serum markers after orchiectomy in nonseminoma?

[retroperitommy]

Hello everybody.

I got a NON-seminoma tumore removed 4 weeks ago and am now wondering about the meaning of the tumor markers, as they at first came down nicely.

But (yikes) the HCG markers are going up again, and I am wondering if that means I lost my chance to get away with surveillance?

I understan that surveillance is often a good choice with seminomas, but nonseminomas are a different animal, so really, I was hoping for any insight from fellow nonseminoatous folks out there.

good night.

[nzsteve]

Hi,

Do you have the 'numbers' from your blood tests that you can post - before, after and now?

To be honest, rising HCG isn't a great sign if its gone down after the surgery, but its hard to know for sure what youre looking at without having the marker results. Around 70% of people are cured by the orchiectomy, but that does leave 30% that do need some more treatment. Have you had a CT scan at all? Did it show up anything?

When's your next appointment with the Doc's? I'd guess they will want to rerun the bloods to make sure it is rising, and maybe do another CT if your last one was more than a couple of weeks ago. If your HCG is rising outside of normal levels you will probably be looking at some chemo, 3 x BEP at a guess.

Hang in there. Even if your markers are going up TC is still very curable. Theres loads of people on these forums that have been through it, so do ask any questions you have.

Good Luck,

Steve

[Ras Joe]

When my markers went up after the I/O and the RPLND with the non-seminoma kind chemo was the answer. I did 3 cycles of BEP which had me cancer free until this summer when I decided to have a brand new seminoma in my left testicle. I know chemo sounds scary, but you'll get through it if you need it. Let us know what the plan is when you get more answers from your doc.

[Scott]

What were you last two hCG measurements?

[retroperitommy]

marker levels


date..........8/18..........8/09..........7/26*
LDH..........500............n/a............591
Hcg..........6.46...........2.73...........12.50
AFP..........290.3.........691.3..........1177.4
*2 days before orchiectomy


I have 2 places looking at my situation, one is UCSF, suposedly a good place.
They say if the markers dont come down in 3 weeks it's chemo, otherwise RPLND. But I read that these markers have a much shorter half-life so I wonder why wait so long?

I also read that 6 weeks past orchiectomy you generally loose the "surprise effect" and end up better doing chemo anyways. But then there is this Teratoma business... Ugh.

So I guess the doc just wants to get the RPLND out of the way before he starts chemo, considering that post-chemo RPLND is supposed to be more difficult.

[nzsteve]

Hi,

First thing to say is while the numbers may look high, they really arnt that bad. Some people have readings into the tens and hundreds of thousands. Whatever happens they are going to cure you

From what I remember half life of AFP is about a week, so youre on track for that. HCG half life is abit shorter (I think around 3-4 days?), so your first test after the surgery fits with what would be expected.

They will want to repeat the test in a week or so just to make sure the HCG rise isnt a freak result. If it has gone up again they will move pretty quick to get you started. As you say probably onto chemo. Its not a nice experiance, but you will get through it.

Have you had a CT scan? If the markers have normalised on your next test you might not need the RPLND, but if theyre suggesting you need it anyway Im wondering if they have detected something on a scan? If you havent had a CT I'd push for the doc's to do it.

Steve

[rosewoodblues]

Hi,

I was wondering what your %-ages are on your non-seminoma diagnosis. If it is predominantly Teratoma (which is more than likely the case) then you are almost certainly a candidate for an RPLND as Teratoma does not respond to chemo. Any shrinkage via chemo is mostly related to any carcinoma/choriocarcinoma portions of the tumors. Mine was predominantly Teratoma and it was RPLND for me. Teratoma can double in size in 10 days so it is a real fast grower and you have to move pretty quickly as I'm sure your doctors know and possibly have discussed with you.
Though an RPLND surgery is pretty invasive you'll snap back quickly as I am 2 weeks out and feeling pretty close to where I was before the surgery. I'm sure that there are others out there that can add to this and feel free to email me directly with any specific questions. I have a thread or two on here as well about what I went through. I am pulling for you!

ken;

[retroperitommy]

ken, I looked at your history and it says you had 26 nodes removed, all of which were ancer-free? THat sounds confusing...

Believe it or not, but my percentages are not available. My doctor tells me also that Teratoma can be benign. The language in the pathology report makes it sound like its primarily embryoal carcinoma, with a little bit of teratoma. I had 3 CT scans, and a couple of lymph nodes look slightly enlarged. No one is making me feel like they're in a rush.

[retroperitommy]

i looked at my path report again. mentions that "very minor" bits of teratoma, immature, are present, nd that its mostly yolk sac and carcinoma.

[matthias]

FYI.

A (mature) teratoma is a benign tumor that has the potential to turn cancerous; an immature teratoma is a malignant (cancerous) growth.

A mature teratoma is chemo- and radiotherapy-resistant. An immature teratoma can be expected to respond very well to BEP/EP chemotherapy.

Given your tumor make-up, a high percentage of EC, and the presence of immature (vs mature) teratoma, I would be optiong for chemo over RPLND.

i looked at my path report again. mentions that "very minor" bits of teratoma, immature, are present, nd that its mostly yolk sac and carcinoma.

[dadmo]

retroperitommy:
I agree 100% with matthias' evaluation.

[IowaBrian]

I would be asking for another blood test to see if the numbers have changed in the last 2 weeks (since 8-18-06). Might not make any difference but I would want to be sure that the rise isn't some type of false positive on the bHCG. You are 4 weeks out so the RPLND window is getting really close if you want that if not it is watch and wait or chemo. Good news is the Chemo should knock it out as the BEP is very very good treatment.
Good Luck
Brian

[retroperitommy]

well folks, that really helped me out here. *THANKS!* I will opt for chemo - unless the oncologist at UCSF (considered expert) tells me otherwise.