Possible seminoma relapse...4 years later

[georgiascanlon]

Hi all,

I haven't posted for a while as we really felt our journey ended in 2013 after hubby underwent right orchiectomy and on advice from the medical oncologist we decided to proceed with active surveillance.

Last Friday was his 4 year check up, we didn't expect much given how much time has passed and given all his previous check ups had been "all clear" - never say never right?

The CT scan showed a 22mm mass on the aorta area in the lower abdomen (I wasn't with him and he's a bit shaken up so I don't have much more specifics than that). His bloods came back HCG had remained the same as previous 12 month results but AFP had gone up from 0.8 to 1.6. The oncologist said this is very minimal change from a marker point of view but felt we are probably looking at a relapse.

After speaking with hubby's urologist the oncologist together with the urologist decided he should proceed with a PET scan.

As such he is heading in for a PET scan tomorrow at 9am followed by an appointment with the oncologist at 12pm same day.

He told us over the phone that PET isn't what they would generally use to diagnose but can be helpful with reccurance.

Does anyone know much about use of PET and what they would be looking further?

I'm assuming if a metastasis is found we will be looking at 3-4 rounds of radiation?

Is it possible to be nothing?


Hubby's history is as follows...
prior to surgery
AFP 2 kIU/L
beta-HCG: 3 IU/L

tumor measured 60x45x45mm
Summary: Seminoma, classic type.
Microscopic tumour extension: focal involvement of the rete testis.
Tumor is not present in the spermadic cord.
Lymphovascular invasion: present
Macroscopic extent of the tumour: Tumour confined to the testis.
AJCC: pT1

[RWA]

Hello, Seminoma is PET active meaning it will metabolize the sugar that is connected to the radiopharma isotope and thus "light up" on the scan. I would suspect that if your husband's mass were identified earlier in surveilance the clinician may have more confidence making treatment descision with CT only. Where this potential recurrence is arriving late i think PET/CT is being chosen for the added benefit of the PET part of the test. This could help rule out if the Mass is not from some slower growing teratoma element that could have been missed in initial pathology.

[georgiascanlon]

Hello, Seminoma is PET active meaning it will metabolize the sugar that is connected to the radiopharma isotope and thus "light up" on the scan. I would suspect that if your husband's mass were identified earlier in surveilance the clinician may have more confidence making treatment descision with CT only. Where this potential recurrence is arriving late i think PET/CT is being chosen for the added benefit of the PET part of the test. This could help rule out if the Mass is not from some slower growing teratoma element that could have been missed in initial pathology.

Thanks RWA for the insight. Are you able to tell me a bit about teratoma? Or link me to somewhere reputable...the wide world of google scares me

[Davepet]

Here's what the Testicular Cancer Resource Center dictionary ( http://tcrc.acor.org/dictionary.html#GlossT) says about teratoma:

Teratoma - (1) Strictly speaking, teratoma is a benign growth. It is an odd sort of tumor in that it is basically composed of a number of different normal types of tissue, growing in abnormal places. I say strictly speaking it is benign, but it can act like a malignant tumor and spread. It is most commonly discussed in the post-chemo situation where the doctors want to remove masses left behind by the chemo because they may have teratoma in them. They do this because any tumor can grow and cause problems later on, plus teratoma tumors can become cancerous themselves, and those cancers are not as easy to treat as germ cell tumors. Because teratoma is made up of normal cells, chemotherapy does not affect it. (2) In the UK, teratoma is synonymous with nonseminoma. Here is a cross reference between the AFIP/World Health Organization and the UK classifications:

There is a chart if you follow the link.

Dave

[georgiascanlon]

Here's what the Testicular Cancer Resource Center dictionary ( http://tcrc.acor.org/dictionary.html#GlossT) says about teratoma:



There is a chart if you follow the link.

Dave

Thanks for that Dave, we had the PET last week and the 22mm mass "lit up". We've got a biopsy booked in for 10th July and an appointment with Dr Grimison on the same day - he's an amazing oncologist in sydney.

I did seperately email Dr Einhorn with the info and given the landing spot is actually where reccurance would occur he seemed to think it would likely be seminoma. I guess that's for the biopsy to confirm though. Will keep you all posted.

[stufax]

PET scan is not very reliable. That is what I know. My doc told me that it is a "nice addition" to CT scans. There should be a lot of options for you, radiation, 3*bep, RPLND. It ****ty to have a relapse but those treatments will nail it. And it's not even sure yet if it is a relapse for sure.

[georgiascanlon]

PET scan is not very reliable. That is what I know. My doc told me that it is a "nice addition" to CT scans. There should be a lot of options for you, radiation, 3*bep, RPLND. It ****ty to have a relapse but those treatments will nail it. And it's not even sure yet if it is a relapse for sure.

thanks stufax i think everything just feels compounded by the fact that I'm due with our second baby in 2 weeks....will keep updating this post though once we've seen the oncologist next week.