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Testicular Tumours Part 2 Vinod Jain 16.09.2014. 2 Clinical Staging (Boden and Gibbs – 1971) Stage I (A) – confined to testis with no spread through capsule.

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Presentation on theme: "Testicular Tumours Part 2 Vinod Jain 16.09.2014. 2 Clinical Staging (Boden and Gibbs – 1971) Stage I (A) – confined to testis with no spread through capsule."— Presentation transcript:

1 Testicular Tumours Part 2 Vinod Jain

2 2 Clinical Staging (Boden and Gibbs – 1971) Stage I (A) – confined to testis with no spread through capsule or spermatic cord Stage II (B) – Clinical or radiological evidence of spread beyond testis but with in regional L.N. B 1 -<2cm B cm B 3 - >5cm Stage III (C) - Disseminated above diaphragm / visceral disease

3 Treatment Modalities – Surgery – Radiotherapy – Chemotherapy Stage wise protocol Care of fertility

4 Treatment Modalities – Surgery Radical orchiectomy Organ sparing orchiectomy Hemiscrotectomy RPLND (retroperitoneal lymph node dissection - Boundaries) Modified RPLND with surveillance - modification Testicular implants (Silicon or saline)

5 Treatment Modalities – Radiotherapy Tele-Cobalt RT – 2500 cGy within 3 weeks to paraortic, precaval, bilateral common iliac and external iliac Inguinal – depending on indication

6 Treatment Modalities – Chemotherapy First line – BEP – Bleomycin, Etoposide and cis-Platinum Second line – Ifosfamide + BEP = Salvage CT Third line – High dose CT with autologous Bone Marrow transplantation

7 Stage wise protocol – Seminoma (SGCT) Stage I- Radical orchiectomy cGy RT in para aortic area Stage II/ B1, B2 – Radical orchiectomy + RT – para aortic + paracaval + Bilat common iliac + ipsilateral ext. iliac. If previous opn/orchiopexy – contralateral inguinal LN with testicular shield Stage II/B3 and stage III – CT x 4 cycles (contd.)

8 CT x 4 cycles Residual retroperitoneal LN <3 cm Follow up CT Complete Remission >3 cm Surgical excision / RT Follow up

9 Stage wise protocol – Non Seminoma (NSGCT) Stage I- Radical orchiectomy + RPLND or modified RPLND with surveillance Stage II/B1, B2 – Radical orchiectomy + RPLND (Boundaries) II/B1 – No CT II/B2 – CT x 2 cycles Stage II/B3 and III – CT (BEP) x 4 cycles

10 CT (BEP) x 4 cycles Tumour marker increased Remission Follow up No remission Autologous BM transplant + high dose CT or stem cell support Follow up Tumour marker normalizes Salvage CT (BEP) + ifosfamide Residual mass Always Excision No residual Mass

11 Follow Up schedule 3 monthly x 2 years – then 6 monthly x 5 years – then Yearly Look for Other testis Abdomen / L.N. Haematological Examination Tumour markers Chest X-ray CT scan

12 Organ sparing surgery Younger age with organ confined tumour of <2 cm size Polar tumours occurring in solitary testis or with contra-lateral tumour (Partial orchiectomy is done)

13 Let us revise Classification Incidence Etiology Spread of tumour Clinical Staging Clinical features Differential Diagnosis Investigations Treatment Follow up schedule


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