Radiation

[kleeze61]

Hello everyone I am new here, but not new to testicular cancer.

After feeling a lump in my left testicle at the beginning of January, and having an orchiectomy I was diagnosed with Stage I classic seminoma. After much discussion with my urologist, a medical oncologist, and a radiation oncologist I opted for the adjuvant radiation. This consisted of 17 treatments the last of which I just finished yesterday. I only experienced a little fatigue during my treatment.
The main reason that I chose the radiation was because my tumor was farely large >4cm, there was local vascular/lymphatic invasion on the pathology report, and mostly because I am a medical student who will begin residency in the fall and at this point in my life I could not suffer a relapse.

After giving a brief history of myself I would like the opinions of fellow survivors on a few questions.
What have others been told about the likelihood of secondary malignancies in tc-survivors, disregarding those caused by chemo or radiation.
I have not found much information on this topic and two different doctors have given me two different opinions.
After having gone through the radiation, and with the knowledge that there is only around a 3% relapse rate I feel I have made the right decision, but I find myself having a hard time worrying about what the radiation has done to my body. I have always been a person who has taken care of themselves and I get frustrated that I have no control over the treatment induced side-effects that may or may-not come
If there are any long-term radiation survivors, I just wonder what the health related quality of life has been like.

I look forward to replies and discussion

[Krokar]

I understand your concerns but yur quality of life will be like you want. There should be absolutely no difference between "then" and "now", but there is normaly big difference in our heads.
If you spent time before for health (fitness,running, organic food ... ?) you should do it also now and normaly everybody do this.

In general, I believe that quality of our lifes is better because we see things we didn't see before and we feel things we dedn't feel before...

Regards,
Alex

[Scott]

It goes back a ways, but the TCRC has a few comments on that topic posted at this link.

There was some discussion in these forums last fall about the article, "Testicular cancer survivors at risk of other ills," too.

[Karen]

My husband had stage 1 seminoma, ~2cm, with no evidence (gross or microscopically-stained) that there was lymphovascular invasion and the spermatic cord was not affeceted. He chose radiation (25Gy over 15 zaps) to be proactive against micrometasteses. I was really worried about this choice because of some articles I read on secondary malignancies. I also had questions on if he should have the paraaortic alone or dog-leg field. We spoke with his radiation oncologist, who I have a lot of faith in, as well as Dr Sheinfeld at Sloan. His radiologist said he has seen only one case of a secondary and Sheinfeld said it was very rare. Both offered survaillance as an option. He finished this February so he's not a "long term" survivor...YET!!!

Keep in mind that the dose of radiation given now, the accuracy in which it is delivered, and the fields zapped, are significantly more fine tuned than what was given 10-20 years ago. When you read articles about secondaries decades from now keep in mind your risks are much less than what you are reading becuase of the advances in delivery/dose/field. As a future med student you should do a pubmed search (medline) and look at CURRENT, large cohort studies from large, respected centers. A lot of times these studies are not taking into consideration family history or other risk factors. In many instances the dose and filed are not know because the studies are relying on archival records that may not be complete.

Don't look back on your decision, what's done is done. Keep up with the survaillance (I gotta learn how to spell that word!) and know that in your cats and x-rays and labs they would pick something up earlier than the average guy who may NEVER get tested and find an early malignancy.

Glad your done with the zaps and all went well, Enjoy moving forward with your life! This experience will teach you compassion for your patients and make you a better doctor. Good luck!

[kleeze61]

To everyone,
Thank you for your responses it is nice to hear from others who have gone through the same experience as I.

Karen,
You are very right about the dosage, the delivery and the technilogical advancement. I have done much reading about radiation treatment in testicular cancer patients and do agree that there is most likely a small but real increased risk for second malignancies. I think part of the concern I have is founded in the fact that I have done so much reading and research and their is no definitve long term study that I can find with survivors who where treated with the new limited field low dosage radiation.
I am very happy with the decision I have chose, and I am moving on with my life, but I do admit a times I find myself thinking about this.
I guess it is still hard for me to accept that at 26 when I am in the best shape in my life this happened. But, as my wife says, "We all have our crosses to carry," and this is mine. I am confident that this experience has made me a more compassionate person, and I have come to enjoy that little things in life much more. If anything else, this experience has helped me realize what I want out of life and what type of person I want to be.

Thanks for listening to my ramblings!

[Karen]

Unfortunately, I think we all need to wait 10 years to see what the effects are in a large population with the current regime. Same with radiation vs. single dose cisplatin for early stage seminoma.

Ramble on anytime...we all do and this is a great site to share and learn!
Best Wishes for a great future