New entrant to the waiting game

[AusRick]

Hi,

I amd 38 and live in South Australia and was recently diagnosed with TC - timeline as follows:

1. Ultrasound on July 28 detected solid mass lesion in right testis of 3.2 x 4.9 x 2.0cm in size.
2. Visited Urologist on August 4 and was sent for CT and blood test, and surgery scheduled for August 7.
3. CT and blood test on August 5.
4. Right Orchiectomy performed on August 7.
5. Visited Oncologist on August 18.

What we know to date:
1. Primary Tumor of approx. 5.0 cm - Pure seminoma - contained within Testis with no vascular invasion.
2. Blood markers all normal.
3. CT revealed one mildly enlarged interaortocaval lymph node, measuring 15mm - the appearances are indeterminate.

The first visit with the oncologist has not really shed any more information. He is concerned with the one lymph node and is scheduling a PET scan to see if the node "lights up". If the PET scan is positive he is leaning towards 3 x BEP as the treatment - we'll discuss this option further. If it is still indeterminate then the staging question remains unanswered and so does the treatment protocol. I'm hoping for Stage 1 and probably will opt for surveillance or 2 x Carboplatin. In any case, if the PET is indeterminate or negative then we will probably start with some surveillance to see if the node continues to grow, etc... and take it from there.

The hardest thing is the uncertainty and the waiting game !

Thanks for this forum the information contained within is great...

[Scott]

Welcome to the forums, AusRick. I'm surprised you didn't mention radiation therapy as a possibility. I would think 3xBEP would be much more treatment than necessary for your situation. Keep us posted.

[AusRick]

Welcome to the forums, AusRick. I'm surprised you didn't mention radiation therapy as a possibility. Keep us posted.

Oops missed that - RT is an option and would usually be the matter of course treatment recommended by my oncologist. However, the long term toxicity puts this as a less desirable option.

Based on my reading so far I agree that 3xBEP looks like over treatment - I will be discussing this with my oncologist after the PET scan results. He seems to think that 3xBEP will better than Carboplatin and didn't actually mention RT with respect to a Stage II diagnosis.

Will keep you posted...

[Scott]

At least in the U.S., radiation therapy is standard treatment for stage IIA or IIB seminoma. See page TEST-3 of the NCCN guidelines for details. I wouldn't expect 3xBEP unless you had distant metastasis or a retroperitoneal lymph node greater than 5 cm.

[Krokar]

At least in the U.S., radiation therapy is standard treatment for stage IIA or IIB seminoma. See page TEST-3 of the NCCN guidelines for details. I wouldn't expect 3xBEP unless you had distant metastasis or a retroperitoneal lymph node greater than 5 cm.

I think that radiation for Seminoma is standard when lymph nodes are enlarged to 2cm, when lymph nodes are greater then 2cm then you receive 3 x BEP.
Carboplation is good choice when your are sure in I. stage, but I would not choose it when some lymph node is incresed because of cancer, that's why AusRick's oncologist didn't recomend this for possible stage II.
But it all depends on oncologists's I have heard for combination of radiation and EP also...

[Scott]

I think that radiation for Seminoma is standard when lymph nodes are enlarged to 2cm, when lymph nodes are greater then 2cm then you receive 3 x BEP.

Here's an excerpt from the NCCN guidelines regarding stage II seminoma:

Stage IIA is defined as disease measuring less than 2 cm in diameter on CT scan and stage IIB as disease measuring 2 to 5 cm in maximum diameter. For patients with stage IIA or IIB disease, 35 to 40 Gy is administered to the infradiaphragmatic area including para-aortic and ipsilateral iliac lymph nodes. As in the management of stage I, prophylactic mediastinal radiation therapy is not indicated. If a horseshoe kidney is present, then radiation therapy is not administered, and the patient is treated with good-risk systemic chemotherapy (described below).

Stage IIC is defined as retroperitoneal disease greater than 5 cm in maximum transverse diameter. Standard chemotherapy for good-risk germ cell tumors is used to treat patients with stage IIC seminoma.

[AusRick]

A little progress update:

Sep 01 - PET Scan - showed moderate uptake in the lymph node indicated on the previous CT scan. Rest of imaged body normal.

Sep 06 - Follow-up visit with medical oncologist for PET results - Staged as II, due to CT and PET scan indications. Discussed treatment options, 3xBEP or radiation therapy. Decided it would be a good idea to seek opinion from a radiation oncologist.

Sep 07 - First visit with radiation oncologist, he reviewed all results and consulted with my medical oncologist and others - both oncologists now agree that radiation therapy would be a suitable approach. He noted that there had been little change in the indicated lymph node between the CT and PET scans.

Sep 11 - Planning (mapping) CT scan for radiation treatment. Second meeting with radiation oncologist - had discussion regarding the radiation field - do we 'dog leg' or not?

Sep 13 - Another appointment with medical oncologist

Oct 03 - Planned start of radiation treatment

I am currently waiting for a reply from Dr. Einhorn regarding my query of whether we need to include the "dogleg" or not...

[testicles001]

Can you post what happened after the radiation ? dogleg ?