Oncologist Appointment

Wednesday, Kristen and I met with an oncologist at Mount Auburn to go over my treatment options. As I mentioned before, there are basically three options: monitoring, radiation and chemotherapy. This doctor recommended two doses of chemotherapy with three weeks in between treatments starting 1 week after the baby arrives.

There are a number of reasons for his recommendation, both in treatment and timing. First, given the size and staging of the tumor, monitoring is generally not recommended. My tumor was about 4.2 cm and monitoring is only recommended for tumors under 4 cm. Second, he recommended chemotherapy instead of radiation due to risk of developing secondary cancers with radiation therapy. Third, Two doses of chemotherapy were recommended instead of one due to lower toxicity, fewer acute symptoms and the belief that the effectiveness is the same - though, he admitted that no specific studies had been done comparing one does with two doses. Finally, he recommended waiting until one week after the baby arrives to give us time with the baby before I feel tired and nauseous from the treatment.

I agree with the oncologist's recommendations. I think waiting is really not my best option - I would really like to reduce my recurrence risk from 20% to 1% and between radiation and chemotherapy, chemotherapy seems like the less risky long term option. The side affects to this treatment, which is relatively mild as far as chemotherapy goes, is mainly fatigue and nausea; there is a good chance I won't loose any hair or suffer nerve damage or hearing loss which are other common side affects. After both doses, I'll have to do following CT scans every 6 months, for about 3-5 years (I didn't write this down). These will taper off over time, but it might not be something that I ever stop doing.

While I do agree with this doctor's recommendations, we are seeking a second point of view and I've started the process of getting my medical records from Mount Auburn to Mass General. Kristen's primary care physician recommended an oncologist there. However he is no longer taking testicular cancer patients, but they did make an additional recommendation. I think he will make the same, or similar recommendation, and it will ultimately come down to location and personality for where we are treated.

Ideally, the baby would come on time and treatment would start in about two weeks, but we may go over the due date, in which case I would not be starting treatment for about four weeks. This carries some additional risks as earlier treatment is always better and the longer it goes untreated, the more likely it is to resist therapy. Given that seminoas are slow growing and respond very well to treatment, this may be an acceptable risk. We have an appointment with the midwives tomorrow and we'll see if there is any thing we can do to have an on-time or slightly early delivery.