after chemo my onco wants me to do 1 last year of scan(maybe 2) and after i will do only Xray and bloodwork. I told to my onco about the protocol in tcrc.acor but he does not seem too concerned about it. He tell me that scan don't represent too much danger for an adult, it only can cause damage when a child is growing. He told me also to stop going on internet because i can see a lot of things that are not necessarily true

Thanks for replying Eric,

So radiation is only bad for growing children, eh? Interesting theory but I'm not buying it.

I think I would be happy to have your follow-up protocol, compared to what my doctor has proposed. In my case I will have something like 48 CT scans over 10 years, counting the 8 I have already had in the four months since my orchiectomy. Here I am counting an abdominal + pelvic CT scan as two scans. Each of these 48 scans has approximately the same amount of radiation as 133 X-Rays (for a helical CT scanner over a single area), so the total radiation from these diagnostic tests will be the equivalent of about 6400 X-Rays over 10 years!

Regarding the internet, I think the saying "Don't throw out the baby with the bathwater" applies here. Maybe your doctor is getting nervous that you are learning more about testicular cancer than he knows.

-TSX

[Eric]

TSX

I don't think you will have CT scan after your 5 years follow up. 48 scan is too much. I think we all have to discuss with our onco to have better protocol.

[Eric]

Also, even if my onco say somthing about CT scan it does not mean i agree with him at 100%. He told me that after radiation and chemo my risk of second cancer is just a little bit higher than other people and to not worry about. It's clear that i prefer to believe in him than what i see on the net but i am conscient that my risk are probably higher than what he says. That's why i am trying to eat well and do sports. On the other hand, all the personal at my hospital agree on one thing, always verify if what you see on the net has been approoved by a cancer society or something like this.

[Scott]

He told me also to stop going on internet because i can see a lot of things that are not necessarily true

Gee, you don't have to go on the Internet for that.