Rate of RPLND with Teratoma after 3xBEP

[mercyriver]

I was wondering if anyone can point me in a direction of rates/percentages, of there being teratoma left over after 3xBEP when teratoma was present in the the original tumor.

I know I've read that the BEP can actually cause the teratoma to grow, but I haven't come across any statistics about needing the RPLND after chemo when teratoma was present in the orginal tumor.

Just trying to get an idea of the likelyhood of my husband needing the RPLND after his chemo is done.

Just as a refresher, my husbands tumor was 20% teratoma (done by IU), but it didn't specify what type of teratoma.

Thanks

Becki

[Margaret]

I wish I knew the correct % to help answer your question but sadly I have no idea. I did want to comfort you though, because my husband did have to have the RPLND after 4 rounds of chemo. We had also hoped he would not need the surgery but now that he has had it done, everything turned out okay. I wanted to ease your mind a bit. He was back at work 2 1/2 weeks after surgery, did so well and after about 5 days, the majority of the pain had passed. His state of mind was better after the surgery because he felt that his chances after the RPLND were better than not having it done. We went home feeling like we had a cure. I know you hope that your husband will not have to go through that, and I don't blame you one bit. But remember if he does, that (as my husband says) it was a piece of cake compared to the chemo. So the hardest part may be behind him.

Prayer to you and I hope you find the answer to your question.

Margaret

[dadmo]

I don't have any statistics on hand but I can tell you that Sloan is very aggressive in the use of RPLND's. My son had enlarged nodes after chemo they shrunk considerably but still Sloan wanted them out. Their view is that you can't tell if what's left is live cancer, teratoma (which needs to be removed anyway) or scar tissue. To ensure a cure they remove them have pathologhy done and then review the case for further treatment.

[mstlyn]

I have been wondering the same thing. My son is half way through with chemo and the question is on my mind more and more.

Will my son have a better chance at complete cure and low risk of recurrence if he has RPLND surgery?

I read so many different opinions on this board that it confuses me.

I am not eager to see my son have the surgery, but I would much rather know if it is the best way to go and plan for it now, then to play the wait and see game.

I also wonder this ... If all of the lymph nodes (the "package" I keep reading about) are removed, does this not leave him very vulnerable to pretty much anything? No immune system? What if the cancer happened to come back in this situation? I realize that lymph nodes can not halt cancer growth, but they do play a role right? If there are no lymph nodes attempting to halt the cancer, this will cause the cancer to go straight to organs, yes?

Another thing I have noticed on this forum is that some people have a small percentage of yolk sac tumor (my son included- 5%) yet I have never seen this addressed.

What is yolk sac tumor, and what treatment does it respond to? Does yolk sac tumor have part in the decision making process where RPLND is concerned?

[Marge Pugh]

To add to your questions here, I also have some regarding RPLND. My son has elected to do the laproscopic procedure. We see the surgeon on 3/20/07. Chris did not want to do chemo since he falls in the 60-70% cured range with just his I/O and can not mentally handle surveillance alone. Can this procedure take lymph by removing the "package" as described in traditional RPLND? Explain how this can be curative and not just diagnostic. I, too, am interested in knowing when its removed what reprocussions could be had. He is ready to face chemo if lymph is found positive.

Where in Michigan are you, Mstlyn?

[mstlyn]

To add to your questions here, I also have some regarding RPLND. My son has elected to do the laproscopic procedure. We see the surgeon on 3/20/07. Chris did not want to do chemo since he falls in the 60-70% cured range with just his I/O and can not mentally handle surveillance alone. Can this procedure take lymph by removing the "package" as described in traditional RPLND? Explain how this can be curative and not just diagnostic. I, too, am interested in knowing when its removed what reprocussions could be had. He is ready to face chemo if lymph is found positive.

Where in Michigan are you, Mstlyn?

Hi Marge,

I am from Flint, Michigan.

I was told by someone when I first came here that the laporscopic surgery was fairly new and not as good as the more invasive, traditional surgery.

Of course I can't speak on it and I wouldn't begin to know where to find that post, so if anyone recognizes this and is in the know, please pass that information on once again for Marge.

