Stage 1 Seminoma with INVASION

[DaveS]

Hi , I am trying to find out the risk of recurrance if I do watchfull waiting when my tumor was 2.8 cm with "lymphvascular invasion present".
Is there still any chance I could have no cancer after surgery?
Does anyone know the percent in this case.
My radiation onclogist said I had 75-80% chance of being cured already with the surgery. But when I mentioned that the pathology report said invasion was present, he said, "so maybe only 50% chance". Did he just make that up?

I start radiation therapy (~40 Gray units) in a week 7/26/06.
I feel I should wait to see if there is cancer before doing radiation.
Also what is the chance of recurrance even with radiation?

Good luck to all,
DaveS

[Krokar]

Hi Dave,

problem with cancer is that "invasion" does not mean somebody can count cells and tell you exactly if there is still some cancer in your body. It can be or not, but that's why treatement is important.

What is important is that you started treatement and with radiation treatement you have around 3% chance of recurrance.

I wish you good luck,

Alex

[dadmo]

Dave,
With the path report stating that you have invasion your best course of action may be to get treatment. Invasion means that it is likely that some cancer cells have spread.

[Karen]

Dave,
With invasion you do need to get zapped. Even if your CAT scan is clean there can be micrometastesis. If you haven't looked at this site already
http://tcrc.acor.org please do. It's a great source of information. Radiation can be to the paraaortic region alone or can include the pelvic nodes (dog-leg or hocky stick field). My husband had just paraaortic and did not get the lead clamshell on the remaining testicle. Read up on what to do for nausea. My husband scheduled his at the end of the day so he could work, leave early, and feel nauseous in the comfort of his own bathroom . Nausea and vomiting doesn't hit everyone and can be controlled, so if you feel sick make sure you tell your doc. Good luck and keep us posted!

[IowaBrian]

My doctor said with invasion it is about 50-50 down from 70-30 without I am in the same boat as you but mine is the NON Sem so no RAD for me. I think they all read the same book about the stats .

[Eric]

DaveS

I had vascular invasion and my doc prescribed me radiation in 2001. I personally think that it was'nt the best thing to do. In 2005 i had a recurence and had chemo. Now i think that my chances to be clear are better now because chemo treat all your body. When you have invasion the chances are really high that cancer cell are somewhere in your body and not only in the area covered by radiation. There is a risk that radiation will be useless and will have to do chemo anyway. At the end you are cured but you had radiation and chemo and increase your chances to have other kind of cancer. If i had to do it again i would choose surveillance or chemo at the beginning.

[DaveS]

some data on recurrance based on pathology report

Hi All,
Thanks for all your replies. it's very helpful.
I searched all day (while at work!) and found these links

http://www.nature.com/ncpuro/journal/v3/n5/full/ncpuro0482.html

and

http://www.urotoday.com/39/browse_categories/testicular_cancer/longterm_outcome_of_postorchiectomy_surveillance_for_stage_i_testicular_seminoma.html

They say
Of those seminoma stage 1 patients, those most likely to have a recurrance
have tumor size>=4cm and rete-testis invasion.
They said lymphovascular invasion was not that predictive.
From that alone i would choose "watchful waiting"
But,
1. I'm not sure if my pathologist even checked for RETE invasion
(What is Rete anyway?)
2. my oncologist said watchful waiting isn't a good option because after many years you get about the same radiation as the treatment
(What is the Gray dose for CAT scan? Then how many scans per year?
Does it equal 30gy for Therapy?)
3. I noticed a few people on this chat who had no invasion of any kind and had recurrance.
Best to all,
DaveS

[DaveS]

rete-testis invasion

Hi Eric,
I just noticed you had spermatic chord invasion.
Maybe that is rete-testis invasion.
I looked up rete-testis and see it is somehow part of spermatic chord, but i am not sure.
See a picture at:

http://en.wikipedia.org/wiki/Rete_testis

[Fish]

Dave:

The rete testis is a series of small ducts that form where the seminiferous tubules merge. So, the rete collects the sperm that is formed in the tubules and transports it to the wall of the testis, where the efferent tubules begin and carry the sperm to the epididymis. I don't think that the rete is generally considered part of the spermatic cord. But since the rete provides a potential exit point from the testicle, you can see why invasion of this area would be a concern.

I chose surveillance after my seminoma diagnosis, and 2.5 years later things are fine. I did not want to have radiation unless I was sure I needed it.

Best wishes.

[DaveS]

rete risk factor not that substantial

Thanks for the info on Rete.
Just to follow up on my effort to find risk factors that predict recurrance, I found this interpretation

"Surveillance has not been adopted by many centers. Thecost of the follow-up program is higher, and there is alwaysconcern regarding patient compliance (12). Warde et al. (19),in their review analysis of major surveillance studies, sug-gested that tumor size 4 cm and rete testis invasion werepredictors for relapse. In the Warde review, patients whopresented with tumors larger than 4 cm had an actuarial 5-yearrelapse-free rate of 76% compared with 87% for those withtumors 4 cm at presentation. Similarly, patients with theinvasion of rete testis had an actuarial 5-year relapse-free rateof 77% as opposed to 86% for the patients without invasion."

So the difference is not that substantial...
-with rete invasion 100-77=23% chance of relapse
-without rete invasion 100-86=14% chance of relapse.
I was hoping for a huge difference, but no such luck.
So I probably will do the radiation.