Treatment and prognosis of testicular cancer
The further treatment of testicular cancer after surgical removal of the testis depends on the tissue type of the testicular cancer. It is directed against possibly remaining residues of the tumor cells and against metastases, which may already have developed in the liver, lungs or lymph nodes, for example. Depending on the findings, the patient receives either chemotherapy or radiation of the affected area.
Removal of lymph nodes in the posterior abdomen is also an option. It is divided into several stages according to the International Workshop on Staging and Treatment of Testicular Cancer, Lugano. The treatment also depends on this.
This has a negative influence on fertility and potency only in the case of previously existing reduced fertility or erectile function. If a man is healthy in this respect, one testicle is sufficient to produce enough testosterone (male sex hormone) for sperm production and erection. In clinical stage I (there are no metastases), the healing rate by removal of the testicle alone is already 80%.
Within this stage there is a further division into low-risk and high-risk tumors. The size and extent of the tumor within the testis plays a role here. Low-risk tumors are mostly only further observed; if a recurrence (relapse of the testicular cancer) should occur, for example in the lymph nodes next to the aorta, radiation or chemotherapy is administered.
This procedure is called Surveillence Therapy, i.e. waiting and observing. However, this requires very good cooperation between the doctor and the patient, as close monitoring must be carried out over many years. In low-risk seminars, late relapses can occur even after 10 years.
However, a relapse of low-risk seminoma only occurs in 20% of cases. Therefore, the Surveillence Method offers a certain protection of the patient from unnecessary or superfluous treatment, which always brings with it certain risks and inconveniences. The further standard therapy for high-risk tumors is the paraaortic radiation.
Here, between the 11th thoracic vertebra and the 5th lumbar vertebra on both sides next to the aorta (main artery), radioactive radiation is applied in several sessions. This results in the destruction of any micrometastases (tiny accumulations of tumor cells that cannot be detected by imaging). An alternative is chemotherapy with carboplatin, which is part of the standard therapy in more advanced stages, but may also be appropriate in the early stages of high-risk seminoma.
If the patient does not wish to undergo either radiotherapy or chemotherapy, surgical removal of the paraaortic (adjacent to the aorta) lymph nodes is also possible. Thus, a cure rate of almost 100% can be achieved in the treatment of stage I clinical seminoma. In stage II (metastases are present in the lymph nodes of the posterior abdomen), the standard treatment for testicular cancer is radiation of the affected area as in stage I.
However, the required radiation dose differs depending on the size and number of lymph node metastases. Alternatively, chemotherapy with 3 substances can be administered. Even in this stage of testicular cancer, the overall survival rate is almost 100%.
- TreatmentPrognosis of the seminoma:
The classification of the propagation stages of the non-seminome is in principle the same as for the seminoma. Here too, a distinction is made between low-risk and high-risk tumors in stage I. In the case of low-risk tumors, the survival method (see treatment of seminoma) is initially used to treat testicular cancer.
If a relapse of the testicular cancer or metastases develops, chemotherapy is administered with three different substances. High-risk patients first receive chemotherapy; alternatively, lymph nodes in the posterior abdomen can be removed. The overall healing rate in this stage corresponds to that of seminoma with almost 100%.
If lymph node metastases have already formed at the time of diagnosis of non-seminomatous testicular cancer, the disease is in stage II, but the cure rate is still 98%. If tumor markers are elevated at the same time, chemotherapy is administered.If the markers in the blood are not elevated, it is first observed for 6 weeks according to the surveillance method whether the tumor markers increase, which would mean a progression (progression) of testicular cancer. If this is the case, chemotherapy is now also started.
However, the markers can also fall or remain unchanged at the same level. In the latter case, surgery is performed to remove the lymph nodes from the posterior abdomen. If the tumor markers drop on their own, no further therapeutic step needs to be initiated initially, but close monitoring is indicated.
Advanced testicular tumors that have metastasized to other organs are treated chemotherapeutically with overall good success. The cytotoxic substances used in the treatment of testicular cancer also attack the metastases in e.g. the liver or lungs. The 5 – year survival rate in the so-called good prognosis group (this classification is based on the level of tumor marker values and the localization of metastases) is 86% in the case of seminoma and over 90% in non-seminoma.
In the intermediate prognosis group, the figures are 73% and 80% respectively, and in the poor prognosis group, i.e. in the worst case, 50% of men with non-seminoma are still alive after 5 years. However, this last group does not exist at all in the case of seminoma. or testicular prosthesis
- Therapy/prognosis of non-seminoma:
