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Suggest treatment for testicular cancer

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Posted on Thu, 16 Feb 2017
Question: First of all, let me give you a brief, I am a male and I am 29 years of age. I was diagnosed with testicular cancer (seminoma) late 2014 and went through orchidictemy, 3 cycles of BEP chemotherapy as it relapsed on my lymp nodes after 3 months and did lymph node surgery in 2015. When I did my first followup after orchedectemy, I was instructed to do a CT and in the CT report they found that there is a metastases on my lymph nodes. Also in the CT was another note under impressions "ill defined hypodense pancreatic lesion - suggest USG correlation". The size of the lesion was 1.6cm x 1.4cm. However Docter assured that its normal to have such cysts and he said we will focus on the metastases and start chemotherapy as soon as possible.

In the CT scan report after the chemo, the metastases decreased but strangely there was no change in the pancreatic cyst. It still showed 1.6x1.4 cm in the report. Later i was recommened to get my lympnode surgery done. We informed the surgeon about the cyst. He too said that its ok and normal to find about such cysts incident to scans for other reasons. During the surgery, after doing the lymp node surgery, docter had done fine needle aspiratation from the cyst and below is the Macroscopic description "Cohesive papillary clusters and singly dispersed epithelial cells with round to oval nuclei with moderate cytoplasm. Stormal fragments are seen" and the Impression states" pancreatic cyst shows epithelial cell clusters with papillary feautures and mild Atypia". The docter assured us that its nothing to worry and its normal to have small cysts which are shown up incedently while doing scans.

During the various followup after surgery, had 3 CT scans which showed that there was a lesion of the same size in the body of the pancreas and also multiple tiny and small mesentric lymnodes (largest .7x1cm). This was consistent and didnt change for all three CT reports.

My docter asked me to do a PET scan this January and report has an uptake of SUVmax 9 on the pancreatic cyst. The impression in the report states "Hypermetabolic lesion is seen at the distal part of the pancreatic body needs correlation with contrast enhanced CT scan"

What does SUVmax 9 mean? Could this be a cancerous cell considering my history? I am yet to do my CT at the moment. Should i be concerned about the multiple small lymph nodes? Will the docter suggest to remove part of the pancreas?

I just dont want to be taken by a XXXXXXX Iam a level headed guy and i just want to know what iam up for what ever it is.

Thank you!
doctor
Answered by Dr. Esmeralda Sera (2 hours later)
Brief Answer:
Pancreatic lession

Detailed Answer:
Hello and thank you for asking .

SUVmax and CA19-9 are effective in distinguishing between benign and malignant pancreatic tumors.
The combination of the two methods improved the sensitivity and accuracy in the diagnosis of malignant tumors
A high SUVmax value indicates malignancy,but it is not absolutely diagnostic.

Your doctor will give the right decision for this situation.
PET -CT is a very safe examination.I will suggest you Ca 19-9.

Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health.



Above answer was peer-reviewed by : Dr. Remy Koshy
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Follow up: Dr. Esmeralda Sera (41 minutes later)
Thank you for your prompt response.

My oncologist already sent my blood samples for CA 19.9. I thought i will jot down some of my questions to be more clearer.

1. Is SUVmax 9 relatively high?
2. With reference to my history, the lesion was present before i took chemo and after chemo with no chamges in size. So is it likely for this lesion to become malignant?
3. Should this be diagnosed as malignant, would this have to be removed i.e. half of my pancreas?
4. Is this connected to my earlier testicular cancer?
5. What is the significance of the multiple small pulmonary nodes? (However there was no uptake in PET scan)
6. Please explain the fine needle aspiration report of the lesion (its mentioned in my history above). What does it mean in lay mans terms?
7. Will i need to take chemo?
8. Would this be charecterised as pancreatic cancer?
9. What is the normal range for CA 19.9?

I appreciate an open and honest answer from you. My intension is to be prepared and not be taken by any surprises. Thank you very much!
doctor
Answered by Dr. Esmeralda Sera (2 hours later)
Brief Answer:
Pancreatic lession

Detailed Answer:
Hi again
1-Your SUVmax it is relatively high
2-The lesion was not changed because the therapy it is not related with the pancreas
3-The lesion seems not malignant,if it was the surgery is indicated
4-It is not connected with your earlier testicular cancer
5-The multiple small pulmonary nodes are not alweys malignant,the fact that there was not uptake in PET scan is psitive
6-The FNA reprts show one pancreatic cyst
7-if it was cancer therapy would be necessary
8-You must wait ct and other tests,CA 19-9 resaults
9-CA 19-9 antigens are foreign substances released by pancreatic tumor cells. The normal range of CA 19-9 in the blood of a healthy individual is 0-37 U/ml (Units per milliliter). CA 19-9 associated antigen levels are elevated in many patients with pancreatic cancer.

Please take me up date for your general resaults tests
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Esmeralda Sera (15 hours later)
Just got my results for CA 19-9. Its 19.9 which is normal

So what does this indicate considering my uptake in the PET scan. Would it be a concern?
doctor
Answered by Dr. Esmeralda Sera (1 hour later)
Brief Answer:
Pancreatic mass

Detailed Answer:
Ok,it is good news.At this point there is nothing to be concerns.Wishing you good health
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Dr. Esmeralda Sera

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Practicing since :1998

Answered : 1343 Questions

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Suggest treatment for testicular cancer

Brief Answer: Pancreatic lession Detailed Answer: Hello and thank you for asking . SUVmax and CA19-9 are effective in distinguishing between benign and malignant pancreatic tumors. The combination of the two methods improved the sensitivity and accuracy in the diagnosis of malignant tumors A high SUVmax value indicates malignancy,but it is not absolutely diagnostic. Your doctor will give the right decision for this situation. PET -CT is a very safe examination.I will suggest you Ca 19-9. Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health.