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Cancer Coaching- Stage 3C seminoma-

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Patients with Stage III seminoma have spread of cancer outside the testes and retroperitoneal lymph nodes and are curable in more than 90% of cases.”

Hi David-  My friend since third grade has a new son-in-law. When they got back from their marriage/honeymoon, he was in pain and was just diagnosed with the following type of testicular cancer:

Stage 3C seminoma. All through lymph nodes. Mass on his liver. 
He lives in Erie and this is where the diagnosis came from. Do you happen to know or have any recommendations for someone to see either at the Cleveland clinic or UH? This is rather time sensitive, and if you don’t have info, that’s fine. Just thought I’d reach out to see. Thanks, Sarah

Hi Sarah- Here are some basics-
  1. Regardless of the cancer center, the patient will undergo a multimodal therapy- a combination of surgery and radiation/chemo-
  2. I would encourage the patient to get a second opinion from either Dr. Klein or Dr. Gilligan- I am not being critical of the Eric institution in any way. It is all about experience with a rare cancer.
  3. Side effects and fertility issues will be important going forward (I am assuming that kids may be in the young couples plans?)
  4. “Stage 3C seminoma . All through lymph nodes. Mass on his liver” is a rare stage of a rare cancer type. The study linked below is long and dense but offers LOTS of good info for the newly diagnosed patient.
The challenge of the patient/caregiver will be:
  1. choose the doctors/hospital with the most experience with this type and stage of cancer-
  2. learn about and think through the various therapies and their pros and cons.
Once the patient/caregiver has chosen the therapy plan, decided which chemotherapy regimens and or radiation to undergo, I would like to research and provide info/studies on any/all evidence-based NON-conventional therapies that can reduce the risk of side effects.

Seminoma: Stage III

Patients with Stage III seminoma have spread of cancer outside the testes and retroperitoneal lymph nodes and are curable in more than 90% of cases.

The following is a general overview of treatment for Stage III seminoma. Cancer treatment may consist of surgery, radiation, chemotherapy, targeted therapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques–called multi-modality care–has become an important approach for increasing a patient’s chance of cure and prolonging survival…

Since patients with Stage III testicular seminoma have widespread cancer, the treatment of choice is systemic chemotherapy. The most frequently utilized chemotherapy combinations include bleomycin, etoposide and Platinol® (cisplatin) (BEP) for 3 courses or etoposide and Platinol (EP) for 4 courses in good-prognosis patients.[1] The cure rate following either of these regimens is approximately 90%
 
New Adjuvant Chemotherapy Regimens: The goal of developing new chemotherapy regimens is to decrease short- and long-term side effects without compromising the chance of cure. Several new chemotherapy drugs show promising activity for the treatment of testicular cancer. The combination of cyclophosphamide and Paraplatin® (carboplatin) chemotherapy appears to be as effective as Platinol, etoposide, and bleomycin combinations without the severity of side effects.[2]
Ohio

Fax: (216) 445-9628

Dr Timothy Gilligan ★
Cleveland Clinic Taussig Cancer Center 
Cleveland, OH
Phone: (216) 444-6833

Most of the studies on advanced germinal cancer include both seminoma and nonseminomatous tumors []. There is no evidence that their chemosensitivity is any different [,]. As there is no bad prognostic subtype for advanced pure seminomas, most of the centers tend to treat them in the same way as the bad prognostic subtypes of nonseminoma. The current standard treatment consists of 3-4 cycles of BEP or EP CHT [,]. The most recent European consensus evaluates the risk of complications []. The retrospective Dutch study of Belt-Dusebout et al. establishes the risk of secondary cancer and cardiovascular complications following the treatment of testicular cancer in general and after CHT in particular []. Cisplatin dose-intensified CHT does not seem to be superior to standard BEP or RT []. Post therapeutic follow-up modalities consist of a four-week post CHT thoraco-abdomino-pelvic CT-scan []. The subsequent management depends on the size of the residual mass. If the latter is less than 3 cm in diameter, a simple surveillance in advised. If it is larger, a PET/CT exam is recommended. If the latter remains positive, a definitive confirmation by biopsy is necessary. If the PET/CT is negative, surveillance may be sufficient [,]. In the presence of active residual tumoral tissue, RT or CHT remains the treatment of choice [,].

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