How would you manage a patient with stage 1 seminoma on surveillance without prior radiation or chemotherapy who develops para-aortic lymphadenopathy without increase in tumor markers?

Would you radiate? Surgery? Chemo? Follow with short interval scans?

How would size of adenopathy (e.g. <2cm vs larger) and time of recurrence (within first 3 or 6 months vs later) inform your decision?

Answer from: Medical Oncologist at Academic Institution

If there is a new lymph node that was not present on prior surveillance scans and is in the typical location (interaortocaval for right sided primary and left para aortic for left sided primary), this is a pathological node and not a reactive node. If it is larger than 3 cm, we prefer BEP X 3 with e...

Comments

Medical Oncologist at Berkshire Hem Onc PC
Would percutaneous needle biopsy be a reasonable n...

Medical Oncologist at Indiana Univ Simon Cancer Center
Not necessary, if this is clearly an enlarging nod...

Medical Oncologist at Veterans Administration Health Care Center
Of course, the good Dr. @Lawrence H. Einhorn is a ...

Medical Oncologist at UPMC Hillman Cancer Center
What about common iliac LN? (both for consideratio...

Radiation Oncologist at University of Buenos Aires, Instituto de Oncologia AH Roffo and CEMIC
I would agree with my colleagues about the feasibi...

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How would you manage a patient with stage 1 seminoma on surveillance without prior radiation or chemotherapy who develops para-aortic lymphadenopathy without increase in tumor markers?

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