Surveillance / general / prosthesis questions

[donnie]

Im 28 and had a seminoma that was 3cm's with no elevated tumour markers. I think i noticed it fairly quickly and didnt hesitate going to the doctor.i had my orchietomy on july 5th and met up with my oncologist a week later. I chose surveillance rather then rediation. My ct scans were clear and the various markers were still not elevated. Im wondering that if i do get some sort of a recurrence are my markers likely to rise, given that they never did in the first place? Is it a good sign they hadnt, or does it mean anything really? Also for anyone that got a prosthetic was yours positioned comfortably from the get go. Mine is very high, so high that when i have an errection it sits along side rather then hanging down. Doc says to pull it reguraly and hopefully as scar tissue heals it will go to a more comfortable position but i reckon he didnt seem too hopeful about that. Any advice or general words of wisdom would be greeatly appreciated. Oh and is 3cm big?

[Fed]

Hey donnie,

Although I cannot help you with your questions about the prosthesis, I can give you some input on the other questions you asked.

If your original tumor did not show markers, it is unlikely that the bloodwork would indicate a recurrence. The fact that there are no markers doesn't tell you anything because there are other germ cell tumors that don't produce markers either. If anything detectable were to increase, it would be the LDH because it is sometimes used as an indicator of tumor burden; however, LDH is the most imprecise of all of the markers because it is also produced by normal cells. In the case of seminoma treated with surveillance, the radiology will be the best indicator of a relapse.

As far as the tumor size is concerned, it really has little bearing on the likelihood of a relapse. The important issue is the extent of invasion. For example, if the tumor is big, but it doesn't invade the rete testis and there's no L/V invasion, then the chances of a recurrence go down.

Hope this helps with your questions. Fire away if anything else is unclear.

[donnie]

Thanks for replying. I was told that the cancer was confined inside the testicle. What is L/V invasion?
Cheers

[Fish]

This refers to microscopic invasion by tumor cells of the blood vessels or lymphatic vessels of the testicle.

When I was doing research after my seminoma diagnosis, I found at least one study that correlated tumor size with risk of recurrence, but only if the tumor was bigger than 4 cm. I don't know if there has been any additional work done on this subject.

[donnie]

thanks for that, i was a bit worried that 3 cm seemed a bit large even though i didnt think it was likely that i had it for long.

[Fed]

When I was doing research after my seminoma diagnosis, I found at least one study that correlated tumor size with risk of recurrence, but only if the tumor was bigger than 4 cm. I don't know if there has been any additional work done on this subject.

Yes, I read this study, as well (and I believe it's referenced in the library and resources part of the Forum). All the docs I talked to during my trials and tribulations were more concerned with invasion into other structures more than size, which makes sense, since invasion of the stroma or vascular structures correlates with spread. Then again, the bigger the tumor, the greater the likelihood of invasion.

[donnie]

My doctor said there were no signs of it spreading so i presume that would mean there were no sigs of invasion. Thanks for all the help

[Sercan]

i have read an article which says if the tumor is bigger than 6 cm surveillance is not recommended. i dont know it is true or not but it says 6

[Fish]

Then again, the bigger the tumor, the greater the likelihood of invasion.

I agree, that's the likely reason for the observed correlation, it would be interesting to see a correlation of tumor size with L/V invasion.