The first 60 days: Seminoma
Seminoma is the slower, more radiosensitive half of testicular cancer. After removal of the testicle most men need no further treatment and are simply monitored; those who relapse or present with spread are cured with a short course of chemotherapy. Below, week by week, is what OnCo's record of Seminoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Stage I.
- RadiologistNamed in the standard of care for: Advanced.
- SurgeonNamed in the standard of care for: Stage I, Stage II, Advanced.
- Medical oncologistNamed in the standard of care for: Stage I, Stage II, Advanced.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Stage I, Stage II.
- Transplant and cell therapy teamNamed in the standard of care for: Stage II, Advanced.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Stage I
Orchidectomy then surveillance; single-dose carboplatin as an alternative; radiotherapy now rarely used because of second cancers.
- 2.Stage II
Radiotherapy for small-volume nodes or chemotherapy (BEP or EP) for larger nodes; de-escalation trials of carboplatin with radiotherapy ongoing.
- 3.Advanced
Three cycles of BEP or four of EP for good risk, four cycles of BEP for intermediate risk; PET-directed management of residual masses.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example hCGand LDH, AFP normal by definition, Tumour size and rete testis invasion, PET after chemotherapy for residual masses over 3 cm), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Stage I seminoma, Stage II seminoma, Advanced seminoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Stage I
- For my situation (stage i), which of the standard options do you recommend and why?Guideline options include: Orchidectomy then surveillance; single-dose carboplatin as an alternative; radiotherapy now rarely used because of second cancers.
- Am I a candidate for Carboplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Stage II
- For my situation (stage ii), which of the standard options do you recommend and why?Guideline options include: Radiotherapy for small-volume nodes or chemotherapy (BEP or EP) for larger nodes; de-escalation trials of carboplatin with radiotherapy ongoing.
- Am I a candidate for Cisplatin, Etoposide, Bleomycin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Advanced
- For my situation (advanced), which of the standard options do you recommend and why?Guideline options include: Three cycles of BEP or four of EP for good risk, four cycles of BEP for intermediate risk; PET-directed management of residual masses.
- Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Carboplatin, PET (positron emission tomography)?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Predicting which stage I patients will relapse”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Late effects of platinum and radiotherapy decades on”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Seminoma: the full pageSeminoma is the slower, more radiosensitive half of testicular cancer. After removal of the testicle most men need no further treatment and are simply monitored; those who relapse or present with spread are cured with a short course of chemotherapy.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.