The pathology report indicated an embryonal carcinoma with vascular invasion. This means I will likely need some chemotherapy.

In an earlier post I said the pathology report was a critical component in determining the proper testicular cancer treatment. It helps determine how likely it is that the cancer has spread and identifies the specific mix of cancers that are present. In my case, the pathology report determined it was an embryonal carcinoma with vascular invasion.

While the prognosis remains very good, this was not the news I had been hoping for. Embryonal carcinomas are relatively fast growing and the presence of vascular invasion means that it is likely that the cancer has metastasized. Had there not been any vascular invasion the chance of metastasis is relatively low and I would probably be able to avoid any chemotherapy.

Stage 1 testicular cancer with vascular invasion has a roughly 50% chance of recurring if the patient doesn’t go through chemotherapy. As far as I understand, it becomes a question of whether to undergo a reduced amount of chemotherapy upfront or to take a chance that you will not need a more intensive chemotherapy regimen later on. If my bloodwork normalizes and my AFP tumor markers decline surveillance may still be an option.

This is an area of testicular cancer treatment where there is no clearly correct choice and oncologists are changing what they consider to be the appropriate action. Ultimately, I will have to wait for my oncologists recommendation on February 10th, but I understand that the two primary options are chemotherapy and surveillance. Chemotherapy would consist likely of one or two rounds of BEP chemotherapy. The odds are overwhelming that this would take care of any lingering metastasis. Surveillance would consist of monthly CT scans for a couple years to confirm no metastasis becomes visible. If this option is selected and I AM cancer free I can avoid the side effects of chemotherapy. If the cancer returns I would have to undergo a more intensive chemotherapy treatment down the line.

My prognosis remains very good, but I’ll have to wait to hear my oncologists recommendation to determine the best course of action.