Seminoma: Surveillance or radiation?

[TSX]

tc2006,

The answers you seek regarding CT versus X-ray are explicitly given in this post. In particular, the last two sentences that I've colored red in the quotation apply here. Go with the X-ray for your chest.

Fish: A helical CT scan of the chest will give you about 133 times the amount of radiation in a single chest X-ray. See the post in the link above for details.

-TSX

[Fish]

I think your approach is reasonable - just keep all appointments. And you're actually on surveillence, short term or otherwise is just a matter of semantics.

My oncologist also prefers to do CT of chest, abdomen, and pelvis. The CT is more sensitive than a chest xray, and therefore sometimes finds "nodules" that are not TC. I have one of these in my lung, after it was first noted at 5x7 mm, we repeated CT 3 months later, the nodule decreased to 2x5 mm, after that it has been occasionally noted (I think probably depending on the exact position of the "slice") as a tiny nodule that appears stable.

Otherwise, I'm ok with the chest CT -- but probably gives me more radiation that an xray.

Either way you should be OK. Seminoma usually recurs in the abdomen (in the absence of radiation therapy)

[tc2006]

oh, and one more correction from my previous post: the next CT that I was told to do, as part of a regular surveillance strategy, would be in August (not October as stated above), 4 months after the first which was in April. - By the way, I was told X-rays of the lungs would be fine, no CT's needed, but the most recent rad. oncologist I spoke to said if it were him, he would rather do regular CT's of the lungs, instead of X-rays. - Any opinions on that? Thx.

[tc2006]

yes, the CT I skipped was one that I had requested, b/c I thought it would help my decision between RT and surveillance; once scheduled, I talked to a couple of doctors (oncologist and GP), and they both said that most likely, we would not see any changes after only 6 weeks, but that of course that it wouldn't hurt either ... Given the fact that every CT adds quite a bit of radiation itself, I then decided to push out that CT to a point in time when it would be more likely to see any changes, which I was told would be about 3 months or so after the first CT.

[Scott]

I was reacting to the words "chickened out ... for no reason." If you and your doctor made a conscious decision to cancel the CT scan because it wasn't necessary, that's an entirely different story!

You should be fine with the approach you're taking, so long as you keep to the program. Hang in there -- life is good.

[tc2006]

TSX is right: it was the CT scan after 6 weeks that I (not my oncologist) had requested and that I skipped b/c I was told that changes would most likely not be noticeable after 6 weeks anyhow. Actually, the original surveillance schedule I was given by a medical oncologist doesn't call for the next CT until 4 months after the first (which would be October).

I talked to another rad. (!) oncologist meanwhile, and he expressed a slight preference for surveillance in my case, mostly b/c of my IBD/diarrhea and autoimmune disease issues that he thought could get worse with RT. When asked whether I'd be losing anything by waiting another 3-4 weeks before deciding between RT and surveillance, he said no; basically, he said, what I was doing by that is something he would call "short-term surveillance" (I know this sounds quite strange). He did say that depending on the next CT scan and whether there would be any larger than 1cm nodes, my "official" stage might be II as opposed to I, which would require higher dose RT than for stage I. But (and I had to agree with him), at least at that point I would undergo RT for cancer cells that are there, and not for cancer cells that are only suspected. So my current plan is to wait another 3 weeks or so, then do the next CT, and then decide the treatment based on any changes (good or bad) the CT may show. Just to be clear: I have NOT ruled RT out yet, and I realize that it probably would be better for my nerves, I just feel I need a little more convincing (i.e. evidence of remaining cancer) before doing the RT. - I am curious what you guys think of this approach - reasonable, or should I just go straight to RT and not even look at another CT short term?

[Don]

Ultimatly each of us has the option of choosing whatever tretment option we feel is right for us, even though it may not be what the doctor prescribed. Having said that I cant for the life of me understand why someone would risk having cancer spread and choosing basically no treatment option.. And not following a schedule to assure that you are OK and not having radiation done do to FEAR or not having CT scans done due to fear of the results.... This is one of the most ridiculous things I have ever heard..... In short I will ask you this...... Which Fear is worse for you--the fear of radiation side affect and/or Ct scan results or the fear of death???? Without following either a surveillance schedule or having radiation treatment you are jeopadizing you life.... Do the right thing hear because beleive me when I tell you(and many other can back me on this) you definetly DO NOT want to have this spread and start having treatment for late stage or cancer that has spread --IT SUCKS!!!!!! DON

[JAYHAWK]

A major "side affect" of surveillance are the mental issues you will face. I still get anxiety prior to my surveillance tests after almost three years. If you cannot accept that situation then other options will be preferable. With surveillance you must also know that it IS a treatment option and that you are proactive with treatment through the on-going surveillance tests. From what I have read of your specific situation however, I too would suggest radiation. Either way your chances of cure are nearly 100%.

That being said however, you have basically chosen surveillance by default. I would reccomend that you get an opinion from your oncologist as to whether radiotherapy is still a viable option at this point.

[DJT]

Hey tc2006, for what it's worth, I get really nervouse before my f/u ct's and a bit cranky,, BUT how COOL is it to KNOW one way or the other.

Putting your mind to rest, or the next chapter,, is far better that being anxious for no good reason. Being anxious doesn't help your immune system either. Go regularly and enjoy hearing good news. You also seem to have found a group here that will help you deal with the not so good.

[dadmo]

TSX:
I agree that six weeks will show little change with seminoma, my concern is that tc2006 will blow off future (needed) scans. All I want is to see you guys beat this thing and to do that you need to stick to whatever schedule you and the doctors agree upon.

[TSX]

Scott & Dadmo,

I think this was a CT scan he requested, only 6 weeks from his last scan with no treatment in between, so it wasn't really surveillance per se. I also think this particular CT scan was unnecessary, since he's got seminoma and six weeks of growth is not likely to produce much of a change. See post 38 in this thread.

-TSX

[dadmo]

tc2006:
You can't be skipping these appointments. There are some good reasons to not go the surveillance route and one of them is not being able to deal with the mental stress. I agree with Scott, you should consider going into treatment. It not a question of how tough you are, surveillance can be draining. If it were me I would probably opt to be treated, I need to feel that I'm being agressive in my treatment and you may feel the same. You have to do what works best for you, but you have to make a decision and stick with it.

[Scott]

(just chickened out of another CT last week for no reason)

You did what?! OK, I usually encourage surveillance, but I don't think it's for you. I think you need to get on with treatment now. Surveillance is only a good choice if you make every single appointment.

[Eric]

TC2006

I had vascular invasion at my original diagnosis, was treated with RT and relapse. TCLEFT on this forum had no vascular invasion, was treated with RT and relapse also. I think that cancer cells go the the lymph node before but if you don't kill them fast enough some of them go to the lung and it can take 4 years to grow during this time you think you are cured. I think it is not predictable and it is probability.

[tc2006]

Does anybody know whether vascular spread of seminoma only happens from the primary tumor, or can even start from (occult) metastasis in the peritoneum? I am just wondering what the odds may be for seminoma to spread to the lungs AFTER I/O, but while (occult) cancer cells are still in the lymph system ...