Lymph node increased in size

[TX Cale]

Cale's latest CT scan shows that his left side para-aortic lymph note has increased from 6mm to 1cm. His doctor is talking about RPLND. Should we do another CT scan first? And has anyone had the new laproscopic done instead of the full blown RPLND? Any thoughts? Thanks

[IowaBrian]

Sorry to hear about the news..
I would ask the doctor if another CT is needed to rule it out as normal. Sure would hate to have the RPLND if it wasn't needed. As for the scope I don't think there has been enough of them done to say that is the way to go. I am for advances in the field and I asked my doctor who heads the robotic surgery at the hospital what he thought and he said he wouldn't do it that way and would ref me to another doctor, he said too much to go wrong but that is just one doctors opinion. I hope I never need the surgery but if so I would have the regular version just to be on the safe side.
Keep us posted and good luck
Brian

[Scott]

I'm not exactly a textbook case. I did have L-RPLND, and I had it a full year after my orchiectomy. Because I had a slow-growing lymph node without elevated blood markers, and because my original pathology was yolk sac, embryonal, and teratoma, surgery seemed like the right approach. I expected to find teratoma. It turned out to be seminoma.

There's debate over laparoscopic RPLND, because there hasn't been enough experience to prove that it's curative. Often, if active cancer was found, chemotherapy automatically followed. That's not always the case anymore. I went back on surveillance and have so far been fine since.

Search for the term "laparoscopic," and you'll find some past threads in these forums on the topic, and information from a few of us who have gone that route.

[Ras Joe]

Another scan might not be a bad idea-- I had a spot in my lung that they were concerned about post-chemo but it turned out to be the angle of the CT scan-- the scan also showed about a 4mm change and at the next scan it was more than 4mm SMALLER?? My doctor said that things that small tumors can sometimes appear to change size b/c of the "slices" that the CT scanner takes. Hope at least some of this helps!?

Joe

[TX Cale]

Cale's Latest Update

Cale's latest blood tumor markers are normal and we've decided to do another CT scan to check that lymph node again. We've scheduled it for August 12. In the meantime we're tracking down an experienced laparascopic surgeon and looking for an oncologist. We're in Dallas if anyone has recommendations. This is a great forum and I really appreciate all the thoughful caring comments that I've been reading, not just for my son Cale but for everyone who posts. Ya'll are incredible. Thanks.

[TX Cale]

Just got the results from the latest (Aug) CT scan. Cale's lymph node has grown even larger to 2.6 x 1.9. Doctor says no more ***** footing around we're having surgery. We're going to go with the laparoscopic and also have his doctor (urologist) in room to assist surgeon and in the event we need to proceed to a full/open RPLND. At the moment we're trying to pick a date that all can make an appearance. We're also tracking down a place to bank sperm - which I know Cale hasn't even thought of yet.

[Joe's Mom]

Hi Cale: Just a suggestion - Have you tried contacting Dr. Einhorn with your concerns/questions? Sounds like you have a plan, but it can't hurt to get his opinion. My son has had TCx2. Dr. Einhorn graciously answered our questions and he is considered "The Expert" with regard to testicular cancer. He answers e-mails quite quickly, or call his office. Here's the most recent info I have for him:

NAME : Lawrence H. Einhorn
PHONE : (317) 274-3515
FAX : (317) 274-3646
E-MAIL : [email protected]
DIVISION : Hematology/Oncology

OFFICE ADDRESS:

Indiana Cancer Pavilion, Room 473
535 Barnhill Dr.
Indianapolis, IN 46202-5289

Good Luck - Keep us posted ... Joe's Mom (Nancy)

[mikeygti]

Cale;

First of all,sorry to hear about your latest CT scan results.

I also think you should get a second "expert" opinion. I'm thinking that RPLND surgery may not be curative at this point,due to the E/C component in your original tumor,and that you should probably head directly to chemo first.

Best of luck in whatever treament you decide to persue.

[dadmo]

I would certainly get an expert involved. In my non-medical opinion your son has active cancer which the RPLND will not cure. Cale will need chemo. I would think that the first priority would be to eliminate the active growth via chemo and then have the operation to remove the nodes if they remain enlarged. I may be wrong here but the sequence of events could be critical.

[danebert]

Dr. Einhorn is an advocate of chemotherapy is a situation like yours. In fact I was in the exact situation as your son. My nodes increased while on surveillance but my markers remained normal. His prescribed treatment was 3 BEP followed by an open RPLND. I had some teratoma and fibrotic tissue found after the RPLND, indicating I had some active tumor before chemotherapy. Second, if you were told that an RPLND should be performed,it probably shouldn’t be laparoscopic. Although some people on this message board will disagree, the lap. approach hasn't been proven as effective and in a situation like yours probably hasn't even been attempted in a situation like yours ( the node increasing in size rapidly). At that rate of increase I'm almost certain it is active cancer. In stage 2 A patients ( nodes less than 2cm) the vast majority were sent for 2 rounds of chemo after the lap RPLND if any cancer was found. You can ask Dr. Einhorn Dr Bosl Dr Foster, Dr. Richie, Dr. Nichols or any other expert in the world and most will agree that 2 rounds of chemo is similar to three as far a toxicities and long term complications are concerned. Meaning if the RPLND is done and cancer is found you are looking at the same situation regarding chemotherapy. Almost no Dr would allow your son to just follow up if active cancer is found. One exception is Scott on this board. His node increased in size slower than you sons if Im not mistaken and Seminoma was found. Due to the fact seminoma is slower growing and far more curable than non seminoma in advanced cases the risk was far lower him than your son.
One final note, regardless of the choices made, the chance of cure is near 99.5%. One road may be longer of harder to pass than another but the ultimate final destination will be the same. Contact an expert to avoid the " What If" factor.