Seminoma: Surveillance or radiation?

[DJT]

Yep, blast from the past. In the mean time (10 years on) my update is- I've been pronounced cured I hope others have been fortunate as well.

[Davepet]

Wow, you just resurrected a 9 year old thread here, Tom123. I am having trouble even finding the post you quoted, so I cannot answer your question accurately .

[Tom123]

Half of all men and a third of all women.

I have read this too, but am confused as to how a 1% or 10% chance comes into play. Is this saying that once cured, your odds are still close to 50% again and a 1% or 10% chance that a new cancer will specifically be from the radiation alone, or due to the fact that radiation was done, it is over 50% now? How do the two factors correlate?

[Fish]

I haven't read any studies where they've tried to quantify the growth rate, or the time from microscopic metastasis to CT detectable tumors. I did see one article that indicated 70% of relapses with seminoma are seen during the first 2 years. I think this is about double the time frame for relapse of non-seminoma. There are some recent (2006) articles on seminoma in the Journal of Urologic Oncology, but they require a subscription. I don't know if you have access to a medical library, but you can search for articles on Pubmed online -- most journals require a subscription (although you can often see a brief summary of an article), so you would have to go to a medical library to get the full article.

This is pubmed

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

You type search terms into the box and hit "go". If you enter more than one term, the search engine assumes "and".

[tc2006]

Fish: I have read (and have been told) that seminoma grows really slowly. Is there any (e.g. scientific) data as far as you know on just how fast (or slow) it is growing? If I knew the answer to that question one could start doing some math as to when something that is microscopically small could show up on a CT ...

[Fish]

Personally, I'm not too knowledgeable on the abilities of PET scans for something like this. In the past, doctors have performed fine needle biopsies to collect tissue samples. I don't know if this is still done or recommended for cases like yours. You could check with you doctor. Your anxiety level seems really high - and believe me I completely understand. I deal with a lot of anxiety also. My doctor gave me a prescription for lorazepam, which helps me to calm down without going to sleep. Something else to consider.

Best wishes.

[tc2006]

Fish, the last (rad.) oncologist I talked to said the same thing - that by not choosing to start radiation I now was practically on surveillance, assuming of course I would do the required follow up. He called it "short-term surveillance" since I had told him that I wanted to revisit my decision not to do radiation based on the new CT results, which I received last week. Now I am of course wondering whether I should continue the surveillance at this point and just wait for the next CT in about 3 months to show any possible changes to these enlarged lymph nodes, or whether there is a better way to find out what these enlargements are - like do a PET scan?

[Fish]

I think your results are good news, congratulations. If I were you, I would stick with surveillence. In my first 2 years of surveillence, I had the CT scans and blood work every 3-4 months, this is fairly standard. If you get some peace of mind, you could probably convince you doctor to increase the frequence to every 2-3 months (of course this will increase your radiation dose from the CT), but seminoma usually grows slowly compared to other types of TC. If at any point the lymph nodes change, you have a good chance of still being able to elect radiation rather than chemo -- the doctors would do a complete re-staging to make the final determination. You've basically chosen surveillence by default. My oncologist told me I had 6-8 weeks to choose, after that I was in surveillence. I'll be interested to hear what your oncologist thinks when you talk to him/her.

Best wishes.

[Scott]

The CT scans will do just fine.

[tc2006]

Just read in another post on this forum that somebody did a MRI to check on some lymph nodes and whether their enlargement was due to cancer cells or not. Is MRI a recommended way to check on lymph nodes, in addition to CT's, or will they likely not provide any further information ? Does anybody know?

[tc2006]

I did a new lung X-ray and CT of the abdomen/pelvis last week. The x-ray was clear (what a relief!). The CT says no changes from the last CT 10 weeks ago, i.e. no new nodes discovered, but the (sub-centimeter) lymph nodes they found last time are still there - "stable". Based on my GP's suggestion that these lymph nodes may just have been slightly enlarged as a result of the I/O (the 1st CT was done 3 days after the surgery), I was hoping that this time these nodes would have appeared smaller or even gone away on the CT, but they didn't.

My urologist who I discussed the results with, not surprisingly repeated his recommendation for radiation; I have not talked to an oncologist yet about the new CT. My thought for the past few weeks has been that if these sub-centimeter nodes showed up smaller this time, I would most likely continue surveillance; and that if they showed up - even slightly - bigger, I would go straight to radiation. Now it feels like I am in the same dilemma as 10 weeks ago with the new CT showing no difference... does anybody have an opinion whether I should look at the results of the new CT as a good thing or as a sign to give radiation serious consideration again ?

[TSX]

Now I'm really confused... If I choose Carboplatin, I still be able to do Radiation if in 6 or 7 years time there's an recurrence. Right? Or will i have to do Chemo?

It depends.

If you have a recurrence that is early-stage (I or IIa) seminoma and you haven't already had radiation, there's no reason why you cannot have it at that time.

I have heard a radiation oncologist say that if a TC patient has already had BEP chemo, it is advisable to avoid radiation to the base of the lungs (which is sometimes included in TC treatment). Apparently the combination of radiation and lung scarring from the Bleomycin can be bad news.

However, with only Carboplatin it shouldn't be a problem.

-TSX

[LordOfChaos]

Now I'm really confused...

Now I'm really confused... If I choose Carboplatin, I still be able to do Radiation if in 6 or 7 years time there's an recurrence. Right? Or will i have to do Chemo?

[tc2006]

Ok, my next CT is week after next (this time, I'll do it for sure!), and I am thinking I'll decide then what to do next - radiation or continued surveillance...

[MRM]

Standard protocol is to do chest X-rays unless the radiologist sees something, in which case a followup CT is ordered.

I'm scheduled to go in for another chest CT in 2 weeks because my last one 2 months ago noticed a couple nodules (3 mm and 1.2 cm) that they're watching. Here's hoping they're nothing.