Radiation, yes or no

[Michael112]

I had seminoma stage 1, no visable spread at all, just the whole testicle had abnormal cells, the diameter of the tumor was 2cm.
I am 22, colon, prostate and lung cancer STRONGLY run in the family, I want to have kids in the next 10 years who are healthy, and I would prefere to have them naturally, and I dont really want to get cancer again for atleast another 45 years, I plan to be ultra healthy from when I start TRT and to take high dose vitamin D and other naturally proven anti-carcinogens, I am afraid when my urologist calls me back he is going to say "no no you should get radiation therapy you would be stupid not to". Would I be smart to push for surveillance? I have a poor enough appetite as it is without needing a permenent dislike of protein shakes, I also have had chronic heartburn wich I 95% cured with diet, I just think I am in the incorrect group for radiation therapy, does anyone here think otherwise?

Also in the case of re-occurance isnt it still treated with radiation? my urologist said if it re-occured I would need chemo..

[Karen]

Michael,
When you say the whole testicle had cancer cells, was there involvement of spermatic cord, rete testes, any sign of lymphovascular invasion etc? We would be better able to give our thoughts and perhaps some similar experiences if you could post the final pathology report.

[Scott]

The decision belongs with you and your doctors, of course, but given the type of anxious posts you've made here, you may be better off with adjuvant radiation therapy as your doctor recommends. Surveillance can be a good choice, but it can also be nerve-wracking.

[Scott]

Also in the case of re-occurance isnt it still treated with radiation? my urologist said if it re-occured I would need chemo.

It depends. Spread of seminoma to the retroperitoneal lymph nodes, caught early, may still be treated with radiation therapy. Spread to the lungs or elsewhere would definitely call for chemotherapy.

[Michael112]

I think I would be more anxious with radiotherapy, I would be worried about long term effects and increase in other cancers, monthly or every 2 month cat scans wouldnt be so bad I dont think.
I felt like **** tonight playing poker with my mates, light headed, disorientated, weak and dizzy(still managed to win though), oddly enough hot flashes arnt as bad, I am pretty sure after TRT I will worry less and feel great, my fitness gear came in the mail today, I should be able to use it in 5 weeks as it is light weight for shoulder rehab, then by january I can hit the gym again and with TRT I should blow up quick

[MRM]

Like others said, your exact pathology would help, but you have roughly a 20% chance of the cancer coming back within 5 years without any more treatment. If you had invasion beyond the testicle, the recurrance chances go up.

Radiation will drop those recurrance chances to less than 5%, but it does raise your risk of a future cancer slightly, although not lung or colon cancer.

Which are you more comfortable with?

[wannalive]

carboplatin

Hi

I've read some adjuvant chemo thearpy for seminoma with carboplatin to avoid risk of second cancer and I was planning to push for that when I was diagnosed

in 2 weeks I had my CT and I had already big enough lymph node and small one in thorax which sends me directly to regular chemotherapy

please check the list I posted in Reserach page, there are papers on this.
you may need to check answers.com or med dictionary for medical terms

Good luck on your further treatment
and make sure you can have regular controls if you choose surveilance
as you may be in a worse trouble later on

Bekir



Clin Oncol (R Coll Radiol). 2005 Oct;17(7):539-42.
The management strategies for stage I seminoma.
Josefsen D, Fossa S.
Department of Oncology, Rikshospitalet-Radiumhospitalet Trust, Oslo, Norway. [email protected]

About 80% of men with seminomatous testicular germ-cell cancer are diagnosed with stage I disease. For many years, the standard treatment for this patient group has been radiation to para-aortic and iliacal lymph nodes at the same side as the orchiectomy. However, iliac radiotherapy is unnecessary in patients without prior inguinal or scrotal surgery. Furthermore, in recent years, other treatment modalities for this patient group have evolved. The use of single-agent carboplatin has shown promising results, similar to the effects obtained by radiotherapy. In addition, surveillance after primary orchiectomy with no additional treatment is found to be a safe follow-up for many of these patients. On the basis of new knowledge about primary tumour risk factors, it is now possible to identify patients at a particular high risk of relapse (rete testis invasion, primary tumour size > 4 cm, or both). This will be a helpful tool to identify patients who can be safely included into a surveillance strategy, and those who could have adjuvant treatment. The final decision about treatment will depend on risk factors, capacity of the healthcare service to carry out frequent follow-up examinations and the patient's own preferences. In this paper, we will discuss advantages and disadvantages of the various treatment options in the management of stage I seminoma.

Bull Cancer. 2005 Mar;92(3):267-71.
[Alternatives to the radiotherapy of stage I testicular seminoma]
[Article in French]
Paule B.
Service d'urologie, Hopital Henri-Mondor, 51, avenue du General-de-Lattre-de-Tassigny, 94100 Creteil.

