Now What?

[tccancercop]

I've recently learned from some of you that Embryonal can be present without elevated AFP. Now i'm wondering if I should have a RPLND for the heck of it??? Why hasn't the doctors emphasized the importance of it if i'm screwed??? My histology is this:
8/05 R/O 95% Embryonal 5%Seminoma w/Giant Cells (AFP 210 PRE -->4.6 post) No vascular invasion present. confined to testicle.

11/05 AFP begins to rise
12/05 begin 4 x EP
3/06 AFP normal at 4.2
4/06 AFP rises to 22, then 52, etc. .
5/06 tumor found around spinal cord
6/06 1 x VIP plus radiation; tumor gone
8/06 - 9/06 HDC w/stem cell transplant Etoposide + Carboplatin (AFP quickly falls to 3.5 almost before start of 2nd transplant)
5/07 - CTs clear and AFP hovering at 3.1 to 3.2.

[djmac]

I've recently learned from some of you that Embryonal can be present without elevated AFP. Now i'm wondering if I should have a RPLND for the heck of it??? Why hasn't the doctors emphasized the importance of it if i'm screwed???

Hi tccancercop,

It appears that in your case, you have AFP expressing embryonal, so you would be marker positive if you recur. The fact that your AFP is normal is a really good sign.

You've been through everything at this point. If you have any masses in your lymph nodes, they will do an RPLND... but these would have to be detectable by CT I would imagine. You've had the chemo, so live embryonal is unlikely. So to answer your question, under these circumstances, I don't think that there is a doctor in their right mind who would do a major surgery like an rplnd "for the heck of it".

Your AFP and CT tells everyone that you are cured!!!

Best,

djm

[Fed]

I second djm's assessment. There really is nothing else to add on my end except for an endorsement of his post.

[AdrianB1971]

.

tccancercop...the case you have mentioned above is mine. 85% EC + 15% Sem and never AFP was elevated [except when I abused with red wine...after chemo (2.2 to 6.5 and then back to 2.3) ]. So, my case is not so good becase very probably the elevated HCG was produced by seminoma component. Is more likely that an possible EC relapse to pressent no markers elevations. In two years of surveillance I had only one abdominal CAT scan !!! Markers where [and are] normal. EC is a very triky subject. It's a smart type of cancer with very 'amazing' skills. Only choriocarcinoma is smarter than EC. After houndreds of hours of medical research on internet and books readed during chemo hours finally I have some image about EC and it's behavior. RPLND seems to be indicated in EC components only for residual masses after chemo. If, after IO, one of markers are elevated the chemo it's the best approach. EC has a 'nice' ability to micropenetrate vascular system and travel some time there and then form new hosts of celular growth[tumors]. The bad thing is that malign EC cells can travel thru vascular system a variable period of time until the local conditions permits the forming of new tumors [low immune system or other agents]. You should not regret RPLND in case of 95% EC. I'm repeating myself : RPLND seems to be viable in EC case only after chemo if residual masses is present.

oopps, I forgot :
If you have AFP elevated before treatment, it is NOT neccesary to be elevated in case of relapse. The celular process is very complex and malign cells also may suffer numberless mutations during relative short period of time. In conclussion : Markers are a useful tools but NOT enough ! You can have a tumor football like, and normal markers! and that even your markers where elevated prior chemo. [beware to multiple CAT and X-Rays. It may accelerate some carcinogenic mutations and even generate some late new cancers!]

[Karen]

oopps, I forgot :
If you have AFP elevated before treatment, it is NOT neccesary to be elevated in case of relapse.

Adrian,
Can you site a scientific reference to back this statement for EC up?

[AdrianB1971]

.

All surveillance protocols have mentioned that. All protocols are like :
1. blood work
+
2. X-Rays,CAT scan [because negative blood work doesn't implies 100% the absence of cancer [despite the prior elevation]]

I've read this 2 years ago and is perfect logicaly. I'll serach for medical material and post the link here