Stage I seminoma surveillance versus treatment

The prognosis for stage I seminoma is excellent, with long-term cure rates approaching 100 30-33 . Stage I is that most commonly assigned to new presentations of seminoma, making up 70 of all incident cases 34 . Seminoma is highly radiosensitive and chemosensitive. Traditionally stage I disease has been most commonly managed with orchidectomy and adjuvant radiotherapy. Of clinical stage I disease, a percentage of patients have occult micrometastases undetectable by imaging. This observation is...

Predicting histology in nonretroperitoneal residual masses

The ability to predict the histology of post-chemotherapy residual masses, both within and outside the retroperitoneum, is important because the prognosis and management differ for tumors composed of viable GCT, teratoma, and necrosis. For masses within the retroperitoneum, logistic regression analysis has attempted to identify parameters that are predictive of necrosis. This identification is critical because additional surgery, although therapeutic for teratoma and viable GCT, is not...

References

Testicular germ-cell cancer. N Engl J Med 1997 337(4) 242-53. 2 Motzer RJ, Geller NL, Tan CC, et al. Salvage chemotherapy for patients with germ cell tumors. The Memorial Sloan-Kettering Cancer Center experience (1979-1989). Cancer 1991 67(5) 1305-10. 3 Germa-Lluch JR, Begent RH, Bagshawe KD. Tumour-marker levels and prognosis in malignant teratoma of the testis. Br J Cancer 1980 42(6) 850-5. 4 Bosl GJ, Geller NL, Cirrincione C, et al. Multivari-ate analysis of prognostic...

Etoposide and cisplatin adjuvant chemotherapy

In patients who have high-volume metastases, the use of well-tolerated adjuvant chemotherapy should be strongly considered. Substitution of etoposide for vinblastine in two randomized studies of standard therapy for good- and poor-risk patients who had disseminated NSGCT showed less toxicity and equivalent or superior efficacy 7,29,30 . Based on the efficacy and tolerability of four cycles of EP in patients who had disseminated GCT, a prospective trial of two cycles of EP was conducted in the...

Morbidity of retroperitoneal lymph node dissection after chemotherapy

RPLND after induction chemotherapy is a challenging operation because of the complexity of the procedure and the severe desmoplastic reaction from prior exposure to chemotherapeutic agents. The morbidity of post-chemotherapy RPLND ranges from 18 to 29 in the standard group 23,79,80 and up to 39 in the complicated RPLND group 81,82 . Perioperative complications may be subdivided into pulmonary, infectious, lymphatic, vascular, neurologic, and gastrointestinal complications. Pulmonary-related...

Risk factors for ITGCN development

There are several conditions that are believed to predispose an individual to the development of TGCTs. For example, in a patient with a testicular tumor, the contralateral testicle has a 25-fold increased relative risk (RR) of developing another tumor. The finding of contralateral testicular microlithiasis on ultrasound in a patient who has had a TGCT has been reported to increase the risk of having ITGCN by approximately 30 times 23 . The clinical importance of testicular microlithiasis...

Importance of early detection

The common sense importance of early detection and diagnosis of testicular cancer has been known for many years. Before the advent of curative therapy, this was one of the few ways (if not the only way) to prevent deaths in the usually young and otherwise healthy men who are affected. In the current era of effective chemotherapy, most (but not all) patients can be salvaged despite delays in diagnosis and, consequently, more advanced disease 2 . This salvage, however, generally requires much...

Relationship between infertility and testicular cancer

Theoretically, any cause that adversely affects testicular function can result in infertility and testicular tumorigenesis. Many studies evaluating testicular cancer have documented an increased risk for abnormal semen analysis parameters in patients who have testicular tumors. Of 15 patients presenting with germ cell tumors, 10 (66 ) had evidence of abnormal spermatogenesis, including poor motility, low sperm concentration, or low semen volume 5 . Conversely, studies have been published...

Prognostic factors

Determination of treatment based on pretreat-ment clinical characteristics was proposed early in the development of effective chemotherapy 3 . In the 1980s, several major groups identified factors * Department of Medical Oncology, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia. E-mail address guy.toner petermac.org predictive of a poor outcome, including tumor marker elevation, extent or bulk of metastatic disease, visceral organ involvement,...