Tammy

PS. I have family that live in Columbus. (I see you are from Bowling Green)

[Chris'Mom]

Hi Becki, just wanted to add my thoughts...we had hoped our son Chris would not need RPLND after four rounds of EP...he also had teratoma in his mix.....after chemo cat scan showed nodes went significantly down but still enlarged...Chris had surgery at Sloan Kettering and as Dadmo and others have stated...he did well, recovered quickly. Yesterday he had a check up there....we go every six months...his scar is barely noticeable...it will be two years since surgery in July, I am bummed that yesterday they said that since he had teratoma in his original tumor, he will need a cat scan every year for the rest of his life...does that sound right to anybody out there reading this...would appreciate your thoughts....but anyway, his bloodwork was great...so if in case your husband does need RPLND, please know it will turn out ok...take care...Mary Ellen

[dadmo]

Jason has the same schedule, once a year for life.

[mstlyn]

yes, probably the same one. your link isnt opening for me either.

is it the Dr Foster and Dr Bihrle RPLND and tc when to operate?.

If you click on my links does it ask for pw?

Robert,

Your links opened for me and went to the sign in page. I just had to register to read the information.

Thank you for passing that information on.

I still did not see anything about the risks involved if the lymph node "package" is surgically removed.

I am wondering if this leaves them without an immune system, or with one that is severely broken down.

[mstlyn]

yes, probably the same one. your link isnt opening for me either.

is it the Dr Foster and Dr Bihrle RPLND and tc when to operate?.

If you click on my links does it ask for pw?

I also forgot to mention that I found that site online once when I was frantically searching for information.

When I saw that I had to register, I moved on to the next site instead.

Good information.

[mercyriver]

Thanks, just what I was looking for

I haven't read through the articals off of medscape yet, but the first one was great. I'll get to the other ones a bit later.

It amazes me that TC can be so treatable and at the same time so unpredictable still.

I absolutly hate the thought of my husband having to go through surgery. But you all are right, he will most likely think it was easier then chemo.

So I guess we will wait and see what happens after the next scan in either late March or early April.

They are still planning on trying to do a PET/CT since he has had normal tumor marker and since the nodes did show up on the PET scan.

Thanks so much for all the links and all the encouragment. I will continue to let you all know how things turn out.

Becki

[mstlyn]

No. I lost a whole bunch of mine, and I am hardly ever sick. You have ALOT of lymph nodes. they take them out as packages, or groups, as that way they can see where it is, and for instance, if they took out 2 in the template, the other 2 might have cancer. that is just an example. maybe another way of putting is that if they take out group A, and there is cancer, then take group B and there is no cancer, it gives them a " idea" of what and where is involved. if they took out 1 node, there might be 2-3 right next to it that had cancer in them. They are following the path. It will have no effect on immune system. The risk is if they DONT take them out in packages, as it can cause spread to other nodes that may not have mets.

But i hope you undertsand what they were saying, and how it is an important too, and curative tool, both before chemo, and after, and the reasons for it.

Ok yes I do understand. Thanks Robert

[Marge Pugh]

Thank you Robert for the link to RPLND. I posted in the other thread some things I still don't understand with regard to the curative vs diagnostic purpose and the significance of similar outcomes of laproscopic vs traditional. It appears that there just has not been enough lap procedures to prove they are just as effective as traditional. I mean, if the idea is to remove the nodes regardless if cancer is present or not then why is it better to do it using the open technique vs lap as long as you have a qualified surgeon who is capable?

[Russell's Mom]

back from Yosemite

Hi Marge,
Not much I can add to all of the info...but wanted to share that Russell ended up with laprosopic, to open. He ended with 3 endoscopy openings and one abdominal incision. four weeks post op, please keep in mind 7 1/2 hours of surgery, and he has been snowboarding twice. He is not back to his old self yet, but we are getting there...I think he will surpass his old self!! Hang on to your courage, it is worth it!! Take care, Russell's mom, Sharon

[Lori]

Becki, we were told by the docs at IU that chemo will not shrink teratoma. My husband had EP and HDC - even with all that chemo we knew he would need the surgeries to get rid of the teratoma. As many have posted on here, my husband did fine with the RPLND.