Suggest Treatment For Testicular Cancer

Question: First of all, let me give you a brief, I am a male and I am 29 years of age. I was diagnosed with testicular cancer (seminoma) late 2014 and went through orchidictemy, 3 cycles of BEP chemotherapy as it relapsed on my lymp nodes after 3 months and did lymph node surgery in 2015. When I did my first followup after orchedectemy, I was instructed to do a CT and in the CT report they found that there is a metastases on my lymph nodes. Also in the CT was another note under impressions "ill defined hypodense pancreatic lesion - suggest USG correlation". The size of the lesion was 1.6cm x 1.4cm. However Docter assured that its normal to have such cysts and he said we will focus on the metastases and start chemotherapy as soon as possible.

In the CT scan report after the chemo, the metastases decreased but strangely there was no change in the pancreatic cyst. It still showed 1.6x1.4 cm in the report. Later i was recommened to get my lympnode surgery done. We informed the surgeon about the cyst. He too said that its ok and normal to find about such cysts incident to scans for other reasons. During the surgery, after doing the lymp node surgery, docter had done fine needle aspiratation from the cyst and below is the Macroscopic description "Cohesive papillary clusters and singly dispersed epithelial cells with round to oval nuclei with moderate cytoplasm. Stormal fragments are seen" and the Impression states" pancreatic cyst shows epithelial cell clusters with papillary feautures and mild Atypia". The docter assured us that its nothing to worry and its normal to have small cysts which are shown up incedently while doing scans.

During the various followup after surgery, had 3 CT scans which showed that there was a lesion of the same size in the body of the pancreas and also multiple tiny and small mesentric lymnodes (largest .7x1cm). This was consistent and didnt change for all three CT reports.

My docter asked me to do a PET scan this January and report has an uptake of SUVmax 9 on the pancreatic cyst. The impression in the report states "Hypermetabolic lesion is seen at the distal part of the pancreatic body needs correlation with contrast enhanced CT scan"

What does SUVmax 9 mean? Could this be a cancerous cell considering my history? I am yet to do my CT at the moment. Should i be concerned about the multiple small lymph nodes? Will the docter suggest to remove part of the pancreas?

I just dont want to be taken by a XXXXXXX Iam a level headed guy and i just want to know what iam up for what ever it is.

Thank you!

Thank you for your prompt response.

My oncologist already sent my blood samples for CA 19.9. I thought i will jot down some of my questions to be more clearer.

1. Is SUVmax 9 relatively high?
2. With reference to my history, the lesion was present before i took chemo and after chemo with no chamges in size. So is it likely for this lesion to become malignant?
3. Should this be diagnosed as malignant, would this have to be removed i.e. half of my pancreas?
4. Is this connected to my earlier testicular cancer?
5. What is the significance of the multiple small pulmonary nodes? (However there was no uptake in PET scan)
6. Please explain the fine needle aspiration report of the lesion (its mentioned in my history above). What does it mean in lay mans terms?
7. Will i need to take chemo?
8. Would this be charecterised as pancreatic cancer?
9. What is the normal range for CA 19.9?

I appreciate an open and honest answer from you. My intension is to be prepared and not be taken by any surprises. Thank you very much!

Just got my results for CA 19-9. Its 19.9 which is normal

So what does this indicate considering my uptake in the PET scan. Would it be a concern?