Adjuvant irradiation is currently the most frequently used standard treatment for the clinical stage I seminoma (CSI) following orchiectomy. There is a potential carcinogenic risk with irradiation that prompted a search for alternative adjuvant treatment approach. The cure in CSI seminoma patients can be achieved with surveillance or chemotherapy. Surveillance takes into account the fact that 80% of patients do not need any adjuvant treatment after orchiectomy and are overtreated by adjuvant irradiation. Recently, one cycle of adjuvant carboplatin has been proven in a prospective randomized trial. Taken together, all three treatment options are acceptable standard strategies for the management of patients with CSI. Finally, the experience with surveillance strategy allowed an in-depth meta analysis of factors predictive for relapse discrimining the patients who are in need of post orchiectomy adjuvant treatment from those who safety can be followed by the surveillance strategy. However, this risk adapted approach is still under prospective evaluation.

[Michael112]

My doctor recomended RT over CT because the CT has an effect on fertility and RT doesnt, although I read RT does temporarily.

The exact pathology said it had no spread to epidymis, or the vas deferens, the tumor hadnt spread to anywhere near by, although the whole testicle had abnormal cells.

I would feel more comfortable with survalience and a naturopathic aproach to preventing cancer.

[Karen]

It's your body and your life...and your choice, so if you are comfortable with surveillance then that is what you should do. The whole testicle having abmormal cell maybe construed to give a larger tumor volume that 2cm. I'd ask the doc about that and if they did microscopic staining of the sections of the cord to make sure it was not involved. If the doc pushes for RT you may want to think about getting a second opinion from an expert.

[wjhall]

I chose RT. Para - aortic only. I feel really confident that this is behind me. RT wasnt a breeze but not that bad. Good Luck.

Jay

[Michael112]

histopathology

Ok well I saw the medical oncologist today, he is recomending RT.

I have the histopathology report here:

2 primary tumours.
1.0x.8x1.6 and .7x.7x.8
Haemorrhage and necrosis present on the larger nodule. No penetration of the capsule.
rete testis is not readily identifiable with only a small residual area adjacent ti the largest tumour.
Theres cholestrol clefts and calcium deposits.

Its a big write up, I just quoted bits and peices but the bottom line is:
Diagnosis:
Seminoma
no other germ cell components identified
no evidance of capsular penetration
no evidence of epididymal involvement
no vascular permeation seen
intratubular germ cell neoplasia present
spermatic cord surgical margin free of tumour


I asked if I could get monthly CT scans and he said I would glow in the dark, so it looks like it would be BEP for me if there was spread.

For the guys who had radiation, what should I expect, I am seeing a radiation oncologist who will explain the side effects to me, but I would like to hear from 1st hand experience, I am concerned about the more longer term effects.

[Scott]

Monthly CT scans would be too much. The TCRC posts recommended surveillance schedules at this link. Adjuvant radiation therapy is a fine choice, but surveillance should be an option, too, and you and your doctor should decide together rather than having the decision made for you.

[Michael112]

Thanks for the link.

I am hearing difrent things about Stage 2 seminoma treatment, I heard a lot that while on surveilance if spread is detected it can be treated with RT, but my medical oncologist said it would need big doses of chemo.
I am confused.

Whats more confusing is whole body CT scans are 0.2-2 rads per exam, why would they be worried about <2 rads every month, <24rads per year, when the other option is 1500-2500rads in 2-3 weeks.

I read that MRIs are safer and acceptable to use for lymphoma monitoring.

[clyde_on]

I am in your boat

I almost have the same situation as you :
I am going surveillance don't get spooked into radiation.
The facts say 85 % of surveillance folk make it with no further treatment.
I believe this study is based of of tumors larger the 4 cm.
If you think, that in this blind study that the other half took radiation that may have not needed it the number (85%) becomes even higher.
In other words if 85% of the folks made it with no further treatment then who knows what would have happened if all chose surveillance I would bet the number would be higher.

See if you can get approved for PET scans this combined with your already in hasd CT scans would be a great indicater of a spread. This will light up any possible small tumors and then you can go with the radiation or Chemo.

You should also know you will be in surveillance regardless so why expose you self to a known cancer casuing treatment.

ALso you hit the nail on the head with "lymphoma monitoring" these suckers grow ohh so slow and are just down right evil.

Take a look at this report:

http://www.webtie.org/SOTS/Meetings/Genitourinary/SUO_12_13_14_2002/transcripts/32/transcript.htm

lastly you are your best advocate!

[rjs]

I was Stage 1 / Seminoma and had the chioce between Surveillance or RT. I chose RT because of the peace of mind it provided to me. Surveillance is an option in our cases, but you must be viligant with all your follow-up appointments and typically this means regular CT scans (not sure of the current schedule). The chances of further cancer from the RT is very low and really not worth worrying over right now. My approach in the end was to do everything I could NOW to make sure all of the cancer was gone and give me the best chance to never have a recurrence. In the end, Seminoma provides you choices and this is a personal decision for everyone.

Side effects from the RT were relatively mild for me. Heavy fatigue and constant nausea, but I never needed additional medication or was stomach sick. The side effects strength can vary from person to person.

Your doctor recommends RT because it is a time proven treatment. I suspect the Radiation Oncologist will be in favor of doing the treatment since that is their specialty. My Medical Oncologist was open to Surveillance and left it up to me. But he made it very clear to me that the follow-ups were non-negotiable and if he even thought I might waver on follow-ups he would recommed RT.

Good luck and hang in there.

-rs