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Post I/O results

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  • Post I/O results

    Hi - I have been reading all the posts on this site over the last month or so since I was diagnosed with TC and have found a lot of comfort and support to any concerns that i may have had so for that I am eternally grateful.

    By way of an update I had my op about 3 and a half weeks ago, and a follow up CT scan last Friday.
    I met with my surgeon on Wednesday to get the results. It was a feeling similar to getting the results of my finals.

    Luckily, he told me that I'd passed. He's forwarding me a copy of the pasthology report in the post but suffice to say, he told me that my cancer was seminoma, and he was certain that it was confined to my right testicle which they removed and that it had not spread. The CT scan also showed/indicated that there was no evidence of it spreading anywhere else.

    However, he then said the as we're talking about cells - there is still a possibility of there being a few cancerous cells knocking about and referred me to an oncologist (cancer expert) who would discuss with me my options. These are;

    1. Surveillance - quarterly check ups and periodic (yearly?) CT scans.
    2. Chemotherapy
    3. Radiotherapy

    I'm kind of swaying to the short term pain, long term gain alternative - option 2 or 3 but am also wondering what others in a similar situation have opted for...???


  • #2
    If the choice were mine I would choose Surveillance. With no evidence of spread you would seem to be an excellent candidate for this option. With a stage I classification you can avoid all of the long-term effects of either chemo or radiation. If you should have a recurrence you will still have those treatment options available. If you stick to your surveillance schedule any future spread would be minimal.
    Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

    Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.


    • #3
      Updated for Path report...??????

      Thanks Dadmo.

      I got my path report and am still waiting to see an oncologist.
      I'd like to be armed with as much info as poss before i see the onc so here's a summary of my report...:

      ...well circumscribed, lobulated tumour measuring 50x35x40 (full size is 60x40x43)... tumour does not appear to invade the tunica.

      Classical seminoma, no non-seminomatous germ cell components and surrounding seminiferous tubules show evidence of intratubular germ cell neoplasia... tumour confined to testis but extends close but does not involve the tunica albuginea. No invasion of rete testis or epididymis.

      Vascular invasion is noted within testicular tissue at the periphery of the tumour but the chord (inc cut end) is free from tumour involvement.

      No necrosis. Background testis shows thickening of the basement of the membrane of some seminiferous tubules with intertestitial fibrosis and tubular atrophy

      Could anyone help decipher the bits highlighted in red?

      From what i can gather i had it whipped out just in time and it was probably a matter of days before it spread... does this mean that i should be considering further treatment or will surveillance be enough....?

      Thanks and any comments will be appreciated.


      • #4
        i should also add that i had a CT scan and it came back that there was no evidence of any spread


        • #5
          Hi UK:

          I believe the intratubular germ cell neoplasia is also refered to as carcinoma in situ. I think these are cancer cells that haven't developed invasive potential. I had this on my first path report in 1988. Not sure what the other red wording means.

          What to do for seminoma is a hard call. I chose surveillance. There are some risk factors, but they don't always correlate with the actual risk.

          Lowest risk of spread is associated with:
          1. age greater than 35
          2. tumor less than 4 cm
          3. no lymphatic or vascular invasion.

          Of course these are only stastical risk factors. So that's why I say it's such a difficult decision.

          I chose surveillance because I did not want any treatment unless I knew that it was necessary. But then periodic ct scans and blood work can be annoying and stressful. Of course, even with treatment there will still be follow up tests.

          Ultimately, it comes down to what you can live with. There is probably no right or wrong decision, as long as you stay vigilant.

          best wishes,
          Right I/O 4/22/1988
          RPLND 6/20/1988
          Left I/O 9/17/2003

          Tho' much is taken, much abides; and though we are not now that strength which in old days moved earth and heaven; that which we are, we are; one equal temper of heroic hearts, made weak by time and fate, but strong in will; to strive, to seek, to find, and not to yield.


          • #6
            So i saw my oncoligist and we sat down and talked throughthe whole of the histology report which was helpful - basically all's well and she explained everything to me line by line...

            Over in the UK I think that it is a matter of course that you get some follow up treatment. It shocked me a bit, especially after getting 'the best report possible' from the surgeon.

            Anyway, i'm booked in for 8 days of radiation - this is due to start on 31st May - and apparently it will take me a couple of weeks afterwards to get over it - in the meantime, i'm off work and going slightly mad. It's really strange because i feel fine but i'm sat here at home in sunny Manchester twiddiling my thumbs! At least work have been fine and told me not to worry about that side of things.

            Cheers - i think i may have to buy a new game for my Xbox now!


            • #7
              [QUOTE=UK Mart]

              Anyway, i'm booked in for 8 days of radiation - this is due to start on 31st May - and apparently it will take me a couple of weeks afterwards to get over it - in the meantime, i'm off work and going slightly mad. QUOTE]

              UK Mart,
              My husband was in a similar situation but he did have some rete testes invasion. He had15 days of RT for a total of 25Gy. From what I've seen in the literature the UK tends to do the same dose in a shorter time frame. What total Gy will you be given? If you get 20-25Gy over 8 days you may have more nausea than a lesser dose per day will give you, so be prepared for that. Good luck with filling the hours!!!! If you get really bored I have a large laundry basket filled with 15 years worth of photos I never find the time to get into albums. I can send it over to you!!!
              Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.


              • #8
                Hi Karen - I'm not sure what a Gy is but the dosage is 6MV per day (I'm not even sure what an MV is either!)

                I think my first appointment in the radiotherapy dept is to answer questions but apparently the side affects should be limited to nausia, exhaustion and possibly the runs too (nice!)

                Also they said that I should be able to drive myself home too which is encouraging.

                As for sorting your photos out... with pleasure... however I've been hijacked by my dad into painting this wooden swing we have in the garden.... then the fence, then apparently i'm doing some weeding which could take a while!!!! Serves me right for asking!


                • #9
                  UK Mart,
                  You get a lot of rain over there, so if you can't paint and garden let me know!

                  A gray (Gy) is a unit of measure of absorbed radiation. MV refers to the kinetic energy from the beam (million electron volts) 6MV is considered low energy. It's what your body absorbs that counts. So isn't that more than you really wanted to know??? As for side effects, you'll be able to drive home but be prepared for the nausea to hit about 2 hours post-zap. Excellent information at this site:
                  Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.