Surgical complications

The gold standard for treatment of all primary tumors is unilateral radical inguinal orchiectomy * Corresponding author. E-mail address sam.chang vanderbilt.edu (S.S. Chang). with high ligation of the spermatic cord 10 . Inguinal orchiectomy provides not only histopatho-logic and staging information but also local control of the neoplasm and, potentially, a complete cure for patients with testis-confined disease. Although morbidity is limited, the most frequent complication from inguinal...

Acknowlegements

The authors thank Carol Pearce for her editing assistance. 1 DeVita VT, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 7th edition. Philadelphia Williams and Wilkins 2005. 2 Cheng E, Cvitkovic E, Wittes RE, et al. Germ cell tumors (II) VAB II in metastatic testicular cancer. Cancer 1978 42 2162-8. 3 Einhorn LH, Donohue J. Cis-diamminedichloropla-tinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 1977 87...

Sarah M Lambert MD Harry Fisch MD

Male Reproductive Center, Department of Urology, Columbia University, College of Physicians and Surgeons, New York Presbyterian Hospital, 944 Park Avenue, New York, NY 10028, USA Testicular cancer is one of the few malignancies that affect men in their reproductive years. Testicular cancer represents the most common solid organ tumor in young men between 20 and 35 years of age. The National Cancer Society predicted that 8250 new cases of testicular cancer would be diagnosed in the United States...

Pathology of teratoma

Neonatal Kidney

Teratoma is a neoplasm of germ-cell origin that is composed of several types of tissue * Corresponding author. Department of Urology, Sidney Kimmel Center for Prostate and Urologie Cancers, 353 East 68th Street, New York, NY 10021. E-mail address sheinfej mskcc.org (J. Sheinfeld). representing different germinal layers (endoderm, mesoderm, ectoderm), forming somatic-type tissue in various stages of maturation and differentiation. Based on findings of genetic studies, it is now recommended to...

Joel Sheinfeld MDab Pramod Sogani Md Facsab

ADepartment of Urology, Sidney Kimmel Center for Prostate and Urologie Cancers, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA bDepartment of Urology, Weill College of Medicine, 525 East 68th Street, New York, NY 10021, USA The management of patients with testicular cancer has evolved significantly over the past 25 years, largely as a result of the ability of cisplatin-based chemotherapy to cure advanced disease 1 . The appropriate integration of systemic...

Complications of chemotherapy

Before the era of effective chemotherapy, disseminated testicular cancer was uniformly fatal 51 . Fortunately, new therapeutics emerged that have changed the face of testicular cancer 52,53 . The current regimen for chemotherapeutic intervention provides exceptional survival, greater than 80 , even in highly advanced stages of tes-ticular neoplasms 54 . The standard of treatment for patients with disseminated germ-cell tumors is currently a regimen of bleomycin, an antibiotic with...

Issues concerning contralateral testicular biopsy

Contralateral testicular biopsy in patients with unilateral testis cancer at the time of orchiectomy for the primary tumor is a highly controversial subject. Biopsy patterns differ among countries as well as between high- and low-volume care centers. Contralateral testis biopsy at the time of orchiectomy for unilateral tumor is routinely performed in most large centers in Denmark, Germany, and Austria 32 . Among German urologists at high-volume centers (> 20 cases year), 95 of patients...

Preservation and restoration of fertility

Currently, men who have testicular cancer have many options available to preserve fertility and potential paternity. The availability of sperm cryopreservation, advances in assisted reproductive techniques (ART), and testicular sperm extraction (TESE) provide the potential for fatherhood for men unable to conceive as a result of testicular cancer treatments. It should be noted that men who have testicular cancer status post chemotherapy have decreased fertilization rates per in vitro...

Retroperitoneal lymph node dissection

In the united States and parts of Europe, the conventional approach to patients who have CS I NSGCT has been bilateral infrahilar RPLND. The main factors in favor of RPLND are that the retroperitoneum is the initial site of metastatic spread in 70 to 80 of patients who have occult metastasis, retroperitoneal lymph nodes often harbor chemotherapy-resistant teratomas, and there is a low rate of relapse following RPLND 12 . The argument for RPLND is thus that the therapeutic focus for CS I...