Postchemotherapy questions about germ cell tumor

I was diagnosed with a mediastinal yolk sac carcinoma (germ cell tumor) back in October of 07. I have been through chemotherapy with good results. Before therapy, my Alpha feta protein level was over 12,000, the tumor was approx. 8 centimeters, and I had a Pet Suv uptake of 22. I just had my first postchemo pet scan and blood work done in the last week or so (a month after my last chemo treatment). Now the tumor is approx. 5x4 centimeters, AFP level is 16, and the Suv of the Pet was 2.3. My doctor thinks that all of the viable cancer is gone and that the AFP level will normalize. So he plans to wait a month and check the AFP levels again. If they are normal (below 8) he is going to send me to the surgeon to have the mass removed. If they don't normalize or come down, he plans on doing two more rounds of chemotherapy. I have a few questions for anyone out there with a similar experience to mine or otherwise qualified to answer.

When the AFP is this close to normal, would it be "acceptable in the medical community" for the doctor to go ahead and order the removal of the tumor, rather than waiting a month to see "what" the AFP does?

Would it be wiser to check the AFP weekly rather than waiting a month?

Is it uncommon to still have an elevated (elevated by 8) AFP marker postchemotherapy when there is no viable cancer? Or, does it take time for the AFP to normalize after chemotherapy? -I have been off chemo for one month.

[Fernando Roque, MD]

Hi.  I need some additional information before I can adequately answer your question:

1.  Is that germ cell tumor ovarian or testicular? It's not clear to me whether you're male or female.
2.  What drugs were given?

Offhand, I don't see any reason why your doctors have to wait for the AFP to normalize before operating, unless you've just finished your chemotherapy regimen, and the doctors are waiting for the effects of the chemotherapy to subside before going in (it takes 3-4 weeks).  Chemotherapy may cause delay in wound healing, and they probably want to avoid this side effect, hence the delay in surgery. But if you've been off chemotherapy for one month, I think they can already proceed with the surgery. Taking that tumor out will actually decrease the AFP levels further.

There is no need to check the AFP levels weekly.  The levels take time to come down after chemotherapy, and little difference may be seen between the results of weekly determinations.

[jgsmith]

First off, thanks for the response. I am a male. The tumor is not of testicular origin, it originated in the mediastinal area (I am told this is rare) I guess the techinal term of my cancer is nonseminoma mediastinal yolk sac carcinoma. I was given 4 rounds of bleomycin, eptopiside, and cistiplatin.

[Fernando Roque, MD]

Hi.  Thanks for clarifying your diagnosis - that you have a primary mediastinal germ cell tumor. Taking into account the additional information you have given, I would say that your doctor is doing the right thing by choosing to recheck the AFP levels after a month instead of proceeding with an immediate surgery.  He probably just wants to optimize your chemotherapy treatment - two courses of chemotherapy can still be given if the AFP is still elevated (meaning there's still residual viable tumor).  The surgery is usually done when the AFP has gone down to normal.