Chemotherapy Guidance - Seminoma, Stage 1

[MAMC]

Hello everyone,

This is my first post here. Thank you for having built such a supportive and helpful community. I am making this post to receive some feedback from individuals that have been through similar diagnoses and to hear about their experiences. To give some context, I am a healthy 21-year-old Male (6ft, 150lb) and I just graduated university in Tampa, FL in December. I am now back home in Puerto Rico and was getting ready to move to London, England on January 23 in order to live with my partner. Testicular cancer arose, so I've had to postpone my travel date until further notice. According to my urologist, I'll be fine to go towards the beginning of March.

Timeline:
Nov 10 - Lump on testicle. Seeing that it is painless I decide to ignore it and get it checked out once I graduate and am back home in Puerto Rico.
Dec 23 - Ultrasound reveals a mass on testicle.
Dec 24/25 - VERY nervous Christmas...
Dec 30 - Urologist appointment. Schedules my Orchiectomy for January 12, 2016
Dec 30 - January 12 - I do tumor marker exams and CT scan. AFP is 0.85, HCG is <1.20. CT Scan comes up clear. I also do sperm banking.
January 12, 2015 - Ambulatory procedure completed successfully. No complications.

I am currently recovering very well and just took my last antibiotic. I met with my urologist today and my pathology came back as:

Seminoma, classic type.
2cm tumor
Neoplasm focally invades the tunica albuginea
Adjacent testicular parenchyma discloses intrabular germ cell neoplasia
Tumoral lymphovascular invasion is identified
All surgical margins are free of neoplastic involvement

He classified me as a Stage 1.

My options are either surveillance or a dose of Chemo. The urologist said that radiotherapy is ruled out as I have a horseshoe kidney. Considering the point of my life at which I am at, and that I will be relocating to England, I have opted to go with the Chemo (which is also what the urologist recommended). I am meeting an oncologist next Tuesday to see what medication/dosage he recommends based on my current results. I know that surveillance would also be a good choice, but I want to be proactive about this and take the necessary steps to be cleared as soon as possible and "close" this chapter. I also do not want to put my body under unnecessary I have repeatedly read on here that every decision is the right decision, and that has really brought me confidence throughout this process. I'm in excellent spirits, and confident that it will all be fine. Any feedback is welcome! Please also feel free to ask me questions.

P.S. - My urologist told me that after removing the testicle they inserted some type of string (he referenced the material fishing threads are made of) to hold things together (can't remember his exact explanation). Just wanted to make sure I wasn't the only one with this string!

All the best,
MAMC

[JeskiM69]

I imagine that you will be getting 1 or 2 cycles of Carboplatin. If you are happy with your decision then you have obviously made the right decision for you. You will be fine. I hear that Carbo isn't too bad and you'll recover fast.

As for those "strings". We all (should) have them. They are permanent stitches where they ligated (cut) the spermatic cord. It's there for two reasons:

1: Is the obvious reason you have any internal stitching
2: As a guide in the event that you ever have an RPLND. If you have the RPLND then they will remove the rest of the cord etc from above that point.

Hope that helps.

BTW, welcome to the family no one wants to join ! But; this is the best family you could hope to join....there's a lot of great guys and gals on here.

- Matt

[MarkOne]

I agree with all Matt has said. There is no wrong decision, it's all about what feels right to you.

I had two cycles of Carboplatin for Stage 1 seminoma. I didn't find it too bad. My experience is detailed here on a couple of other posts, but in summary I had 3 to 4 days of feeling like I had a real good hangover after each cycle and felt wiped out and exhausted, gradually improving over a month or so.

At the time, I wanted this cancer beat and didn't think I would stick the surveillance well but now if I had to make the same choice again then I think I would choose surveillance as there was an 85% chance I didn't need the chemo and the follow up isn't proving that difficult. Nothing wrong with the choice I made though. More than happy with the outcome.

Good luck with whatever choice you make.

[MAMC]

Jeski and Mark, thank you so much for your advice - I really appreciate it.

Jeski, thanks for clearing that up for me! It's good to know that it is meant to be there and why it is there.

Mark, after the chemo, what was your follow-up like? Do you still get a CT Scan done every year? Also, how come you would chose surveillance if you'd have to make the decision again?

Thanks again for being so kind, both of you.

[MarkOne]

Yes, my follow up schedule to date has been 3 monthly bloods and physical check over with annual CT scan and a chest X-ray at 6 months I think. I am almost at 2 years out now and if my upcoming CT is clear then I think my checks will drop to 4 monthly.

Why would I probably go surveillance if it happened again? Just because my head has had time to clear from that initial panic at hearing I had cancer, I and my family now know a lot more about seminoma and also the impact or not of the surveillance schedule on our lives. I now know I can keep to the schedule without a problem and that even if I did relapse I am confident that 3 X BEP would sort it out so I am a little more swayed by the "why put yourself through chemo that you have an 80% chance is unnecessary" argument. It's a personal choice though and to make it you need to know your oncologists assessment of YOUR chances of relapse based on your pathology and risk factors so you can way up the odds in your mind. Remember, there is no wrong choice whatever way you go, just go with what feels most comfortable to you.

[MAMC]

Mark, again, thanks for sharing your experience with me! I am aware of the possibility that I am cured, but would still like to do the chemo to increase my chances of certainty.

[Moglog]

I was stage I and went on surveillance, and it turns out I ended up needing chemo anyways. Looking back on it, it's easy for me to say "oh, I wish I just went for the carboplatin!" but really you just gotta do what's right for you. Like my oncologist said, it's a solvable problem, it just depends if you have to solve it the easy or hard way. The hard way sucks for sure, but it's good to know the solution is there.

[MAMC]

Moglog, as they say - hindsight is 20/20! I know it won't be a walk in the park, but I know 1x Chemo (probably Carboplatin) won't be hell either. I'll be fine! Thanks for your input!