Next?

[dt22207]

Hey guys,
Thanks for your expertise and I hope I can impose again to get your opinions about about chemo vs. wait and watch, which are the two options probably being recommended for me now.

I got the biopsy report and the doctor told me I appear to be Stage 1 pT2, which he said is very good.

The CT scan showed nothing. He said that the oncologist will want to do further blood tests, and his thoughts are based on the assumption that tumor markers go back down.

In medicalese, here's what they told me:

The biopsy found a mixed germ cell tumor with three components:

A. Choriocarcinoma (extensive beta HCG and PLAP Positivity), intratesticular in region of hemorrhage

B. Yolk Sac Tumor (AFP positive), intratesticular in region of hemorrhagic Tumor

C. Classical Seminoma, predominating.

Tumor appears limited to the testis without tunical invovement. Vascular invasion of the predominantly seminomatous elements are seen within the pertesticular tissues but the spermatic cord margin is free of tumor.

In English, the doctor said the seminoma is by far the largest part of the tumor. When the pathologist first reviewed the specimen, they called it a seminoma, but because my elevated tumor markers suggested non-seminoma, he asked them to look more closely and they found the other components.

Of the three, he said the choriocarcinoma, though small, is the most likely potential trouble maker because it's more adept at spreading.

He referred me to an oncologist and said that he will want to do further blood tests to confirm that tumor markers are actually going down. If not, he says the recommendation will be for chemo.

If the tumor markers are down, he says the choices will be watching and waiting or undergoing chemo. His strong recommendation is that I undergo the chemo. If he were me, he says that's what he would do. And he expects that's what the oncologist will recommend.

So, I'm leaning towards undergoing chemo. But would love to hear opinions and advice. Thanks again. Dan

[Scott]

As you said, if markers don't normalize, chemotherapy is a given. Did you discuss RPLND, too?

[dt22207]

Hi Scott,
Yes, we discussed RPLND and radiation, too. The radiation he said was not recommended period because of the type of cancer. The RPLND he said was an option for some people, but in my case not one he would recommend because it would not provide any assurances about the choriocarcinoma.

I'm not sure I recall everything he said about it, but basically he said the RPLND would show whether the cancer was in the lymph nodes, and if they came up clean it might assure me I didn't need chemo for the other two types of cancer they found. But he said the choriocarcinoma does not progress through the lymph nodes, that it can pop up anywhere. So even if the RPLND convinced him the other two had been stopped cold, he would still wind up suggesting chemotherapy for the third one, which he said was the more unpredictable and troublesome of the three as it can turn up in the lungs or brain without visiting the lymph nodes.

Does that make sense?

Dan

[dadmo]

Dan:
That makes perfect sense. A more common form of tc is Embrynol Carcinoma and that also can skip the nodes and go directly to other areas of the body. It's for that reason that even with node involvement they need to be sure the cancer is dead so it's usually chemo first.

[Scott]

Yes, that all sounds right, Dan. (Radiation therapy is only an option for pure seminoma.)

You'll want to read the section of this TCRC page that starts, "Some countries in Europe..." You may also want an opinion from a testicular cancer expert on surveillance (with chemotherapy only when there is confirmed spread) vs. adjuvant chemotherapy in your specific situation.

When will you have new blood test results?

[dt22207]

Thanks. That's an interesting article. Seems like you've only got so many bullets in the gun to stop this thing and you want to be sure to use them when they're the most likely to kill it.

I visit the oncologist in two days and I assume they'll take more blood then.


Thanks again.

[Fed]

It is pretty clear to me from your posts that you are on top of your game. This is huge, and it's going to help you ride this out better. Hats off to you for taking charge!