Good Risk Tumour Markers but on the High-ish Side

[Davie]

Hi there,

I'm 37 and I was diagnosed with TC on 7th March 2006.

After a scare in 1997 when I had a little hardness in my right testicle and a dull ache, I left it and it all went away (except the dull ache which always persisted on and off for 10 years).

Therefore when I discovered a little hardness in 2004 at the back of my testicle near my epididymus, I naturally ignored it - again. The hardness turned to a lump in Aug 2005 and foolishly I assumed nothing was abnormal. I had no symptoms except an occasional dull ache, but that had been around for 10 years!

Nothing changed in the between Aug 2005 and Feb 2006, so I don't know what prompted me to go the doctors when I did, BUT THANK GOD I DID!!

My histology following orchiectomy states and I quote (British terminology) "Mixed germ cell tumour of the right testis seminoma 10%; teratoma (90%) --- embryonal carcinoma (MTU), scanty foci of mature teratoma, and foci of trophoblast (MTT); extensive vascular invasion; stage pT2."

I think this means that my teratoma is almost all embryonal carcinoma with very little but focused mature teratoma and focused choriocarcinoma.

My CT found one 3 cm tumour on an RP node, but nothing on any other organs. That puts me in nonseminoma stage IIb.

My AFP/bHCG levels were 800/400 then 500/1500 then 600/2200 before ochiectomy, one week after and prechemotherapy respectively. I'm currently in the second week of my first cycle of 3 x BEP, which apart from a couple of days of tiredness hasn't been too bad (but I'll reserve judgement until the cycles have accumulated!)

Given I have only one 3 cm RP tumour, my prechemotherapy level of bHCG seems on the high-ish side, although still good risk. I guess I may have caught it just in time, as things seem to be rapidly on the rise just before I started chemo. Also I assume that the little choriocarcinoma may have more of an effect on my bHCG. Any other thoughts?

I'm under Professor Horwich and Dearnaley at the Royal Marsden in London. From what I can gather seem to be among a handful of doctors who are true TC world experts, so I feel in safe hands.

My research has indicated that minimal, low volume RP disease has a cure rate up to 98% with 3 x BEP, so I would urge anyone reading this who has any doubts whatsoever, not to be a fool like me and get down to the doctors ASAP. Even with delay things still can look good, but the earlier you get it diagnosed, the better the cure rate.

I'm hoping that given only "scanty foci of mature teratoma" I may escape without a postchemo RPLND, but if I have to have it then I'll just get on with it.

Cheers......Davie

[Scott]

Welcome, Davie. It sounds as though you're going to be just fine once you get through treatment. Be sure to keep us posted.

[dadmo]

Davie:
I'm sorry you waitred so long to get checked but it sounds like you have everthing under control. Good luck and keep us posted.

[Davie]

Thanks for the kind words.

I went in for my day 15 bleomycin shot today and they've also put me on precautionary antibiotics for a week as my white count is on the low side - although I think this is typical 2 weeks into the first cycle?

I started chemo on the 30th March and my AFP/bhCG was 582/2648. On the 4th March, four days into my chemo my AFP/bHCG was virtually unchanged at 633/2661, but I was warned in a lot of instances the tumour markers go up before coming down.

On 7th March a week after chemo and only 3 days after my unchanged results, my AFP/bHCG has dropped to 404/1571 (a drop of about 40% for each) which is good news, and also gives you faith that the chemo is doing what it is supposed to do.

Cheers......Davie

[logic]

'scanty foci of mature teratoma, and foci of trophoblast'

What does this mean in American terminology?

[Davie]

Logic,

Scanty means very little and foci is the plural of focus. So I think it means very little but focused mature teratoma (teratoma differentiated) and focused trophoblast (choriocarcinoma).

Cheers.......Davie

[Davie]

I rang the hospital over the weekend and found out my AFP/bHCG has dropped from 404/1571 on day 8 of chemo to 177/314 on day 14 of chemo.

This gives me an initial half life of 5 days for AFP and 2.5 days for bHCG. I've found out that the AFP should be in the range 5-7 days and bHCG 2-3.5 days for chemo treating metastatic TC, so I'm pleased with my results.

Alongside waiting for my full diagnosis, getting my AFP/bHCG results is just as nerve racking. Does getting these results become any easier in future?

Davie

[merc]

Not for me...

Hi,

Well... this is a bit of a funny question.
To me, it LOOKS LIKE it does. But then, as the blood test day approaches, it becomes more and more freaky, and every time I have more test I feel that I will never, ever be "immune" to them :-/

However, I've only been in surveillance for 8 months. Baybe it does get easier after a couple of years or so...!

(Let's see what the others say)

Bye!

Merc.

[dadmo]

Our family is almost two years into this and blood test time is still un-nerving.

[Kim]

My husband went for his two year this past week and is clean. Praise God. No, it still doesn't get any easier. I'm an oncology nurse and I still get nauseated every time we go for labs and scans.
The choriocarcinoma reflects an elevated beta. That is the only one that reflects on the beta, I believe.
My husbands AFP was 43,500 upon diagnosis. His LDH ws 579 and beta neg. His was nonseminoma. Doing great now.
However, still has severe bouts of fatigue, sweats horribly, and the bottoms of his feet hurt and didn't start for a year after chemotherapy. Anyone else having or had these problems.
We learn chemo effects for "today" but not later. It would ease my mind to know what, if any, of these problems are chemotherapy related.

[MRM]

I think it does get easier. Not that I don't think about recurrance every time I have a blood test, but knowing the odds, I'm pretty sure I'm fine.

The first few months I was on surveillance, I was sure every small backache and cough was a recurrance and I had a bad feeling a couple times that cancer was back before I even got my test results. But that was all nerves.

It will get better. Just don't become so complacent that you don't go to your appointments. That gets easy to do as you go into your second through fifth year and visits become more and more infrequent.

[Davie]

I was reading a few archive posts and noticed that many people in a similar situation to me (one enlarged node in the abdomen of 2-3 cm - no other spread) had much lower serum markers ie <100 for both AFP and bHCG (sometimes no recorded markers).

Occasionally I'd come across someone who had one small node in the abdomen but much higher markers like me.

I was led to believe that AFP and bHCG values were directly related to tumour volume, hence there use for prognosis. If this is so, why if you only have one 3 cm abdominal mass do some people have virtually undetectable markers and yet some are much, much higher (i.e., my pre-chemo markers AFP = 633, bhcg = 2600).

Thanks.......Davie

[Mom]

It depends on whether your tumor(s) are seminoma or non-seminoma. Someone with a large abdominal tumor with no markers or low markers suggest a seminoma. On the other hand you can have high markers with small tumors if your tumor(s) is a non-seminoma. My son's tumor in his ab was so small that it only showed on an MRI. They suspected he still had live cancer after his I/O because his markers never dropped. They were low (in the hundreds). He ended up with 3 x BEP. His markers returned to normal during the second round of chemo. Dianne

[Davie]

Thanks Mom,

But what I still don't understand is that two people with non-seminoma and the same very small abdominal tumour volume, can have dramatically different markers levels.

For example I've read of several people with a 3 cm abdominal non-seminoma tumour having AFP/bhcg significantly less than one hundered, and yet others with similar size of non-seminoma tumour having AFP/bhcg in the high hundreds/low thousand.

I thought tumour markers correlated with tumour volume? What am I missing?

Davie.

[Scott]

Cell type is a big factor. For example, AFP is secreted by yolk sac elements, and hCG is usually very elevated with choriocarcinoma.