RPLND or CHEMO?

[retroperitommy]

Hello there, y'all....

have you had non-seminoma? Have you had chemo and/or RPLND?

If so, I would really like to hear some recommendations which one I should do.

My doctor says I have a choice of open RPLND next week, or 3xBEP chemo. My Tumor markers are elevated, and the CT scan shows "something" that might be a couple of enlarged lymph nodes.

Cant figure out which one to do. And I have to decide very soon.... please help!

Thanks muchly.

[nzsteve]

Hi,

Ive had both, and to be honest, neither of them are a pleasant experiance. Unfortunatly its not a nice choice to for you to have to make!

Have you had any more bloods since your last post?

As someone has posted in another thread, the % of terratoma in the primary tumor might have a bearing, as this doesnt respond to chemo. Other than that I think you should ask your doctor what his plan is if the RPLND does remove some cancerous nodes. It probably breaks down like this:

RPLND now: cancer removed = yes then chemo; no = surveillance
Chemo now: effective = onto surveillance; uneffective = RPLND or 2nd line chemo

Given that your markers are rising, and that the CT probably shows something, if he is going to follow the RPLND with chemo if cancer is removed then I would go for the chemo now, with the hope that this is 100% effective. In most cases it is, and you wouldn't need the RPLND ever. I think in your situation I would head for chemo.

You might also consider contacting someone from the experts list for a second opinion.

Steve

[Davie]

Raised markers after I/O indicate a biologically active disease, and I would have thought it'd be chemo for you.

However, I'm no doctor and you or your oncologist should contact a recognoised world expert, on the experts list to confirm the best plan of action.

[AdrianB1971]

hi

You have EC component and there are a high probability to already have ocult metastase on remote sites [like lungs for example]. I think the best option is 3 x BEP [with high hydratation you will not experience long term side effects]. Only if, after chemo, the lymph nodes are still enlarged you may consider post-chemo RPLND or very close surveilance [because there can be dead tissue].

If you choose RPLND first and having EC as tumor component you have a great risk to be not cured and doing chemo anyway.

[dadmo]

retroperitommy:
The elevated markers indicate active disease. It would seem that the first priority would be to kill the disease with chemo and then do an RPLND as a clean up.

[Scott]

If your tumor markers haven't normalized, chemotherapy is really your only choice.

[rosewoodblues]

hi retroperitommy,

what are your percentages? What makes it a non-seminoma is the precense of Teratoma which does not respond to chemo treatments. nzsteve is right (I might have been the one to mention it) since Teratoma does not respond to chemo the amount of Teratoma could be the deciding factor as to which way to go first. You might realize that ultimately you could have to endure both. The chemo to deal with the carcinomic types and the RPLND surgery for the Teratoma.
As well the HCG's are more often related to the Teratoma than the carcinoma's. They both affect the levels however Teratoma will push the HCG's higher faster than the other.

If the doctor hasn't told you Teratoma tumors grow at a rate of doubling in size approximately every 10 days. I am not wanting to scare you but merely give you the information that I got. I just got done with an RPLND surgery and it was painful but worth it! The chemo will most assuridly be to slow / stop the carcinomas and the RPLND will be to stop the spread of Teratoma (if that is what is on the move).

can you put up some more info like your pathology report? was it beyond the testicle in any way? percentages? all that jazz. that is of course ONLY if you want to. It is important as well to talk to more than one doctor if you can possibly do it.

peace and love be with you,
ken;

[retroperitommy]

thanks for the info, it looks like chemo. path report says teratoma is very minimal. I am seriously wondering if maybe the surgeon didnt get all of it out in the orchiectmy.

I am waiting for more tumor markers coming tomorrow I hope. if teratoma grows 100% in 10 days, should I be feeling growth in my testicle again - if it was to be the cuprit?

[Scott]

What makes it a non-seminoma is the precense of Teratoma... As well the HCG's are more often related to the Teratoma...
If the doctor hasn't told you Teratoma tumors grow at a rate of doubling in size approximately every 10 days...

Ken, in the U.K., "teratoma" means the same as "non-seminoma" does in the United States. However, in the U.S., teratoma isn't as you describe it. See this link for details.