Post-BEP Follow Up

I had my first post-chemo CT scan in September 2019, about five weeks after completing my third cycle of BEP. I was due to have an appointment with my oncologist a few days later, however on the morning of my appointment, my specialist nurse called to ask if we could reschedule for a week later as they needed to speak to a surgeon before they could give me full feedback from the scan. That didn’t sound good to me and I asked for some brief details over the phone. The main piece of information I took away was that the mass in my abdomen, which the chemo had been targeting, had made barely any reduction is size.

This completely threw me, as my expectation was that the chemo would have reduced and hopefully eliminated the tumour. My understanding was that surgery was something that would be reverted if chemo failed. This got me feeling rather down for a couple of days, thinking that the chemo had been a complete waste of time and effort. After that, I got together some plans to move onto some non-pharmaceutical treatments and I started to feel a lot more confident.

When Pia and I turned up for the rescheduled appointment, my oncologist started showing us the latest scan. We listened patiently, waiting for the bad news to drop. He explained that the spots on my lungs were no longer present (good start!) and pointed out that the main mass in my abdomen now appeared to be less dense which indicated that it was likely to consist of dead cells. At this point Pia and I needed some clarification. Pia said, “So is this good news?”, to which my oncologist replied, “Oh yes!”. We both burst out laughing, having had out pessimistic expectations turned on their head.

What I had not realised, and I would argue had not been explained to me properly, was that a tumour the size of mine would not be expected to reduce in size. Once a tumour of this type is more than about three centimetres across, the chances of it reducing in size are minimal, even if it has responded well to BEP. My tumour had been closer to six centimetres and so didn’t really stand any chance of getting smaller.

In my case, my oncologist was happy that the chemo had been successful and that the tumour was now a residual mass of dead cells. This news was most elating and I was on quite a high for the next couple of days.

What was recommended though, was to have the mass surgically removed. The reason given for this, was that it could possibly contain mature teratomas, which had the potential to lie dormant but then become active and cause trouble somewhere down the line. Although the surgery was recommended, it was neither deemed to be urgent nor necessarily even required. Many people with residual masses such as mine had continued to live normal lives for decades with no bother. That was reassuring.

After a couple of weeks, Pia and I visited Southmead Hospital in Bristol to speak to a surgeon about the recommended procedure. It is known as retroperitoneal lymph node dissection (RPLND). It is not a trivial operation, but major surgery that involves opening the abdomen down the middle and teasing the sticky tumour tissue away from everything that it is touching, including blood vessels and internal organs. It would involve a hospital stay of around five days and a full recovery would be expected to take three months. The surgery is also not without risks including damage to blood vessels, damage to organs, damage to nerves and the possible loss of a kidney.

Whilst some of these risks seemed small, I didn’t feel that they were risks I was willing to take at that stage, particularly if the surgery was not considered urgent. I was also hoping to start getting back to normal life after several months of disruption to my year, and I didn’t want to be taking another three months out unless I really had to. My oncologist was comfortable with this decision.

I started trying to get back to normal, knowing that there was the possibility of needing to have surgery sometime, but not necessarily any time soon.