RPLND or Surveillance?

[Aras06]

I was diagnosed about a month and half ago. I had a RIGHT orchiectomy and the pathology showed I had a non-seminoma 0.6 cm tumor with 10% teratoma. I had a ct scan shortly after which showed a 1.7 cm LEFT periarterial lymph node (spelling probably wrong). I had a few people read the ct scan and there was a difference of opinions, one of them thought it was a blood vessel. I had my 2nd scan done last week at high resolution (closer spacing) and it showed a 1.5 cm left periarterial lymph node. So we are sure now that it is a lymph node, I was told the shrinking in size isn't significant. I am told my options are either surveillance or RPLND. I don't like either option. I am 25 years old and I'm worried that the radiation exposure from surveillance will give me other problems 15 years later in my life. And I'm pretty scared with any kind of surgery. My surgeon who did the orchiectomy wants me to do a laproscopic RPLND with him. I guess if I was going to decide for someone else I would want them to do the surgery. But I'm just terrified about it.

[MRM]

If a lymph node is enlarged, you shouldn't be offered surveillance at all-- it would either be chemo or the RPLND, depending on whether or not your tumor markers are normal.

[Aras06]

My markers are normal. I guess I'm going to start scheduling for the RPLND. What bothers me is how there isn't any way to know what really is in there without surgery.

[IowaBrian]

I agree with MRM,but you need to see the cancer doc too. Other things they are going to look at are your blood numbers before and after surgery. As for the scope RPLND, if it was me I would pass I don't think there has been enough of them done I would do the regular version. I think before you make up your mind you need to talk to the cancer doc and get the info from them before any surgery, chemo might be bad but it looks a lot better then surgery and then having chemo after anyway.
There is much more info needed before they do surgery if it was me.
Also I would get a 2nd opinion if surgery is called for your doctor shouldn't get mad in fact he should be able to guide you to others in that field so you can get in right away for the consult since time is a factor.
What part of the country are you in there is a lot of people on this board that can give you some names of doctors if needed.
Good Luck
Brian

[Aras06]

My surgeon told me he has done 3 of these procedure laproscopically. My oncologist said that he would have liked this number to be higher but given the reputation of the surgeon he would still highly reccommend me to him.

[Scott]

Three is a very small number. You should strongly consider getting a second opinion from a center with more experience before proceeding.

[Aras06]

I thought it was a pretty small number too. But he apparantly pioneered laproscopic prostate surgery in north america, this is his specialty. I would like to get it done laproscopicly. What other centers would you suggest. I live in so CA.

[nutless1]

In your situation (and I was) I would go with surveillance and watch that node very closely,maybe a PET scan? I still ended up with the RPLND a year later though.

Whatever you decide you have caught it real early and will be cured - if you don't like the thought of surveillance you end up on it anyway RPLND or not, moreso perhaps with a lap version.

The only risk with waiting now is that maybe at the next scan in a few weeks the node will be 4cm in size, or have spread to the lungs - but in that case Chemo will cure you anyway.

[Scott]

The TCRC experts list includes a couple in southern California.

[Aras06]

Does anyone know the mortality rate for RPLND surgery?

[Scott]

As noted at this link, "In the hands of an experienced surgeon, the mortality rate associated with an RPLND should be approximately 0%."

[Mizu]

Just to add my thoughts on your concerns re: radiation. I had my RPLND done in march of this year and am on the subsequent surveillance schedule - monthly chest X-rays and I just had a baseline CT scan last week. So either way you will have some exposure to radiation.

My CT scans were clean after the IO, but because of vascular invasion of the tumor I opted for RPLND at sloan as recommended by the doctors there - you never know for sure. I got the impression that they don't like the laparoscopic version very much at sloan (I asked about it) - they see the laparoscopic surgery as a staging procedure to figure out how much chemo one might need afterwards, while the open version is seen as a curative procedure (meaning that if few nodes test positive the surgery may cure you and you might not need chemo later).

Best

Michael

[MROSE]

Hello! Along with Scott, I would definitely take a bit more time to get another opinion or to browse the list of experts who do the RPLND. My boyfriend just had his RPLND at Sloan-Kettering in NYC and his oncologist was not thrilled about the lacroscopic option that is being offered today and I believe that is because of the nature of the surgery. The full RPLND is much more effective in successfully removing all of the lymphs in that area, but if you are seeing someone who is VERY familiar with the lacroscopic procedure you are most likely in good hands. In your case, it sounds like your enlarged lymph node isn't problematically large enough to cause surgical issues so I understand why you would want to consider the less invasive procedure. If you want to talk about the RPLND and what it entails, I have a fresh memory of it! Just send me a message.

DONT BE AFRAID TO GET A SECOND, THIRD, or FOURTH OPINION

[Aras06]

Strange turn of events. I'm still kind of confused/shocked.

Just got a call from the place I got the 2nd CT Scan done. The surgeon and radiologist reviewed the CT scan and both now agree that it is a VEIN, not a lymph node as originally thought. They will make the appropriate changes to the report and re-send them to my oncologist. They suggest I do surveilance.

[Scott]

Interesting. I'd go for it.