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**kellyrulez** · 05-19-07, 10:24 PM

CT-Scan report:

CT CHEST, ABDOMEN, AND PELVIS WITH CONTRAST

HISTORY:
This is a 31 y/o male with testicular cancer.

TECHNIQUE:
7mm axial images are obtained from lung apices to the symhysis pubis during the intravenous administration of 150 cc of Isovue-300 and after oral contrast. There are no prior exams at this facility for comparison.

CHEST:
There is a minimal dependent atelectasis in the posterior lung basis. There is a 5mm right middle lobe density (image # XXX) and a 3 mm desity in the lingula (image # xxx). These findings are nonspecific and my represent focal post inflammatory change. Serial follow-up is suggested, however. The large airways are patent. No infiltrate of effusion are identified.

The heart and great vessels are grossly unremarkable. There are no abnormally enlarged axillary, mediastinal, or hilar nodes. No pericardial effusion demonstrated. There are no gross lytic/blastic osseous lesions.

ABDOMEN:
There are linear hypodensities in the liver probably representing unopacified hepatic veins. The gallbladder, spleen, pancreas, adrenal glands, and right kidney are unremarkable. There are some dependent calcifications in a hypodense, slightly greater than water desnsity, left renal lesion (image # xxx) which could represent milk of calcium in a complex/hemorrhagic cyst. However, other etiologies are not entirely excluded. Consider sonographic correlation. There is no ascites or abnormally enlarged lymph nodes identified. The abdominal aorta is nonaneurysmal. The visualized spine is grossly unremarkable.

PELVIS:
There are small gass bubbles and linear soft tissue stranding in the anterior subcutaneous fat of left lower interior abdominal wall extending inferiorly to the inguinal region of uncertain etiology. Gass bubbles are noted in the subcutaneous fat adjacent to the left anterior iliac spine (image # XXX) which may be due to recent intervention/post treatment change. Please correlate clinically. The bladder is grossly unremarkable. The prostate is nonenlarged. No free fluid is demonstrated in the pelvis. The appendix is not identified with certainty, however, no gross pericecal fluid collection to suggest abscess or inflammatory changes are identified. There are no abnormally enlarged lymph nodes.

IMPRESSION:

1. Tiny focal densities in the lingula and right middle lobe. These are nonspecific and possible post inflammatory. However, follow-up is suggested.

2. Hypodense left renal lesion with dependent calcification with slightly greater than water attenuation possibly a complex/hemorrhagic cyst with milk of calcium or other process. Suggest sonographic correlation.

3. Nonspecific soft tissue stranding density in the subcutaneous fat of the left lower abdomen and inguinal region with scattered gas bubble in the subcutaneous fat. Thsi could be due to prior treatment/intervention. Please correlate clinically. Infectious/inflammatory process is not completely excluded.

**kellyrulez** · 05-19-07, 10:47 PM

I went over both reports including the images with my urologist yesterday. The path report is clearly pretty good. As for the CT can, my doc suggested that the densities in the lungs are possibly too small to clearly identify them at this point. he suggested to check again on the next scan to see possible differences.

With regards to the "cyst" in the aobdomen, he said this could be a diverculum or kidney stone and again suggested to monitor it. The gass bubble in the pevlis are due to the surgery that I had 3 days prior to the cat scan.

Bottom line: he said this is a pretty good result, but he recommended some adjuvant RT to make sure it's finished. we talked for about 1 hour about RT vs. surveillance and he made his case for RT. He referred me to a radiation oncologist (got appointment next Tue.). He also recommended a good medical oncologist and wants me to see him as well.

I will go over the reports with these 2 oncologists and see what they recommend and then make a decision.

your thoughts and input are greatly appreciated. thanks in advance!

**Fed** · 05-19-07, 11:04 PM

Kelly,
This is indeed a good report. I also had seminoma stage I-A, so it sounds like you are pretty much in good shape. Both surveillance and RT are great options for your subsequent treatment, so you don't have any bad choices. You should definitely speak to the medical oncologist to consider your options. My urologist, like yours, had suggested RT at the onset, but my med onc and rad onc (and my second opinion) advised against it because it could be overkill, especially without lymphovascular and rete testis invasion. The orchiectomy alone carries an 80-85% cure rate for cases like ours, so it is basically going to boil down to what approach makes you the most comfortable. Keep yourself informed as you have until now, and whatever you choose, rest assured that you will be cured (if not already). Cheers!

**dadmo** · 05-20-07, 01:12 AM

Kelly,
The path report is quite encouraging and with a 80-85% chance that you'ree cured it would seem that surveillance is a great option. I would save th RT for future use if it is ever required. With close surveillance the situation should never get critical and at this point you have an 80 chance of getting a treatment that you don't need. As Fed said you have no wrong decision here but I wanted to give you my choice.

**Apache** · 05-20-07, 03:23 PM

do surveillance. even I am someone who likes to be proactive but surveillance wasn't too hard. plus, it only lasted 4 months and then I got sent to the cleaners. stay positive.

**Already Bald** · 05-20-07, 08:35 PM

I would seek an additional opinions at a center of excellence, and I would ask, "If I choose RT now, would that mean I would avoid the possibility of chemo in the future?"
Anyway, You will be fine- just stay on top of it.
Just for the record, I think I would lean towards the RT.
Best,

**kellyrulez** · 05-22-07, 05:06 AM

thanks for the replies. regarding getting a second opinion from a center of excellence, how does that usually work? I don't have the money to fly to NYC or IND to see some of the docs listed on the TCRC experts list. Is it also possible to consult these people over the phone (I assume it isn't)? How did you guys do it?

