Our Young Patient Oğuz's Hopeful Story - Germ Cell Tumor

In this article, I want to tell you about Oğuz. Through his story, I will share reflections from a patient's perspective and information about the particular cancer we diagnosed, presented as a narrative. My aim is for these hopeful treatment stories to guide patients treated for similar diseases and, above all, give them accurate information.

His family's only son, Oğuz was 24 when diagnosed with cancer. He came to us after 1,5 months of treatment for a persistent cough and breathing difficulties that began with a flu-like infection. Because treatment had not helped and a chest X-ray showed a mass, he had been told to attend an oncology clinic. We initially found the X-ray suspicious and decided on CT, followed by blood tests and biopsy. Biopsy identified a 16 cm tumor between the heart and lung. The precise diagnosis was Mediastinal Germ Cell Tumor as the disease identified.

Mediastinal germ cell tumors are rare tumors generally seen in young men aged 20-40. Rarely, they occur in children. Germ cell tumors are known as testicular cancer in men. Similar tumors occasionally develop in the chest cavity called the mediastinum. They have aggressive biology and grow rapidly. Physicians without sufficient expertise may recommend immediate surgery, but operating before identifying the tumor type can have fatal consequences. In these aggressive tumors, surgery delays necessary chemotherapy. Both cells remaining in the operative area and cancer cells that detached and spread during tumor development can multiply rapidly during surgical recovery, creating a much harder-to-treat situation.

"Because cancer had never occurred in my family, the disease had never crossed our minds. We were shocked when we heard. We did not know how to feel. My family and I agreed to diagnosis and treatment, saying, ‘Do whatever needs to be done.’"

Oğuz's breathing problems, particularly his cough, were found to be due to pneumonia, and antibiotics were started promptly. Meanwhile, without delay, the growing chest mass was biopsied. Besides routine blood tests, alpha-fetoprotein (AFP) and beta HCG, which can rise in germ cell tumors, were requested. Testicular ultrasound and PET-CT investigated whether the disease originated in the testes and how far it had spread.

Testicular ultrasound showed no testicular problem. The tumor truly originated in the mediastinum, the chest cavity. PET-CT also found no spread outside this area.

"My cough and fever improved within days and I felt better. Receiving my pathology result and hearing my doctor speak hopefully made me very happy. But a difficult process lay ahead. Controllable side effects such as treatment-related hair loss, infection risk, a very small risk of reduced fertility, fatigue, nausea and vomiting frightened me somewhat. Despite everything, I had cancer but a substantial chance of recovery. This made me happy. I believed in treatment and held firmly to my friends and doctors. "

Blood tests and biopsy showed that we faced a nonseminomatous germ cell cancer.

Germ cell tumors are treated in two subgroups: seminomas and nonseminomas. Their behavior differs, so treatment differs too. Seminomas are more radiosensitive, while nonseminomatous tumors benefit more from chemotherapy and respond less to radiotherapy.

We completed investigation and diagnosis within 3 days, accelerating the process through direct discussion with pathology. Oğuz's fever subsided and antibiotics controlled the lung infection. Mediastinal nonseminomatous germ cell tumors receive chemotherapy containing cisplatin, etoposide and ifosfamide (or bleomycin). VIP and BEP regimens have high success rates. However, because of the disease's nature, recurrence is likely and life expectancy short particularly in high-risk patients and those without a complete chemotherapy response.

One unpleasant, potentially long-lasting and permanent chemotherapy side effect is damage to testicular function in young men, slightly reducing the chance of future fatherhood. Sperm is therefore stored (frozen) before treatment.

We likewise began treatment after explaining all potential side effects and management comprehensively and storing sperm. The doctor-patient relationship is important for both sides. We started after describing side effects and treatment details as clearly and fully as possible without causing our patient to lose hope.

"My chemotherapy at Antalya Memorial Hospital consisted of 4 intensive cycles. Given every 21 days for 5 consecutive days, with short chemotherapy sessions on days 9. and 16., I completed the first two cycles. Although the first 5 days shook me somewhat, I recovered quickly. After the first cycle, I was sent home. I could think of nothing when I went home. I tried to stay strong with my doctors' and others' support. My family always supported me. My mother did not normally live in Antalya but never left my side after learning about my illness. My employers and colleagues never withheld material or emotional support. I was fortunate to have doctors who knew their work."

After two chemotherapy cycles, chest CT was performed and the alpha-fetoprotein level, previously high at (2800), was retested. Treatment response was assessed by measuring the decrease in the blood tumor marker and mass size.

Let us hear the rest from Oğuz:

"We eagerly awaited the CT results after treatment. Seeing the tumor shrink was the first time I felt things would turn out well. My tumor-specific blood test, alpha-fetoprotein, had also fallen from around 2800 to nearly normal. I was delighted and felt much stronger and more hopeful."

