seminoma

Seminom: General

Seminoma is the most common form of testicular cancer. It is one of the so-called Germ cell tumors (germinal tumors) and develops from the spermatogonia, These are precursors of the male germ cells (sperm). Other germ cell tumors of the testis are summarized by the term non-seminoma. They arise from various other tissue types.

Researchers assume that both seminomas and non-seminomas emerge from the same precursor – degenerate cells of the embryonic development in the womb. This precursor of testicular tumors will testicular intraepithelial neoplasia (TIN) called. An exception is the very rare “spermatocytic seminoma“: It does not develop from the TIN, but directly from seed-forming cells, so only during the final sperm formation.

The World Health Organization is still different other subtypes of the seminary. These include, for example, the classic seminoma and seminomas, which also contain cells of other tissue types (such as connective and supporting tissue). The latter are very rare. The type of testicular cancer that can be diagnosed on a case-by-case basis can be determined by a pathologist when examining acquired tumor tissue.

The mean age of seminoma patients is included about 40 years.

Seminoma: symptoms

One palpable, painless hardening in the scrotum is one of the main signs of testicular cancer (such as a seminoma). Usually only one testicle is affected, more rarely both are pathologically altered.

Also a enlarged testicles may be evidence of a testicular tumor. He is often of one heaviness accompanied. In addition, a pull may occur that can radiate into the groin.

A possible sign of testicular cancer (such as seminoma) are also enlarged breaststhat can hurt too. Breast growth is caused by hormones produced by many testicular tumors.

To read more about signs of testicular cancer (such as a seminoma), see Testicular Cancer Symptoms.

Seminoma: causes and diagnosis

Why some men get a seminoma (or other testicular cancer form), you do not know exactly. But you know several now risk factorsthat promote such a malignant tumor:

Accordingly, men are especially at risk, the one earlier testicular cancer behind you. Also a Undescended testicles Increases the risk of a malignant testicular tumor – even if high altitude has been repaired surgically. Genetic factors also seem to play a role in the development of seminomas (or testicular cancer). Thus, in some families the same tumor accumulates. For more on these and other risk factors for testicular cancer, see Testicular Cancer: Causes and Risk Factors.

How can a seminoma be diagnosed?

In one detailed conversation (Anamnesis) the doctor interviews the patient in detail on the symptoms (such as nodes in the testicles). He also asks about possible risk factors such as a previous testicular cancer or undescended testicles. Patients should also report to the doctor about possible testicular cancer in close relatives.

This is followed by a physical examination. Dbei will be the doctor among others the two Test the testicles and chest, Important information also provides a comprehensive blood test, If, for example, the blood level of the protein AFP (alpha-fetoprotein) is elevated, it may indicate testicular cancer – especially a so-called non-seminoma. In a seminoma, on the other hand, the AFP value is inconspicuous.

Imaging procedures like computed tomography help determine the spread of the tumor.

For more information about necessary tests for suspected seminoma or testicular cancer, see Testicular Cancer: Examinations and Diagnosis.

Seminoma: treatment

As with other types of testicular cancer, a seminoma is the surgery The first step: The surgeon removes the diseased testicles, epididymis and spermatic cord. This mandatory intervention becomes Ablatio testis or orchiectomy called.

In a few cases it is possible not to remove the whole testicle, but only the degenerated part. This procedure is advisable especially for patients who only have one testicle. So is the testosterone production, which takes place in the testicles, continue to be guaranteed.

A Partial removal of the testicle may be useful in another case: Testicular cancer usually only affects one testicle alone. However, as a precaution, a tissue sample from the second testis is often taken and examined for cancer cells. Only about five percent of testicular cancer patients will find it – there is then a bilateral testicular cancer. If possible, the surgeon leaves as much healthy testicular tissue as possible, so that the fertility and testosterone production are at least partially still guaranteed. Sometimes it is unavoidable to completely remove both testicles.

Further treatment after surgery depends on how far the tumor has progressed.

Seminoma: treatment in stage I

In stage I, the seminoma is limited to the testes. Investigations (such as computed tomography, CT) revealed no lymph node involvement and no distant cancerous metastases (distant metastases). After surgery, the patient is considered healed in principle. However, it can not be safely ruled out that the tumor has not yet formed even the smallest metastases – so small that they can not be detected by CT and other examinations. Depending on how great this possibility is, the operation is followed by one of three possible follow-up treatments: surveillance strategy (surveillance), radiotherapy or chemotherapy.

1. Monitoring strategy

In Europe and the US, an early-stage seminoma is usually followed by a “wait and see” strategy after surgery: the patient is thoroughly screened at regular intervals to detect any possible return of the cancer at an early stage.

2. Radiotherapy

In some patients with seminoma (stage I) radiotherapy is recommended as a precautionary measure after the testicles have been removed: the posterior abdominal cavity is irradiated. This should eliminate any existing smallest cancerous deposits in the lymph nodes along the abdominal aorta. Irradiation is done five days a week for a period of two weeks.

However, radiotherapy is recommended for stage I seminoma only in special cases. After all, the treatment itself can cause a malignant cancer after years or decades (secondary tumor).

3. Chemotherapy

As an alternative to radiotherapy, after the testicle removal in seminomas (stage I), chemotherapy may also be used as a precaution. The patients receive a well-tolerated drug that can inhibit the proliferation of cancer cells (cytostatic). The chemotherapy is carried out once or twice. The patient does not have to stay in the hospital for this (outpatient chemotherapy).

Seminoma: treatment in stages IIA and IIB

In stage II seminoma adjacent (regional) lymph nodes are affected by the cancer cells (IIB stronger than IIA). The patients then receive one after the testicle removal radiotherapy.

If irradiation is not possible for some reason, choose one instead chemotherapy: In three cycles, the patients are each given the three cytostatics (anticoagulants, cytotoxins) cisplatin, etoposide and bleomycin (PEB) in a vein.

Note: Clinical trials are currently investigating whether stage IIA or IIB may be treated more effectively with combined radiotherapy and chemotherapy.

Seminoma: treatment in the stages IIC and III

If the seminoma is even more advanced (stage IIC and higher), experts recommend after the testicle removal three to four cycles of chemotherapy, Again, the three cytotoxic agents cisplatin, etoposide and bleomycin (PEB) are used.

Seminoma: Disease course and prognosis

The seminoma has a relative even in the advanced stage good prognosis – and is a better than the second main group of testicular cancer (non-seminomas). One reason for this is that the seminoma is less prone to forming metastases than a non-seminoma. Therefore, virtually all patients with stage I seminoma can be treated with standard therapy. In stages IIA and IIB, the cure rate is over 95 percent. In higher seminoma stages (from IIC), 80 to 95 percent of patients can be treated successfully.

In some cases, after treatment has been completed, it will become one Relapse (recurrence), On the one hand, the likelihood of this depends on the stage of the first seminoma at the time of diagnosis: the more advanced the first seminoma was, the sooner it will come back later.

On the other hand, the risk of relapse is also influenced by the type of initial treatment. For example, if stage I seminoma is merely monitored after surgery (surveillance strategy), the risk of relapse is higher than if radiotherapy is followed by surgery.

Overall, it comes at a seminoma (and other forms of testicular cancer) but rarely relapses.