Seminoma

The seminoma is the most common form of testicular cancer. Read how it is treated and how the chances of recovery stand!

Seminoma

The seminoma is a malignant tumor of the testicle. Of all testicular cancers, seminoma is the most common. It is generally operated and - depending on the stage - treated further, for example by means of radiation. Overall, the seminoma has a better prognosis than the other malignant testicular tumors. Find out everything important about the seminar here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. C62

Product Overview

seminoma

  • description

  • symptoms

  • Examinations and diagnosis

  • treatment

  • Disease course and prognosis

Seminom: description

The seminoma is the most common form of testicular cancer. It is one of the so-called germ cell tumors (germinal tumors) because it develops from precursors of the male germ cells (sperm). In contrast, non-seminomas arise from other cell types in the testes.

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

The World Health Organization distinguishes between other subtypes of seminoma, such as classic seminomas and seminomas, which also contain cells of other tissues (such as connective and supporting tissues). The latter are very rare. The different types of testicular cancer are differentiated in a tissue examination by the pathologist.

Seminoma: frequency

The seminoma accounts for about 55 percent of all germ cell tumors in men. The remainder is non-seminoma, with combinations of a non-seminoma and a seminoma. The mean age of seminoma patients is around 40 years.

Seminoma: symptoms

Everything important about signs of testicular cancer (such as a seminoma) can be read in Post Testicular Cancer Symptoms.

Seminoma: causes and diagnosis

Read all about the causes, risk factors and diagnosis of testicular cancer forms such as seminoma in the article Testicular Cancer.

Seminoma: treatment

As with other types of testicular cancer, surgeons also remove the affected testes, epididymis and spermatic cord from the seminoma. This mandatory procedure is called ablatio testis or orchiectomy.

During surgery, a tissue sample can be taken from the other testicle and examined for cancer cells. In fact, approximately five percent of patients also have altered cells in the second testis. This can then optionally be mitentfernt same.

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 yes in the testes, continue to be guaranteed.

Further therapy depending on the cancer stage

How a seminoma (or another testicular cancer) is treated depends on how far the tumor has progressed:

  • Stage I: Testicular cancer has not yet metastasized.
  • Stage IIA: The cancer has up to five lymph nodes in the abdomen, but none of them is larger than two centimeters.
  • Stage IIB: There are more than five lymph nodes in the abdominal area affected. Their size is between two and five centimeters.
  • Stage IIC ("bulky disease"): The lymph node metastases are larger than five centimeters and may grow into neighboring organs.
  • Stage III: There are lymph node metastases also above the diaphragm or tumor formation in other organs (such as lungs or skull).

The metastases are formed by the detachment of cancer cells and either via the lymphatics (lymphogenous metastases) or the blood (hematogenous metastases) to other body regions, where they settle. In lymphoid metastasis, the cancer cells first begin in the lymph nodes at the level of the kidneys and then spread out over the pelvis. Later, lymph nodes on the neck can also be affected. In the course of hematogenous metastases, especially daughter lungs are formed in the lungs. In the further course, the brain, liver and bones can also be affected.

Seminoma: treatment in stage I

Patients whose seminoma was less than four centimeters and in which no cancer of the seminiferous tubules (Rete testis) could be detected, belong to the so-called low-risk group. You have a good prognosis and a low risk of recurrence. Therefore, after the removal of the testicles regular surveillance examinations (surveillance) over five years are sufficient.

In high-risk patients, on the other hand, the seminoma was larger than four centimeters and passed over to the seminiferous tubules.Here, the guidelines of the European Association of Urologists recommend two alternative therapies:

1. radiation (radiotherapy, radiotherapy)

The organs of the posterior abdominal cavity are irradiated with a specific energy, namely an energy dose of 2 Gray (Gy) five times a week until a total dose of 20 Gy is reached. In this way, also eliminated cancer cells - especially in the lymph nodes along the abdominal aorta - are destroyed.

2. Chemotherapy

Chemotherapy is performed with the cytocidal agent carboplatin. According to studies, this form of treatment is as effective as radiation. In addition, in most cases, cancer precursors (TIN) in the neighboring testes are eliminated.

Seminoma: treatment in stages IIA and IIB

Experts recommend radiotherapy in these stages of cancer. This is to eliminate the metastases of the posterior abdominal area. A total energy dose of 30 Gy in stage IIA and 36 Gy in stage IIB is recommended.

Alternatively, patients may also be treated with chemotherapy. The patients are given the cytostatics (anticancer drugs) cisplatin, etoposide and bleomycin a total of three times in the vein.

Seminoma: treatment in the stages IIC and III

The patients in these advanced stages are divided according to their prognosis into groups. The classification is essentially the same as for non-seminomas, but there is no bad prognosis group (only one good and one mediocre / intermediate) for seminomas. Read more about this stage classification in the article.

Patients in both groups are treated equally: they receive three cycles of chemotherapy with the usual drugs cisplatin, etoposide and bleomycin. Alternatively, only cisplatin and etoposide can be given, but then four times.

Subsequently, other herds of cancer are closely monitored. A removal is not absolutely necessary. To differentiate between scar tissue and an active cancer focus, positron emission tomography (PET) can be helpful. By means of radioactive substances living tissue and thus metastases of the seminoma are detected in this imaging process.

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Seminoma: Disease course and prognosis

The seminoma has a relatively good prognosis even in the advanced stage.

In some cases, relapse occurs after treatment is complete (recurrence). The likelihood depends on the stage of the first seminoma at the time of diagnosis and its treatment:

stage

performed therapy

Likelihood of relapse

I

only surveillance

once carboplatin

Irradiation with 20 Gy

15-20 %

3-4 %

3-5 %

IIA

Irradiation with 30 Gy

5-10 %

IIB

Irradiation with 36 Gy

10-15 %

If relapsed, patients will receive four cycles of the anticancer drugs cisplatin, etoposide, and vinblastine or ifosfamide. If the first testicular cancer tumor was only irradiated, the relapse therapy with the usual cytostatics (three times cisplatin, etoposide, bleomycin). Overall, also has one seminomaRelapse quite good chances of recovery.


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