Seminoma: metastatic spread to bone?

[djmac]

Hi all,

In the months prior to my diagnosis, I was being treated for lower back pain/sciatica. Also, I had a lower back injury where I slipped on a log and landed on my tailbone in July. I keep telling my doctors about this, but they all seem unconcerned (My onco, and 3 urologists).

The quesition is, does seminoma ever spread to bone in the absence of lymph node metastasis? Does it ever spread to the vertebrae? If it did, would a CT scan pick it up? Should I push them for a bone scan?

djm

[TCLEFT]

My Met was in my mediastinum. It surrounded my Trach/Esoph/Aorta. Put a good deal of pressure on my thoracic vertebrae and hurt like Hell. They never told me if it would met to the bone, however, any pain warrants a closer look. Just to get them thinking, ask them what the path is for gonad development in embryonal development. The jury is still out as to whether mine was a reccurrence or seperate occurrence (remnants of my fetal days). Keep bugging them DJ. You know how those Doc's are.

[Krokar]

I understand your feeling djmac, I habe been trough such questions also, BUT in practice I never heard that seminoma would go into bones around lymph system, around lungs or any other organ. Seminoma is not traveling with blood over venes and because of this some other organ must be included before it can spreed.
What can be possible is when there would be some other non-seminoma component and even in this case this would be very, very rare (case I never heard about it).

You can check yourself with CT for your better feeling, but I'm almost sure your back pain has nothing to do with TC.

Regards,
Alex

Hi all,

In the months prior to my diagnosis, I was being treated for lower back pain/sciatica. Also, I had a lower back injury where I slipped on a log and landed on my tailbone in July. I keep telling my doctors about this, but they all seem unconcerned (My onco, and 3 urologists).

The quesition is, does seminoma ever spread to bone in the absence of lymph node metastasis? Does it ever spread to the vertebrae? If it did, would a CT scan pick it up? Should I push them for a bone scan?

djm

[leaffan-Dave]

DJM,
We have uncanny same symtoms with the exact same initial diagnosis with the Urologist saying he "thinks they got it all". I have been experiencing lower back pain also and when I went to my family physician about it he immediatley sent me for a bone scan which I had last Friday. Results should be given to me by Wednesday. When I told my Urologist about it on Thursday he was very concerned and is scheduling me for a CT Scan this week. This is all before even having appointments set up with the oncologist. They never explained why they are so concerned but I am guessing it is becuase of the TC. I am doubting that it is connected but better to be safe than sorry! I will let you know the outcome.
Dave

[tccancercop]

Earlier this summer, I actually had mets to my T5 vertebrae . . . a doughnut shaped tumor formed AROUND (thank god) my spinal cord!!! Oh a week of Cipsplatin, Ifex, Vinblastine VIP and 17 radiation treatments made the tumor disappear. . .then i got to have a tandem stem cell transplant!

I would opt for an MRI. . .at least thast what I had done and it showed the spinal cord, and tumor, very good!

[Sans rt1]

I have lower back ache that I am told is "probably" from scar tissue / ahesions resulting from my RT (a very rare side-effect I am told - lucky me!). When I reported my back problem to my oncologist in October, he was quite concerned and ordered bloodwork and a full pelvic/abdominal CT as well as some other CT views and X-ray that they called a "windows for spine". Those luckily were all clean, so no recurrence, and my oncologist told me that if anything was in or around my spine, the CT would have shown it.

When I started having my backache, it was about 4 months after RT, so I was quite concerned. When I did searches on the symptoms - like backache and seminoma, or spine and pelvis seminoma - I found articles and papers on all kinds of wierd seminoma mets - that totally freaked me out. Based on what I read, seminoma can show up in wierd places, like the spine - not just lower back, and in the pelvic bone, but it is probably fairly rare - I read about some grew there from an adjacent lymph node, but some there was no mention of that.

So, it is good that you have told your doctors about your prior back problems, and I think your CT would have shown it originally if there was anything there. I don't think they would order a bone scan without good reason - especially if other scans would have shown it. But I can see your concern as it might be easy to dismiss any back pain or would your back pain mask anything, etc. Worth discussing with your oncologist - hopefully he can ease your mind by telling you how your followup would catch any met if your back pain masked a symptom.

[djmac]

MRI Results

Here is my follow-up:

After my I/O my back pain symptoms went away... I had a couple of good months, and then they came back. No sciatica, but some numbness on left buttock, and pain in the sacrococcygeal region, usually after sitting for extended periods. I read all kinds of papers about seminoma spreading to bone and/or spine (not good).

Anyway, I went to the ortho, complaining about pain, and he gave me a choice between a bone scan and MRI. I chose bone scan because it seemed faster, less traumatic, and more definitive. I called his office after reading some more and switched to MRI for the following reasons:

1. Bone scan would not reveal anything about what is going on in non-osseous structures

2. A positive bone scan would have to be followed up by MRI and/or CT to determine exactly what is going on.

3. A negative bone scan would have to be followed up by MRI to try to determine the cause of my pain.

4. Although a bone scan would be far less psychologically traumatic to a claustrophobe like me, it does carry a small risk (tiny) of radiation induced malignancies, since it involves injection of a gamma-emittor (technium-99)

5. Bone scan actually takes much longer (3 hours versus ~30 minutes)

So I went through with the MRI. I had to keep my eyes shut for the entire procedure or I would have seriously lost it. While I was getting my results today, I felt nauseous, and my heart was racing...

