Stage I non-seminoma - RPLND necessary?

[maureenj79]

My husband was diagnosed with what I believe is Stage I (hasn't spread farther than the testicle). However, they are saying he should have RPLND even though the CT scan, X-Rays and pathology report state that it has not spread. Is this a common recommendation?
He does not want to do the RPLND unless it is necessary. Anyone else in this same situation? What would you do? The tumor was mixed germ cell, embryonal carcinoma, yolk sac tumor, mature teratoma, and focal choriocarcinoma.
Would it make more sense to just get some chemo? Or is that not a good option?

Thanks for your help...

[dadmo]

maureenj79:
It would seem to me that if his original markers were low and they have no evidence of spread that your husband should be a candidate for surveillance. You might want to have a phone consultation with one of the experts on this list. http://tcrc.acor.org/experts.html

[jtyler]

Maureen,

I'm not at all well-versed in the implications, but do you know what the percentages were of the types of cancer you mentioned [found in his tumor]?

I may well be wrong on this one, but if I remember correctly, the course of action can be figured out [to a point] based on which cancer type is the most dominant/highest percentage.


Just curious.

Cheers,


JT.

[maureenj79]

We don't know the before and after numbers just yet. I hope we get them soon because I just want to know.
I know he had mixed germ cell non-seminoma, it was made up of embryonal carcinoma, yolk sac, mature teratoma and focal choriocarcinoma. No percentages though...
I guess my main question is why do RPLND if it doesn't seem to have spread? Doesn't the 10-20% chance of nerve damage make it more scary to do RPLND then to just do surveillance and if there is something, then get the chemo?
Are the side effects of chemo worse than the chance of having RPLND and damaging yourself, having retrograde ejaculation or other worse problems?
Did any of you that had RPLND have any major problems like this? I wonder how common some of these things really are.
We're trying to get an appt. with a really good specialist, but he's so busy and we don't know if we'll get an appt. with him for a while, which sucks. But if we wait past 6 weeks, we're in surveillance anyway, so why not just keep doing that?
His orchiectomy was 2 weeks ago today.
And the pathology report said it was just the testicle and had not spread to any of the other things (whatever tubes and stuff they take out - sorry i don't know what they are called). So if it hasn't spread to areas near the testicle, why would we remove those lymph nodes anyway? CT scan showed nothing, chest X-ray showed nothing... so why do the RPLND?

[Scott]

As long as his tumor markers return to normal and all other tests results are good, surveillance is a good choice.

[MRM]

Recommending an RPLND is standard, so don't be offended by it. Surveillance is probably an option, though.

He should discuss his odds of recurrance with experts. If he has a high likelihood of the cancer coming back, an RPLND will decrease it. If he has an average chance of cure already (70%) or better, he may want to go with surveillance. Choloricarcinoma can be agressive.

He has to be able to handle the uncertainty, epecially in the early months, that the cancer may still be in his body or could come back. If he can't handle that mental stress, then surgery may be the way to go.

Also know that chemo is much tougher on the body than an RPLND, and in expert hands, the chance of retrograde ejaculation or other problems is small. That may factor into his decision.

Most doctors in the U.S. do not recommend chemo for stage I testiclular cancer.

[premct]

Hi Maureen,

I was also in Stage I when first diagnosed. The key is waiting for the pathology report to come back and determining whether you are in Stage I-A or I-B. The difference between I-A and I-B is that in I-B, "vascular invasion" has occurred. The key is waiting for the pathology report to be finalized.

Also, just to put it in perspective, in my case, I was first diagnosed as I-A, but upon further review, I was put into the I-B class. With Stage I-A, you have the choice typically between RPLND or surveillance. With I-B, RPLND is recommended (at least this is Sloan's protocol).

Since my tumor was 75% embryonal (high risk for relapse) and I was in Stage I-B, I ended up having the RPLND. My tumor markers were all normal before the surgery. Upon doing the surgery, they found 7 out of 30 positive lymph nodes for cancer. This means that had they not done the surgery, it probably would have shown up in my lungs or something within a couple of months. I am now going through a 2-cycle EP chemo regiment. It is a preventative measure, reducing the potential relapse from 30% to 1%, according to stats. They want to make sure there is nothing "microscopic" still there after the lymph node dissection.

Sorry for rambling, but the key is the pathology report. Once you get a finalized report, it will make the decision making more straightforward. If you have any questions, whatsoever, feel free to shoot it my way, as I have gone through the gamut in the last 3 months.

Good luck!
Prem

[Chris'Mom]

To respond to your question regarding the RPLND surgery, my son had it done at Sloan Kettering and had no side effects, no retrograde problems...it is major surgery, but he recovered nicely, ...hope that helps.. M