the low down diagnosis

Here's what we found out on Wednesday Jan 12, 2005 (from Frank's email to Schmink)

the nitty gritty:

--
The pathology report says the tumor was mixed germ cell, 95% embryonal,
less than 5% mature teratoma, focal seminona.
It was classed pT2 (tumor extends through tunica albuginea with vascular/lymphatic invasion).

CT scan shows: "There is a large inhomogeneous mass seen in the left periaortic area that
measures 6 cm x 5 cm in size.  This displaces the left renal vein anteriorly and extends over
routine 7 mm images anterior to the left psoas into the region of the left common iliac artery."
(the orchicetomy was on the left side)  N.B - the onc thinks the size is underestimated by
at least 2 cm (in the head-to-toe measurement).

Bloodwork on 12/27 (10 days before the orchiectomy):
LDH 258, AFP 9897, B-HCG 372

Bloodwork on 1/10 (5 days after the orchiectomy):
LDH 216, AFP 9464, B-HCG 451

So it's non-seminoma that has metastatized into the retroperitoneal lymph system,
with a big frickin mass sitting on my aorta.
The urologist suggests chemo first and maybe surgery later after the mass has shrunk.
The oncologist/hematologist suggests the same, except he will probably insist on
surgery after chemo.

The urologist isn't big into staging; the oncologist said pT2, N3, S2; or stage IIC.

Here's the plan: I go get a port-a-cath next week, then start chemo on the 24th.
3 rounds of BEP (maybe a fourth if the tumor markers don't fall like they should) with Neupogen
between rounds; 12 weeks total (more if 4 rounds).
Intermediate CT scans, with the likelihood of surgery after the chemo is done.