So I find out that I have several tumors in my lower back (in L3, L4 and S1 vertebrae). Thankfully, they are consistent with small hemangiomas, benign tumors of blood vessels. There were no significant lumbar disc bulges. Moreover, my back pain began to ease considerably after reading my MRI report.

My new GP is from the school of thought that most back pain is psychosomatic. He was treated for his own back pain by Dr. John Sarno, who wrote the book on this topic. He diagnosed me as someone with a great deal of anxiety, and believes that TC has not helped matters (obviously). He said that I'm spending too much time huched over my laptop reading about TC and all of the other things that could be wrong with me, when I should spend time "hunched over a beer, enjoying my life". He also prescribed buspirone (anti-anxiety medication). He told me that I should either take that, or start running again, and get over my fear of exercise, because chances are, there are no physical reasons why I should have back pain. I hate taking drugs, so I'll try the exercise for now.

Talking to him was cathartic, so I'm done with this for now... at least until January 29th (the date of my next scan)

So the questions are:
Has anyone here have any experience with hemangiomas? Any back pain caused by these tumors? Anyone ever require treatments for these?

and

Is it normal to be this anxious? Feeling sick to my stomach before getting results? Not being able to concentrate on the task at hand? etc?

djm

[huckchef]

I too was having the same symptoms and still am today. I had the MRI done as well and nothing was present as far as cancer. I was told I had degenerative disc disease(loss of moisture in the disc) between my L4 and L5. Exercise and Aleve seem to help!
I've wondered why this has just come about(age and many years of sports, I guess). I wondered if radiation could of caused it but have never asked an MD. Were any of you treated with radiation?
Just curious!
Brian

[tlh]

I feel your pain

DJMAC,

Oddly enough, in the months before my diagnoses I was having terrible lower back pain. I used to get this pain once in awhile stemming from some lower back injuries I suffered early in my military career so I didn't worry much about it. Surprisingly, it was while researching chronic lower back pain that I ran across the TC-NET site and did a self-exam. (looking back on it, I had some other symptoms also, but they weren't bothersome enough to worry about) I found the lump on my right testicle and after all of the tests, consults and finally surgery I was diagnosed with Stage 1 pure Seminoma. However, all follow up tests and scans concluded my back pain (which has all but disappeared since Radiation -- very odd) had nothing to do with TC.

I followed surgery with 27Gy Radiation in the traditional "hockey stick" field to include para-aortic and pelvic regions. I have followed up with all of my scheduled x-rays and blood work. I have also been seen by a Proctologist who did a Colonoscopy, my primary care physician who did the digital rectal exam and my urologist. I have developed a pain in my perianal area and sometimes right buttock (same side I was radiated in) since Radiation. All of the tests were negative, and the pain has gotten somewhat less since I found out the results -- funny how that happens. The specialists all seem to think this is very minor nerve damage from the Radiation Therapy. Much like you, I was also told to quit sitting around and start exercising again as I have put on some extra weight since the initial diagnoses.

I didn't mean to make this so long, however, I wanted you to know you are not alone with the pain and definitely not alone with being so anxious about every little ache and pain. And yes, I also get so stressed in the days before a follow-up that I can't concentrate on anything either.

[djmac]

DJMAC,
Surprisingly, it was while researching chronic lower back pain that I ran across the TC-NET site and did a self-exam. (looking back on it, I had some other symptoms also, but they weren't bothersome enough to worry about) I found the lump on my right testicle and after all of the tests, consults and finally surgery I was diagnosed with Stage 1 pure Seminoma.

Sounds like back pain saved your life! For me it was kidney stones... those are what sent me to the uro in the first place...

djm

[tlh]

I would have to agree. I wonder sometimes what would/could have happened if I decided to ignore the pain and just keep taking Advil? I'm sure nothing good would have come of that!!

[Fed]

Hey dude,

Before I take a crack at this, I first want to say that seeing your thought process written up is a testament to your scientific training. Awesome stuff!

Although I cannot address the hemangioma question, I can certainly relate to the anxiety. The waiting for the next doctor's appointment is what drives me nuts. To me, the feeling of revulsion is quite reminiscent of an anxiety attack (I used to get those several years ago). The exercise option does sounds very appealing to me. I really miss being active, but I still have to take it easy while I'm still healing from the I/O (almost 3 weeks out). Let us know how that works out.

Best,

[Scott]

I can certainly relate to the anxiety. The waiting for the next doctor's appointment is what drives me nuts. To me, the feeling of revulsion is quite reminiscent of an anxiety attack (I used to get those several years ago).

I believe that nearly all of us experience this to some degree. For stage I seminoma that will be treated with adjuvant radiation therapy, Fed, I hope your anxiety will be minimized and that what you do have will be channeled for good things.

[dadmo]

I should spend time "hunched over a beer, enjoying my life"

If we don't find ways to enjoy life everything will be for nothing.

[Scott]

Is it normal to be this anxious? Feeling sick to my stomach before getting results? Not being able to concentrate on the task at hand? etc?

Normal? To some degree, absolutely. Healthy? Clearly not so much. I think a key is to find a way to harness that anxiety to channel the energy into action.