"Although some side effects troubled me, I communicated well with my doctors. Learning about potential side effects and following medication instructions helped me get through the process quite well."

"After 4 cycles, CT showed that the chest tumor had not completely disappeared and alpha-fetoprotein had not fully normalized. My doctor discussed high-dose treatment and stem cell transplantation."

"They would give 2 more cycles of TIP and collect my stem cells after the first cycle. They explained that if viable cells remained in the tumor removed from my chest after these two cycles, stem cell transplantation with high-dose treatment might be performed. Even if the collected cells were not used then, they would offer a chance if the disease recurred later."

Treatment continued in Medstar Hospital's Hemato-Oncology Department. At this Memorial Health Group hospital in Antalya, following the TIP protocol I prepared, Prof. Dr. İhsan Karadoğan, who established and runs our stem cell transplant center, collected and stored stem cells after chemotherapy. We prepared for possible high-dose chemotherapy and transplantation if surgery after the planned two cycles did not show a complete response, meaning all cancer cells dead, in the removed tumor.

During second-stage treatment, we took a more protective approach because of the greater danger of blood counts falling. We were particularly restrictive about nutrition.

"I could eat only what they specified. Everything smelled and tasted bad then. You do not want to eat much. Having to eat only hospital food left me quite hungry. I could eat potatoes because they did not smell, and sometimes toasted sandwiches if allowed. I lost some weight. I completed both cycles and eagerly awaited results and meeting Dr. Mustafa."

After the standard 4 BEP cycles, stem cell collection and 2 TIP salvage cycles, totaling 6 demanding chemotherapy cycles, Oğuz's alpha-fetoprotein, his blood tumor marker, had completely normalized. The tumor had shrunk markedly on CT but remained 4 cm. Surgery was planned by thoracic surgeon Dr. Necdet Öz, highly skilled and experienced in many similar operations.

"My tumor had not shrunk much further, but alpha-fetoprotein had normalized. The light in Dr. Mustafa's eyes told me this was over. His words supported that feeling. He said: Oğuz, we need to remove the remaining tumor surgically. This will show exactly how successful we have been. If no living cells remain in the removed tissue, that means a complete response, and we can follow you without additional treatment."

"He congratulated me on my efforts throughout and said one last effort was needed for surgery. His words encouraged me and gave hope. I had no doubts because, throughout the process, he had explained mediastinal germ cell tumors step by step as though teaching a medical student and taught me how to fight. I was ready for surgery."

Surgery found no living cancer cells in the tumor that had shrunk from 16 cm to 4 cm. The cancer tissue had shrunk and undergone complete necrosis (decay). With no viable cancer cells and a fully normalized blood tumor marker, postoperative chemotherapy or radiotherapy was unnecessary.

"During postoperative recovery, I eagerly awaited pathology. Before discharge, Dr. Mustafa and Dr. Necdet visited with the report and gave me the good news. I had a complete response: the removed tissue consisted entirely of dead cells, with no viable cells remaining. My preoperative alpha-fetoprotein had also completely normalized. I had succeeded. The news greatly accelerated recovery and I was soon discharged. My chest wound healed and I felt very well. "

We successfully completed treatment for Oğuz's very challenging mediastinal germ cell tumor and reached a happy ending. The cure rate in this group is around %50. Our whole team believes Oğuz has achieved this outcome.

Of course, as with every patient and disease, future recurrence remains possible. None of us can eliminate that risk. We offered the best we could, the best treatment science provides, with caring hands, and achieved success. We also ensured Oğuz and his family completed the process without physical or psychological injury.

None of us, including healthy people, can predict life's surprises. It was time for Oğuz to be happy and proud of himself and his family. We proudly sent him back to his life and family.

“I believe I went through a difficult process. My doctors and the entire healthcare team were wonderful. Their high standards were clear throughout, and they cared for me very closely. I felt part of a family."

"I never paid attention to alternative treatments. From diagnosis throughout treatment, I tried to follow every task given to me as well as possible. I did not use alternative medicine products or vitamins hoping they would help cancer without my doctor's knowledge. In the end I recovered, thankfully. Thank you very much."

As he finished, the hope in Oğuz's eyes and smile on his face became fixed in my memory as proof of our success.

Oğuz is now completely healthy. Almost 2.5 years have passed since diagnosis. He keeps every 3-month checkup, continues tests, eats healthily, does not smoke, exercises regularly and does everything possible to protect his health.

Many physicians and support personnel contributed with multidisciplinary teamwork. Endless thanks to everyone, from oncology to hematology, urology to pathology, our oncology pharmacist, experienced nurses, psychologist, nutritionist and staff.

For beautiful tomorrows lived without losing hope…