Home Forums General Surgery SEMINOMA TESTIS – FINAL MBBS REVISION

  • This topic has 0 replies, 1 voice, and was last updated 5 months ago by Anonymous.
Viewing 1 post (of 1 total)
  • Author
    Posts
  • #3920
    Anonymous
    Inactive

    TESTICULAR TUMOR CLASSIFICATION

    GCT TESTIS/ SEMINOMA OVERVIEW
    • Seminoma and non-seminomatous tumors come under germ cell tumors
    • The overall incidence of testicular germ cell tumors is only 1% to 2% of all cancers in men; however, it is the most common malignancy in males between 15-45 years
    • Testicular cancer is ten times more common in northern European ancestry and five times more common in Caucasians compared to races.
    • They are highly responsive to chemotherapy in comparison to the other testicular cancers
    • Seminoma accounts for about one third of all testicular germ tumors and highly treatable with a survival rate of 98% to 99% if diagnosed early
    • Subtypes of seminoma include classic seminoma (95% cases) occurring in men 45 years or older and spermatocytic seminoma occurring in older men and having excellent prognosis

    ETIOLOGY & RISK FACTORS OF SEMINOMA
    • Risk of seminoma increases with age
    • Most recent theory suggests that environmental endocrine disrupters exert estrogenic and/or anti-androgenic effects, resulting in arrested development of the gonadal cells
    • Seminoma probably starts as carcinoma in situ during intrauterine growth phase. A widely accepted hypothesis is Testicular Dysgenesis syndrome (TDS).
    • TDS includes hypospadias, cryptorchism, germ cell tumors, and impaired spermatogenesis due to reports that all these conditions share common risk factors starting as early as the fetal stage.
    • Approximately 10% of all patients with germ cell tumors report history of cryptorchism.
    • Aircraft maintenance personnel, farmers and firefighters exposed to organochloride pesticides seem to have a higher risk of developing testicular cancer.

    SYMPTOMS AND SIGNS OF SEMINOMA
    • The most common presentation is an asymptomatic painless testicular mass, although presence of pain doesn’t exclude diagnosis of seminoma
    • Since testicular cancers occur can reduce spermatogenesis, infertility may be the presenting symptom in some cases
    • Serious, acute pain may occur with rapid tumor growth, associated with hemorrhage or infarction (if the tumor outgrows its blood supply)
    • Physical examination usually reveals unilateral, firm to hard palpable scrotal mass which is localized to the testis.
    • Bulky retroperitoneal lymphadenopathy can produce an abdominal mass. Lung metastases can present as cough, chest pain, and shortness of breath
    • The diagnosis is confirmed by imaging, typically with an ultrasound test initially

    DIFFERENTIAL DIAGNOSIS
    • Non-seminomatous germ cell tumors
    • Testicular dermoid cyst
    • Testicular secondaries from other primary
    • Trauma

    DIAGNOSIS
    IMAGING TESTS
    • The initial evaluation is by testicular ultrasound. Several studies have reported that non-palpable, asymptomatic masses that are 2 cm or lesser in size are more likely to be benign tumors. Benign lesions may include testicular cysts or tiny Leydig cell or Sertoli cell tumors.
    • X-ray chest is advised to rule out lung metastasis
    • A CT scan of the abdomen and pelvis performed to stage the disease and to demonstrate abdominal or retroperitoneal lymphadenopathy
    • PET scanning is generally done as part of the initial workup but is useful to assess response to treatment

    STAGING OF TESTICULAR CANCER
    • Stage 0 – Cancer that is within testis and confined within epithelium (testicular intraepithelial neoplasia)
    • Stage 1 – Tumor confined to testis
    1A – Localized to testis without lymphovascular invasion
    1B Localized to testis with associated lymphovascular invasion
    • Stage 2 – regional spread to retroperitoneal lymph nodes
    • Stage 3 – Distant spread to lungs, brain or lymph nodes of chest and neck

    BLOOD TESTS
    • Several laboratory values are done to assess and follow-up tumor burden. These include beta human chorionic gonadotropin and alpha fetoprotein, and LDH. Alpha-fetoprotein (AFP) elevation indicates at least some non-seminomatous disease and those patients are then treated as non-seminomatous GCT patients.
    • Beta-human chorionic gonadotropin (HCG) is present in 5% to 10% of seminoma cases and tend to be associated with metastatic disease but levels have no prognostic value or impact on overall survival rates
    • Lactate dehydrogenase (LDH) are measured to assess and follow-up tumor bulk post treatment.

    TREATMENT OF SEMINOMA TESTIS
    Treatment of testicular seminoma depends on the stage of the disease but surgery, a radical orchiectomy (removal of testis), is almost always the primary intervention.

    TESTICULAR EPITHELIAL NEOPLASIA
    • Radiation therapy
    • Follow-up
    • Orchiectomy

    STAGE I SEMINOMA
    • Orchiectomy followed by surveillance.
    • Patients who opt for active treatment rather than surveillance, the treatment consists of surgery to remove the testis, followed by chemotherapy

    STAGE II SEMINOMA
    ? When the tumor measures 5 centimeters or lesser in size:
    ? Orchiectomy, followed by radiation to lymph nodes in the abdomen and pelvis.
    ? Combination chemotherapy.
    ? Surgery to remove the testicle and lymph nodes in the abdomen.

    ? When the tumor is larger than 5 centimeters:
    ? Orchiectomy, followed by radiation to lymph nodes in abdomen and pelvis or combination chemotherapy with long-term follow-up.

    STAGE III SEMINOMA
    • Radical orchiectomy followed by combination chemotherapy. If there are tumors remaining after chemotherapy, following modalities can be considered
    • PET surveillance with no treatment unless tumors grow
    • Surveillance if tumor measures less than 3 centimeters and surgical removal of tumors larger than 3 centimeters.
    • A PET scan two months after chemotherapy and surgery to remove tumors that appear on the scan.
    • A clinical trial of chemotherapy

    PROGNOSIS
    The overall survival rate is greater than 95%. If diagnosed early, when the cancer is confined to the testicle, the survival rate is 99%. If the cancer has spread to regional lymph nodes the survival rate is 96% and even in the presence of distant metastases the survival rate is more than 70%.”

Viewing 1 post (of 1 total)
  • You must be logged in to reply to this topic.