Brief overview
- Prognosis: Generally very treatable; successful cure possible in most cases; one of the highest cancer survival rates; relapses are rare; fertility and libido usually remain intact
- Symptoms: Palpable, painless hardening in the scrotum; enlarged testicles (with a feeling of heaviness); enlarged, painful breasts; advanced symptoms such as coughing and chest pain with lung metastases
- Causes and risk factors: Exact cause unknown, genetic factors suspected; correspondingly increased familial risk; also increased risk with undescended testicles or malposition of the urethral orifice
- Diagnosis: Medical history; palpation of the testicles and breast; ultrasound; blood test, magnetic resonance imaging, computer tomography; possible exposure of the testicles
- Prevention: regular self-examination of the testicles; screening for risk groups
What is seminoma?
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 testicle are grouped together under the term non-seminoma. They arise from various other types of tissue.
Researchers assume that both seminomas and non-seminomas originate from the same precursor – degenerated cells from embryonic development in the womb. This precursor of testicular tumors is called testicular intraepithelial neoplasia (TIN). The very rare “spermatocytic seminoma” is an exception: it does not develop from the TIN, but directly from sperm-forming cells, i.e. only during the final sperm formation.
The average age of seminoma patients is around 40 years.
You can read more about other forms of testicular cancer in our article Testicular cancer.
What is the prognosis?
Seminoma has a relatively good prognosis even at an advanced stage – and overall a better prognosis than the second main group of testicular cancers (non-seminomas). One reason for this is that seminoma has less of a tendency to form metastases than non-seminoma.
For this reason, practically all patients with stage I seminoma can be cured using 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 still be successfully treated.
Secondly, the risk of relapse is influenced by the type of initial treatment. For example, if a stage I seminoma is only monitored after surgery (surveillance strategy), the risk of recurrence is higher than if the surgery is followed by radiotherapy.
Overall, however, seminoma (and other forms of testicular cancer) rarely relapse.
Symptoms
A palpable, painless induration in the scrotum is one of the most important signs of testicular cancer (such as a seminoma). Usually only one testicle is affected, more rarely both are pathologically altered.
An enlarged testicle may also be an indication of a testicular tumor. It is often accompanied by a feeling of heaviness. In some cases, there is also a pulling sensation that may radiate into the groin.
If the cancer has already metastasized, symptoms specific to the affected organs are added. For example, coughing and chest pain if metastases have formed in the lungs.
You can read more about the signs of testicular cancer (such as seminoma) in the article on testicular cancer under “What are the symptoms?”.
Causes and risk factors
It is not known exactly why some men develop seminoma (or another form of testicular cancer). However, several risk factors are now known that promote such a malignant tumor:
According to this, men who have had testicular cancer in the past are particularly at risk. An undescended testicle also increases the risk of a malignant testicular tumor – even if the undescended testicle has been surgically removed.
Genetic factors also appear to play a role in the development of seminoma (or testicular cancer). For example, the same tumor occurs more frequently in some families.
How can a seminoma be diagnosed?
In a detailed consultation (anamnesis), the doctor asks the patient about the symptoms (such as lumps in the testicles). He will also ask about possible risk factors such as previous testicular cancer or undescended testicles. The doctor will also ask about any testicular cancer in close relatives.
This is followed by a physical examination. Among other things, the doctor will palpate both testicles and the breast. A comprehensive blood test also provides important information. If, for example, the blood level of the protein AFP (alpha-fetoprotein) is elevated, this may indicate testicular cancer – especially a so-called non-seminoma. In the case of a seminoma, however, the AFP level is normal.
Imaging procedures such as computer tomography help to determine the spread of the tumor.
You can read more about necessary examinations for suspected seminoma or testicular cancer in the article Testicular cancer.
Treatment
As with other types of testicular cancer, surgery is the first treatment step for seminoma: the surgeon removes the diseased testicle, its epididymis and the spermatic cord. This mandatory procedure is called ablatio testis or orchiectomy.
In a few cases, it is possible to remove only the abnormal part of the testicle rather than the entire testicle. This procedure is particularly advisable for patients who only have one testicle left. In this way, testosterone production, which takes place in the testicles, is still guaranteed.
If possible, the surgeon leaves as much healthy testicular tissue as possible so that fertility and testosterone production are still at least partially guaranteed. However, sometimes it is unavoidable to remove both testicles completely.
Further treatment after the operation depends on how advanced the tumor is.
Treatment in stage I
Surveillance strategy
In Europe and the USA, the “wait and see” strategy is usually chosen for early-stage seminoma after surgery: The patient has a thorough examination at regular intervals in order to detect any return of the cancer at an early stage.
Radiotherapy
In some seminoma patients (stage I), the doctor recommends radiotherapy as a precautionary measure after the testicles have been removed: the doctors irradiate the posterior abdominal cavity. This is intended to eliminate any small cancer metastases in the lymph nodes along the abdominal aorta. Radiotherapy is carried out five days a week over a period of two weeks.
However, radiotherapy is only recommended for stage I seminoma in special cases. This is because the treatment may cause a malignant cancerous tumor (secondary tumor) to develop years or decades later.
Chemotherapy
Treatment in stages IIA and IIB
In stage II seminoma, neighboring (regional) lymph nodes are affected by the cancer cells (more so in IIB than in IIA). Patients then receive radiotherapy after the testicles have been removed.
If radiotherapy is not possible for certain reasons, chemotherapy is chosen instead: in three cycles, patients are administered the three cytostatic drugs (cancer drugs, cell toxins) cisplatin, etoposide and bleomycin (PEB) into a vein.
Clinical trials are investigating whether stage IIA or IIB seminoma can be treated with fewer side effects using a combination of radiotherapy and chemotherapy.
Seminoma: treatment in stages IIC and III
If the seminoma is even more advanced (stage IIC and higher), experts recommend three to four cycles of chemotherapy after the testicles have been removed. Here too, the three cytostatic drugs cisplatin, etoposide and bleomycin (PEB) are used.
Prevention
You can find out exactly how best to proceed with a self-examination of the testicles in the article Scanning the testicles.
As the exact causes of testicular cancer are not known, it is not possible to prevent it beyond a healthy lifestyle.
Anyone with a known family history, undescended testicles or a malposition of the urethral orifice who is at risk is well advised to have appropriate preventive examinations carried out by their doctor.
