I'm new

[italian_tc]

Hi to everyone...I'm a newbie here...this is my first post and i'm not too happy to be here... I'm 27 from Italy..sorry for my English..

I got my istologic today and it say:
non seminoma - embryonal carcinoma
less than 5% seminoma
with vascoular invasion at Ilo level (this make sense in english?)
tunica ok
and a lot of other words that i can't translate....

my markers pre orchiectomy:
afp 28.1 bhcg 70
- after 18 hours
bhcg 40
- after 1 week
afp 12.5 bhcg 5
- after 13 days
afp 5 bhcg 0

ct scan clean (abdomen pelvis and toracic...do I need to scan brain?)

I think i am at stage 1 but high risk...what to expect now? any suggestion?
i'm scared if i have to chose beetween chemio and rpnld...if i'll can i will chose wait and see...
bye! and thanks to all for sharing this experience! I think this is very good!
davide

[Scott]

Welcome to the forums! I believe you'll find that monthly surveillance now, knowing that chemotherapy is your safety net if you need it, will turn out to be a good choice.

[dadmo]

Welcome to the forum. From the numbers in your markers you don't need a brain scan you're still in the very early stages. You may be an excelent candidate for surveillance if the number keep droping. The worst that may happen is that you need some chemo but I would say your in a great position to be cured. Please keep us posted.

[italian_tc]

Hi...thanks for the fast response!...and thank you for the positive think!
i'm a little worried because embryonal seems to be the worst...the best for recurrence, and vascular invasion too...and I have both..
I read a clinical studies for non seminoma stage 1 make on a big number of people(589). This show how is better to make adjuvant chemio with 2 cycles of bep.
175 people stage1 non seminoma with vascular invasion
153 chose adjuvant ct and 22 chose surveillance RPNLD was not an option
from 153 ct only 2 relapses, from 22 surv 12 relapses...

maybe true? I will speak with a good oncologist on monday...I hope he knows what to do!
be shure...I will not stop posting! I'm very lucky finding you!
bye
da

[Michael112]

Hi, a lot of diffrent doctors will tell you diffrent things in terms of risk factor for your situation.
Doctors in australia say I am 30% to have spread, while pubmed studies show im 17% to have spread.


I think you should find a local oncologist who specialises in TC.

[dadmo]

italian tc:
Just open this link for the names of some tc experts in Italy.

[Scott]

Let's assume all those numbers are correct. I also assume the 12 on surveillance who relapsed had chemotherapy and were cured.

Look at it this way: 10 out of the 22 men on surveillance avoided any chemotherapy. Assuming those who had adjuvant chemotherapy would have relapsed at roughly the same ratio, then 83 out of 153 men had chemotherapy that they didn't need.

On another side of this question, we also read references here to a study that found 1xBEP was as effective as 2xBEP as adjuvant treatment for stage I non-seminoma.

[dt22207]

Best of luck with your decision. I'm in a similar position with stage 1 nonseminoma w/vascular invasion, tumor markers returning to normal and a clean CT scan.

I decided to take the 2 cycles adjuvant BEP and start on Monday.

It was one of the hardest decisions I've ever had to make because even after talking with doctors, getting great input here and reading everything I could, there was no clear right or wrong.

Take good care of yourself.
Dan

[italian_tc]

hi guys...tks to all for the support...this is really important for me!
sorry but sometimes is difficult to see the half good if you read the half bad...(i hope make sense... )

tks for the contact, i've an appointment with the best tc oncologist in Italy. Dr.Pizzoccaro (segnaled on tcrc) is retired and i will be treated by his student Dr.Salvioni in istituto Nazionali dei tumori, Milan Italy.(i have segnaled this to tcrc) so, i think everything will be ok.

The final questions are...is less bad to make 2 bep or rpld? for the future? for the pain? to be cured? i'm in time to do ajuvant chemio (1 month before i/o)?

tks again to all...and good luck dt22207 for your treatment!

[Scott]

Since you have such a high percentage of embryonal carcinoma and vascular invasion, RPLND is probably not the right first line treatment. Embryonal carcinoma can spread through the blood to the lungs without spreading to the retroperitoneal lymph nodes first, so if you do have spread, you're likely to need chemotherapy.

[italian_tc]

tks...i've missed this info about embryonal carcinoma. Do you know where can i find details about tc istology spread and treatment?

[dt22207]

I found it useful to read these NCCN guidelines, which someone posted here.

http://www.nccn.org/professionals/ph...testicular.pdf

What Scott said is what my doctor told me. A RPLND that showed no cancer would not necessarily mean I was free of cancer because the cancer I have can bypass the lymph nodes. I'm sure your doctor will tell you if the same is true in your case.

In my case the choice was this: There is about a 65 to 70 percent chance that I am cured right now by the surgery.

If I do the two cycles of BEP, there is about a 98% chance that I will be cured.

If I choose surveillance, and have a relapse, I will probably be given three cycles of BEP and will once again have a 98% chance of being cured.

So the choice was take less chemo now and risk the chance that I really don't need any chemo. Or, choose surveillance and then face more chemo if I find the cancer comes back.

I don't know if you will face the same choice, but it's something to maybe start thinking about.

The positive in this is that in either case, the cure rate is wonderful. So in that sense you can't go wrong.

Take care.

[Scott]

Also see questions 5 and 35 from this TCRC interview with Dr. Craig Nichols.

[dadmo]

I agree with Scott. Your treatment will probably start with chemo and then if needed it will be an RPLND, and when that's done you're cured. Cured, sounds nice doesn't it.

[italian_tc]

yeah! sounds very good! now i understand something!!!
and i find this (it seems to be a very useful doc) http://www.uroweb.nl/files/uploaded_...ularCancer.pdf
..and wow...one of the oncologist who wrote is the boss of my oncologist...if i understand they will give me 2 bep...we will see!
tks again
davide