testicular cancer

general info

between 20-40 years,

survival excellent 91% or

more common on the right side,

can be bilateral,

mostly seminoma

CRYPTORCHIDIA

an undescended testicle,

An orchiopexy (also spelled orchidopexy) is the surgical procedure used to move an undescended testicle down into the scrotum and permanently secure it in place.

risk factor for testicular cancer

1. CRYPTORCHIDIA

2. orchiopexy

3. age between the ages of 20 and 45,

4. family history

5. Hypospadias: where the opening of the urethra is on the underside of the penis rather than the exact tip.

classification

1. germinal tumours 95 %

2. nongerminal: Leydig cell, Sertoli cell

3. seminoma

4. non seminoma:

carcinoma in situ

embrional carcinoma

teratocarcinoma

choriocarcinoma

yolk sac tumor

TNM

T1 limited to testes

T2 invaded beyond tunica albuginea

T3 spermatic cord

T4 scrotum

No no lymph node met

N1 smaller than 2 cm

N2 between 2-5 cm

N3 bigger than 5 cm

Mx cannot be assessed

Mo no distant met

M1 distant met

M1a non regional lymph node or lung

STAGES

Stage I confined to testis

• Stage II/a retroperitoneal nodes less than 5 cm

• Stage II/b bigger than 5 cm

• Stage III supradiaphragmal lymph node

• StageIV distant met

IMPACT OF FERTILITY

frequent infertility : tumor can secret hormones (like hCG), cause localized inflammation, and disrupt blood flow, impairing healthy tissue function in both testicles.

the treatment can cause infertility also

radiation, chemotherapy, Retroperitoneal Lymph Node Dissection(The vital nerves that control emission and ejaculation run directly through this area)

recommended cryopreservation before chemotherapy

Local Diagnosis

physical examination :

Testicular Mass : solid painless

Infection: sudden, severe swelling and redness, sharp pain, fever, and burning during urination.

Trauma: hematoma (blood collection) or testicular rupture, which can mimic a solid tumor on a basic touch exam.

Hernia: An inguinal hernia : it will be pushed back

imaging :

Sonography (High-Frequency Scrotal Ultrasound) : the lump is fluid-filled (a benign cyst or hydrocele) or a solid, vascularized tissue mass, which strongly points to malignancy.

Magnetic Resonance Imaging (MRI).

labs :

• AFP (Alpha-Fetoprotein): Elevated primarily in non-seminoma germ cell tumors. It is never elevated in pure seminomas.

• beta-HCG (Human Chorionic Gonadotropin)

• LDH - Lactate Dehydrogenase

searching for metastasis

AFP

\(\beta \)-hCG

LDH

abdominal and pelvic CT and MRI

chest X ray and CT

treatment of seminoma

1. orchietecwomy

2. Active Surveillance: no active treatment is given immediately after surgery

in case of relapse : standard chemotherapy or radiation

3. Adjuvant Chemotherapy (Platinum-Based): For patients who cannot or do not want to follow a strict, multi-year surveillance schedule, a brief course of preventative chemotherapy is offered to kill any hidden, microscopic cells.

metastatic seminoma

1. Low-Volume Metastatic Seminoma: cancer has spread exclusively to the retroperitoneal lymph nodes in the back of the abdomen ( stage 2 ):

Radiation Therapy (Radiotherapy) : very sensitive

Chemotherapy

2. High-Volume Metastatic Seminoma: metastasis traveling beyond the abdominal lymph nodes to distant organs like the lungs, or bone:

Systemic induction chemotherapy is mandatory. radiation is not gonna work.

non seminoma treatment

they are aggressive radiation is not enough

1. Active Surveillance (Relapse Rate: ~30%) after orchiectomy

2. For patients who are high-risk (LVI positive) or who choose not to undergo intense:

Adjuvant Chemotherapy or Primary Nerve-Sparing RPLND

3. Post-Chemotherapy Residual Tumor Management: Chemotherapy is highly effective at killing active embryonal or yolk sac cancer cells, but it cannot kill teratoma cells. Teratomas are chemo-resistant! : surgical Post-Chemotherapy RPLND is mandatory.

TREATMENT OF METASTATIC TUMORS

1. Primary Chemotherapy : 4 CYCLES

2. Once the 4 cycles of chemotherapy are complete ( after two months ) : PET-CT scan ( only for Seminoma )

3. Residual Mass Surgery: no in seminoma

4. Salvage Surgery vs. Salvage Chemotherapy: When a patient experiences a true cancer recurrence or treatment failure:

Salvage Chemotherapy: If a patient finishes 4 cycles of BEP and their serum tumor markers begin to rise again, it indicates systemic, viable cancer relapse. The patient requires immediate second-line salvage chemotherapyregimens like TIP (Paclitaxel, Ifosfamide, Cisplatin) or high-dose chemotherapy with stem-cell rescue.