Thanks!

**Already Bald** · 05-22-07, 08:12 AM

Originally posted by kellyrulez

thanks for the replies. regarding getting a second opinion from a center of excellence, how does that usually work? I don't have the money to fly to NYC or IND to see some of the docs listed on the TCRC experts list. Is it also possible to consult these people over the phone (I assume it isn't)? How did you guys do it?

Thanks!

You can probably get Dr. Sheinfeld to come visit you in Hawaii!

I think if you called either IU or Sloan they will tell you how to get a second opinion. The key is to have your pathology reviewed again, and hope for the same result. The way to do that is go to the lab in your center, and sign out the actual slides (cross sections of your tumor on glass microscope slides). They can then be shipped to IU or Sloan.
Also, there may be another center in Hawaii that has experience with TC- I would even ask your current doc his/her opinion.
Best,

**kellyrulez** · 05-30-07, 09:28 PM

Here's an update.

I emailed Dr. Einhorn last week and he said that since my tumor is fairly small I have a 90-95% chance of being cured by the orchiectomy alone. With radiation there is a 97-98% cure rate. He is comfortable in recommending either treatment option (surv./RT).

I had an appointment with a medical oncologist yesterday. He also said that I'm an ideal candidate for surveillance. He said that he is not an opponent of RT, in fact often recommends it, but in my case surveillance is a very good option. Also, Dr. Chong told me that RT can negatively effect the nerves in the abdominal area and worst case lead the the loss of ejaculation (= dry ejaculation). He said that a PET-Scan might help determine if there is some activity in my lymph nodes and in the anomalies in my lungs (is that correct?). [How useful is a PET-Scan in your opinion?] I like he fact that he talked about the anomalies in the lungs without my asking about it, something the rad onc last week didn't pay any attention to.

I also sent recuts of my microscopic slides to Dr. Thomas Ulbright at IU for a second opinion. I hope he'll confirm the first pathology.

Still, I really feel torn now between both options. It's really a personal decision- as everybody here had said. I have a very good insurance company at the moment, I'm basically covered 100%. I finished graduate school not too long ago and right now I'd definitely have the time to "treat" the disease. I don't know what I'll do in 6 months and where I will be. I'm not concerned about the follow-up schedule, I'll stay on top of it, regardless of prior treatment. I'm more worried that it might come back and then I may have to go through more extensive treatment. My med onc said that a recurrence can often be treated with RT, and there's always chemo if RT is not an option.

Your thoughts are always appreciated. Thanks.

**Matt_24** · 05-31-07, 06:39 PM

I also had to choose between surveillance and RT. I'm in "game" mode as well - and want to do all that I can NOW, so I just don't have to deal with it anymore. I was more comfortable with blasting any micro-metastisis now, versus later. My docs all gave me the pros and cons of either choice, but I just decided to do it now. So - after two more treatments, hopefully I'll never have to deal with cancer again. I wish NONE of us ever had to deal with this crap.

Either way you choose, you can't go wrong. It is good you are on top of everything.

**kellyrulez** · 06-03-07, 02:26 AM

Second Pathology Report from Indiana

I got the second opinion on my pathology from Dr. Ulbright at IU yesterday. It reads:

Microscopic Description:

In our opinion, this left testicular tumor represents a pure seminoma. it has many of the usual features, including a nodular proliferation of cells with generally clear cytoplasm, well defined cytoplasmic membranes and nuclei having the "squared off" nuclear edges characteristic of this neoplasm. This is seen in association with fibrous septa containing a prominent lymphocytic infiltrate. No non-seminomatous germ cell tumor elements are identified. Peripheral to the tumor, many of the seminiferous tubles show intratubular germ cell neoplasma of the unclassified type (so-called "carcinoma-in-situ). Additionally, there is fairly widespread atrophy with many tubules being sclerotic or showing a Sertoli-cell-only pattern and some containing occasional microliths. There are, however, foci of residual seminiferous tubules showing intact spermatogenesis. There are some "floating" tumor cells with vascular spaces, but we feel this represents implantation artifact, we are not able to recognize any definite evidence of true lymphovascular space invasion or extra-testicular extensions in these sections. The spermatic cord is not involved.

So, generally, Dr. Ulbright confirmed my first pathology. Does this description offer any new or different information that could be helpful with regards to making a decision b/w RT and surveillance? I still have to talk about the report with my oncologist, though, but any info is always appreciated. I specifically wonder if I should be concerned about the atrophy, intatubular germ cell enoplasma, and the "floating" tumor cells. Unfortunately I have no idea what these findings mean for my prognosis.

As always, thanks a bunch for your input.

**Karen** · 06-03-07, 03:00 PM

Great job of getting confirmation of the patholgy and additional opinions from the experts! You're in the same place you were...personal choice between RT and surveilance.

My treatment opinion agrees with comments from Matt and AlreadyBald. My husband chose being aggressive with the treatment and getting 15 zaps to the paraaortic lymph nodes. Three rough weeks but no lasting effects. I have not seen studies of abdominal nerve damage.

We can throw in our 2 cents but it really is what you are most comfortable with. emotionally, physically and financially.

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