Chemo and Staging pT2- What kind of treatment could you see?

With that, I'm seeing people post one thing or the other, do people get chemo and radiation? They said I would as I have seminoma and nonseminoma.. I was just curious as to what this could all look like. Thank you! 

Hi

Are they considering radiotherapy for the lymph node? Regarding single cycle of carboplatin; anti nausea meds really work and I never felt nauseous. It seems like most people don't lose their hair. - I didn't.  Whether, and how soon, you can work depends on what kind of work you do. I'm fortunate enough to have a desk job and a very good employer. I took a month off, but in reality could have probably started a phased part time return maybe 10 days earlier. If you do a physical job you might need a bit longer. You feel quite fatigued, but you do have days when you can feel quite normal.

Best wishes

G

Thanks Teahupo, They said the nodule on my lung was pretty normal and nothing to worry about. I'm not sure if it's something with the lymphovascual invasion maybe? I guess I'll know more tomorrow with the oncologist, I will post what they maybe come up with as well. Thanks for your input! 

I had pure seminoma, which seems to be about the least complicated situation.  Single cycle carboplatin is pretty much standard for stage 1.  Radio is a very targeted treatment and from your description I'm not sure what they would be targeting. I don't think that it is a standard treatment for most testicular cancer. Maybe someone else has experience.

Hi JSly07, if you have a mixed tumour with 75% seminoma and 25% embryonal carcinoma (which is a non-seminoma), then this means you don't have a pure seminoma so this rules out Carboplatin as the sole chemotherapy treatment. It will likely be BEP or EP for chemotherapy. Carboplatin can only be used for pure seminomas. Your oncologist may well put you on a course of BEP / EP (the number of cycles will depend on the oncologist's assessment). The radiologist may suggest some type of treatment also for the lymph nodes. Carboplatin is relatively manageable- it is kind of like "chemo lite"- I had 2 cycles for my seminoma last year. I know many people who had BEP treatment which is harsher than Carbo- they had hair loss, nausea, etc- but they are fine now. I think it's important to be realistic and objective despite what seems like very difficult circumstances, so please do come to the forum as I personally found everyone here very willing to share their experiences, and this helped me massively. Good luck for your appointments, best, Kevin

Thank you so much Kevin for this, I really appreciate it and is definitely giving me a more clear understanding! I am prepared for whatever, and really ready to get through the treatment part. I was just confused on what kind of treatment can be treated for two different kinds of cells that I can't recall but one can't have radiation. So I really appreciate this! I hope you are well, take care!  

Hi, 

Last year I had 2 cycles of BEP due to stage 2 non-seminoma with LVI. I have read that some oncologists feel 1 cycle gives the same benefits but is less gruelling for the patient. 

A cycle was over 3 weeks:

Wk1 - Mon to Fri in hospital 

Wk2 - Bleomycin on Monday at day clinic (took a couple of hours from arrival to leave but actual chemo was only about 30mins) 

Wk3 - same as week 2 

Cycle 2 was meant to start straight after but I got sepsis and pneumonia so it was delayed two weeks for recovery. With COVID, I would advise you to be so careful if you are offered BEP. 

I lost my hair towards the end of cycle 1 and managed to get back to work a week after I finished cycle 2 (working from home). 

Best wishes for your appointment.

Hi JSly07,

This is a US-based site but I found it very helpful insofar as giving detailed explanations of the different types of tumours and different treatment options based on type of tumour and staging. I recommend it if you want to really delve into all the granularity on TC.

http://thetcrc.org

I am not a medical professional but I read a lot on TC when I was diagnosed, and I also spoke to many doctors and patients around the world (I am based in Asia), and I found that in the US, for early stage tumours, active surveillance post-orchiectomy appears to be preferred. In Europe and the UK, there recently has been more of a move towards adjuvant chemotherapy (whether carboplatin for seminoma, or BEP for non-seminoma).

However, active surveillance is only an option for those with Stage 1 diagnosis (as it has been found that a higher percentage with Stage 1 are "cured" after the orchiectomy alone).

Whether or not you are put on a chemotherapy regime depends on the staging of your tumour- so the oncologist will be able to explain this with you.

As I said, I am not a medical professional, but you mention your diagnosis as pT2 staging but with lymph node invasion. The lymph node issue is what may bring you into Stage 2.

With Stage 2 non-seminoma, BEP is most likely as a course of treatment for chemotherapy.

If you check the TCRC site, they provide a very detailed breakdown that explains Staging in detail.

Radiation therapy appears to differ slightly in the US and the UK, but the idea is to target cells in the lymph nodes. What is important is that I think that a pure seminoma is sensitive to radiation. As you have a mixed tumour, the radiation oncologist will be able to explain whether radiation treatment and what sort of course of treatment might apply to you.

RPLND is discussed on the TCRC site, but I believe it is less commonly used in the UK/Europe than in the US.

I think a lot depends on the country you are in, and also the specific hospital you go to, regarding treatment.

My advice would be to listen carefully to your doctors but also be prepared to ask as many questions as you feel you need to, in order for you to make as informed a decision as possible. If you are uncertain, there is no harm in seeking a second opinion.

If you search my name in this forum, you will see I have posted a lot about my own experience. I had Stage 1 seminoma and did 2 cycles of carboplatin as adjuvant treatment. I wrote about why I chose to do the carboplatin rather than opt for active surveillance.

However, based on your diagnosis, as I mentioned, carboplatin would not be an option for you as you have a non-seminoma, so I advise you search the forum for posts from those who have undergone BEP / EP and you can also read about those who had radiation (less common on this primarly-UK forum).

all the best, Kevin