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Wrong surveillance protocol?

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  • Wrong surveillance protocol?

    I just checked the TCRC link for surveillance protocol and realize that my doctors are wrong probably.

    Here is a sentence from the link "Our surveillance protocols do not call for abdominal CT scans post RPLND or post radiation. Studies have shown that the odds of a recurrence in the retroperitoneum are very small following these therapies, and these odds do not justify the use of a CT scan."

    I am doing 2 CT scan each years since 2002 and it's probably unecessary.

    Now that i got chemo this years(my recurence was detected with chest Xray) they still want me to do 2 -3 scan each year and fro the first years they precribe thoracic scan but in the OHSU protocol they only talk about blood test and chest X ray. Should i fight with them to eliminate this unecessary radiation or they want me to do this in case they see an early enlargement of my nodes in the mediastinum?

    Stage 1 seminoma in august 2001
    with invaded spermatic chord and treated with RT
    Relapse november 2005, 4 BEP and now back to surveillance

  • #2
    Hi Eric,

    I have had CT-Scan every other month for the first year - my oncologist just wanted to be sure.
    In the second year we have delayed them to every 3 months for the first half year and then one more 6 months after that.

    Each doctor will have their own take on this and if you have concerns you should voice them - and they should take the concerns into account, especially if you have protocols from Cancer Centers that are authorities in this field to present.

    I personally wouldn't be too concerned about the CT-Scan post chemo, but the ones prior seem to be above and beyond what was needed, but you're not elaborating about your specific case, so it's hard to give a definitive opinion.

    - Martin
    Stage IIa, non-seminoma (90% embryno / 10% teratoma); I/O 12/22/04, 3 x BEP, RPLND 05/12/05


    • #3
      Hello ,
      I had my first CT -Scan couple of month ago , almost a year after my RPLND . Two month blood work and chest X-rays are the only tests that i have ona regular basis ( every two months ) . Per my Doc , post RPLND ct-scans are not needed but it's good to do one a year just to make sure everything is clear.
      2/18/05 I/O , 90% embryonal carinoma , 5% yolk sac , 5% Teratoma , RPLD 3/7/05 , 3 nodes < 5mm , AFP 2 , hcg < 2 , IIA non seminona, Surveillance...


      • #4
        Here is my story

        2001- orchiectomy + adjuvant radiation
        2002 to 2005- follow-up(scan+ chest x-ray + blood test)
        nov 2005- relapse in the mediastinum
        fev 2006- end of chemo and back to clean results.

        My doctor wants me to do some other scan in the next years but i think it's begin to be too much radiation and maybe it's better to go with just chest x-ray and blood tests. I don't want to feel like a hiroshima survivor. I got radiation and chemo and my odds for a second cancer will be too increased if i continue to get 2 scans each years. If i follow the OHSU protocol i can drop the scans and go only with chest X-ray.

        Stage 1 seminoma in august 2001
        with invaded spermatic chord and treated with RT
        Relapse november 2005, 4 BEP and now back to surveillance


        • #5

          Check into the type of equipment used to do your CT scans. My understanding is that the new helical scanners have much lower radiation dosage per scan than the older style scanners.

          I was concerned about the same thing, and one oncologist I spoke with mentioned that we may be able to substitute at least some of the scans with MRI. The problem with MRI, if I recall correctly, is that it is much more expensive and so incurs the wrath of the insurance companies, and that the resolution is not quite as good as a CT scan.

          Since you are at higher risk for second cancers, I would think you would want to keep an extra close eye on the areas where the risk is substantially increased, which would be the abdominal area if you got adjuvant radiotherapy in 2001.