Presentation on theme: "Testicular cancer: current views Dr. M. Mangala MD (Kin); FRCS (Ireland); MMed (Wits); FCS (SA) Urology 38 th BMA CONGRESS."— Presentation transcript:
Testicular cancer: current views Dr. M. Mangala MD (Kin); FRCS (Ireland); MMed (Wits); FCS (SA) Urology 38 th BMA CONGRESS
Background 1% and 1.5% male neoplasms 5% all urological tumors Prevalence 2-3/100000 In the 15-34 y.o 62/100000 5% cases bilateral Duplication of the short arm of X12 Isochromosome 12p or I(12p)
Diagnosis Scrotal US Sensitivity 100% MRI Sensitivity 100% and Specificity 95-100% High cost: not justified
Diagnosis Serum tumour markers AFP produced by yolk sac: T1/2 5-7 days hCG expression of trophoblasts: T1/2 2-3 days B subunit specific LDH marker of tissue destruction (bulk) Inguinal exploration and orchidectomy Radical orchidectomy
Tumour marker by histological type hCG (%)AFP (%) Seminoma70 Teratoma2538 Teratocarcinoma5764 Embryonal6070 Choriocarcinoma1000
On orchidectomy Organ-sparing surgery In suspicion of a benign-lesion In synchronous, bilateral testicular tumours In metachronous, contralateral tumours In a tumour in a solitary testis The tumour should be less than 30% of the testicular volume.
Staging and clinical classification To determine the presence of metastatic or occult disease Tumour markers Nodal pathway screened Visceral metastasis excluded Abdominal, supra-clavicular nodes, liver Status of mediastinal and lung metastasis Status of brain and bone if suspicion
Staging and clinical classification Abdominal, pulmonary, extra-pulmonary, mediastinal node assessed by CT Supraclavicular nodes. PE and CT Retroperitoneal nodes CT MRI as CT but cost limit its use. FDG-PET: F/U of Residual mass seminoma post CRx WW or active treatment?
Classification TNM pTX: Primary tumour can’t be assessed pT0 : No evidence of primary tumour pTis: Intratubular germ cell neoplasia pT1: Tumour limited to testis and epidydimis without vascular/lymphatic invasion _ pT2: same with invasion
Classification TNM pT3: Invasion of the spermatic cord pT4: Tumour invades scrotum with or without vascular/lymphatic invasion Serum markers Sx, S0, S1, S2, S3 according to level of LDH, hCG, AFP.
Treatment: Seminoma Low-stage: I,IIA Surgery, DXT to retroperitoneum High-stage: IIB, III (Bulky and elevated AFP) Primary CRx (Sensitivity to platinum) Residual mass Mx controversial
Treatment: NSGCT Low-stage RPLND Surveillance Tumour within tunica albuginea Normal tumour markers after orchidectomy No vascular invasion No sign of disease on imaging Reliable patient
Treatment: NSGCT Surveillance Monthly visit 1/12 for 2 years Bimonthly third year Tumour markers each visit CXR, CT Scan q 3/12