Help??

[ssavino]

My husband finished radiation in late Jan. and just got his first ct scan last night. MD called today and said there is a "suspicious" lymph node that they would like to monitor so he needs another scan in 6 weeks. Has anyone been through this and how likely is it that there is cancer there?

[Fed]

First off, what was the original staging of the primary tumor? I am assuming that it was seminoma, since radiation is used only under those circumstances. Were there any suspicious nodes found on an abdominal/pelvic CT on or around the time of his orchiectomy? If so, what dose of radiation was used?

I take it the suspicious node showed up on a follow-up abdominal/pelvic CT. If there is no further growth in 6 weeks, then there is the possibility that it is just scar tissue or necrotic (dead) cells. The important issue is to compare it to a previous CT to see if this is a new growth.

[ssavino]

Yes it was a pure seminoma and there was no lymph node involvement. This is his first scan since treatment and before surgery.

[Fed]

Yes it was a pure seminoma and there was no lymph node involvement. This is his first scan since treatment and before surgery.

I just backtracked and saw your previous posts. Let me see if I understand this correctly: was this the first CT scan he has gotten in relation to his TC diagnosis and treatment? I may have missed something, but if that is indeed the case, then how did they know there was no lymph node involvement to begin with? (this cannot be assumed based on the pathology alone). Seminoma with retroperitoneal lymphadenopathy (Stage II) is usually treated with 35-40 Gy of radiation to the retroperitoneal lymph nodes, whereas dosing for adjuvant radiation in patients with a stage I diagnosis is 20-25 Gy.

I'm just trying to put all the pieces together so I can make an "educated and informed" comment.

[ssavino]

No, he had a scan the day of diagnosis, prior to surgery.

[Scott]

It would be really unusual to have a recurrence in the radiated area, assuming pure seminoma was the correct pathology. The TCRC surveillance protocols after radiation therapy don't even call for CT scans, because the risk is so low.

I assume tumor markers are still normal?

[ssavino]

I think they just drew the markers today so I am not aware of any results.

[Fed]

No, he had a scan the day of diagnosis, prior to surgery.

Cool. Thanks for clarifying that.

Like Scott, I am also surprised that they did a pelvic/abdominal CT because that's not part of the standard post-RT surveillance protocol.

That aside, did the doctor say what was the size of the node? Usually if the node is less than 1 cm, there is nothing to worry about. My last two CTs have shown a 5 mm node, and my oncologist said that as long as it doesn't grow or change shape, everything will be OK. He did say that it bears observation.

Hope this helps a bit.

[ssavino]

More info

WEll I spoke to Sheinfleds nurse and she says the CT report says there is a 1.1 by 1cm nodule in the lower left quadrant of left pelvic area. This is where his radiation was. his tumor markers are normal and thats why we wait 6 weeks before repeating scan. I feel like its from radiation. I am feeling hopeful its nothing but still its not a great feeling for 6 weeks of our summer. My husband was very upset last night and just keeps saying he does not want to be sick.
S

[Fed]

Hey S,
A 1 cm node is borderline, so all you can do at this point is observe it. Sometimes you can get adhesions produced by the radiation treatment (see previous posts/threads by Sansrt1), but I don't know whether these would be visible on CT. It seems to me that, as much as it sucks, your husband is going to have to wait it out until the next CT. Sometimes nodes like these just stay like that for no reason, and as long as it doesn't get bigger, it will be OK.
I know there must be loads of anxiety going around. Right now neither you nor your husband has any control over this, and I believe this may cause frustration. I had no idea your husband was under Joel Sheinfeld's care. Rest assured that he's in great hands (a friend of mine trained under him, and Sheinfeld did my second opinion along with a second pathology review).

[djmac]

Hi Ssavino,

whatever happened with your husbands ultrasound a couple of months ago? I remember there was some concern for a second TC... I'm assuming all is ok?

Best of luck with the node, but I'd be really surprised if it turned out to be something. Recurrences in an irradiated field are exceedingly rare.

Regards,

djm

[ssavino]

Yes you remember correctly. The ultrasound showed a hydrocele. We just keep getting these scares. Thank God everything turns out all right. I feel confident now that this too will be just a scare so I am trying to put it out of my mind for next 6 weeks.

S