Seminoma of the testis: tumor characteristics, treatment, prognosis
Seminoma eggs are among the most frequent tumors of this organ. It accounts for almost half of all cases of neoplasms of the male reproductive organs. Among patients with this diagnosis are men aged 30-50 years are at the peak of sexual activity.
Testicular tumors make up about 1% of all human tumors and are considered a fairly rare pathology. On the other hand, in young men is the testicle affected by cancer more often than other organs, accounting for more than half of all cases of cancer in this age group. And high mortality with delayed treatment.
The testicles are extremely important because they perform hormonal functions. Testosterone ensures proper development and work of the male reproductive system and also affects the overall metabolism. Another objective of the gonads is ensuring the ability to bear children due to the formation of sperm – male sex cells.
Testicles located in the scrotum, that is somewhat removed from the surface of the body that is necessary to create comfortable conditions for reproduction and maturation of sperm. Source seminoma becomes epithelium, whose cells are continuously dividing.
Causes and stages of the disease
Observations suggest that seminoma of the testis occurs more frequently in certain age periods, which is associated with causes that provoke the tumor. The peak of the disease accounts for:
- Childhood up to 10 years;
- The average age from 20 to 40;
- Older age after 60.
In children the cause of seminoma teratoma may be formed in utero. This tumor may be benign initially, but in the first decade of life is malignancy. Teratoma causes about 90% of all «children» Semin.
The middle-aged men causes seminoma is more diverse. Among them:
Cryptorchidism – «popushina» the testicle into the scrotum is the most common cause of cancer, increases the probability by about 10 times. Sex gland not located in the scrotum, experiencing constant influence of higher temperature, which disturbed metabolism and spermatogenesis, there are prerequisites to malignant transformation of the epithelium, so when cryptorchidism has always shown the operation to return the body in the scrotum.
There are genetic mechanisms of tumor development. If close blood relatives (father, brother) was ill or sick with seminomas, the odds of her other male family members increased.
Seminoma is most often diagnosed in Europeans, especially in Scandinavian countries, Germany, while among the inhabitants of Asia and Africa the percentage of morbidity is very low.
Stage seminoma is based on its size, the ratio of the tissue of the reproductive gland, metastasis:
- Stage I, when the neoplasia is located within the body metastasizes;
- II – the tumor extends beyond the boundaries of the tunica, but changed the size and shape of an egg;
- in stage III, the tumor invades the shell of the body appendage;
- at stage IV seminoma grow into the surrounding tissue.
When seminoma a grade 1 tumor limited to the tissue of the same gland and has not metastasized, so the effectiveness of the treatment of the most high, and the prognosis of this tumor is favorable. A further increase in seminoma leads to damage of the surrounding tissues, lymph nodes, internal organs, require more active treatment and gives much less chances of recovery or at least stop the growth of the tumor.
Manifestations and diagnostic methods of testicular seminoma
The symptoms of testicular tumor the first time are absent, the tumor does not bother the patient. As you increase the size of the seminoma in the sexual gland lesion appears the seal of the knot, not bringing pain. In some cases, a tumor may quite early become painful, especially if it grows or compresses the structures of the spermatic cord.
Large tumor cause not only pain, but also a feeling of heaviness in the scrotum, and even abdominal pain. Over time, the tumor becomes visible to the naked eye, deforms the scrotum, leads to swelling of tissues.
In addition to the local symptoms, the stage of metastasis, there are signs of lymph node and internal organs. Metastasis to the lymph apparatus of the retroperitoneal space provokes back pain, compression of the loops of the intestine may cause intestinal obstruction.
Violation of lymphatic drainage from the lower half of the body, compression of the inferior Vena cava is manifested swelling of legs, extension of subcutaneous venous network. If metastases peredelyvayut the ureters, that is, the risk of developing hydronephrosis with stagnation of urine in the pyelocaliceal system of the kidneys, which inevitably leads to failure of the organ.
Distant metastasis is possible in the mediastinal lymph nodes, then the patient concerned cough and shortness of breath. At the advanced stage seminoma are increasing symptoms of intoxication, the patient loses weight rapidly, lost appetite, increasing weakness, there is constant fever.
Most men with the appearance of any seal, even painless, in the scrotum tend to go to the doctor, because the testis is not only on providing sexual activity, but also an element of the reproductive system, so their health is extremely important for patients young and Mature age.
To suggest a tumor of the gonads may already be at the stage of the initial examination when the doctor has the ability to probe the body. In addition to palpation of the testicle, necessarily examines the lymph nodes of the groin, supraclavicular area, abdomen to exclude metastatic changes.
Following the diagnostic stage is diaphanoscopy – raying tissues of the scrotum. The method is simple, cheap, requires no sophisticated equipment, but allows to distinguish the tumor from the cystic changes.
Of instrumental methods in case of suspected tumor of the testis, ultrasound is used, allowing to determine the exact location, size of the neoplasia, the presence of sprouting in the surrounding tissue (invasion). Seminoma to distinguish from other types of cancer of the testicle allows an MRI.
An important step of diagnosis is seminoma laboratory tests for tumor markers. When this tumor determine alpha-fetoprotein, human chorionic gonadotropin, enzymes (LDH, alkaline phosphatase). More than half of the patients with seminomas these indicators increased, however, the normal level does not exclude the presence of a tumor.
For the diagnosis of metastases using x-ray and ultrasound of the lungs, abdominal organs, kidneys, possible CT, MRI and radioisotope bone scan.
The most accurate diagnosis allows you to put a biopsy of tumor tissue under a microscope. Biopsy take through inguinal access under local anesthesia. If seminoma is confirmed, then sex gland, and the spermatic cord should be removed.
Treatment of testicular tumors
In the treatment of germ cell tumors of the testis applies a comprehensive approach that includes surgical removal of tumors, radiation and chemotherapy. In each case, the scheme is developed individually with consideration of patient’s age and stage of the disease.
Removal of the tumor is performed during the operation of orientaliste when excised the affected testicle the spermatic cord. An incision is made in the groin, not the scrotum, as in the latter case, dramatically increases the likelihood of postoperative metastasis via the lymphatic vessels. This intervention is considered radical. If there are metastases in the lymph nodes, then remove them as well. The distribution of metastases generally occurs in the retroperitoneal lymph nodes, therefore, is a retroperitoneal lymph node dissection through a vertical midline incision.
Given that testicular cancer is most common among young men, is of great importance the ability to conduct conserving surgery. The indication for it I think:
Radiation therapy can be performed before surgery to reduce tumor size and facilitate its removal, and after orientaliste, to kill cancer cells that may cause relapse. The irradiation may be subjected to a lymph node affected by metastatic process, which is especially important when the impossibility of their radical removal.
Systemic chemotherapy is justified, starting with the third stage of the disease. The most effective schemes, including the platinum drugs (cisplatin), bleomycin, etoposide.
When removing two gonadal reduced level of testosterone, which adversely affects General health and sexual function of men, therefore in the postoperative period is shown hormone replacement therapy drugs testosterone.
Treatment of testicular cancer significantly affects reproductive function in men, perhaps not only temporary, but persistent and irreversible infertility. This fact must be considered in young patients hoping to have children. In this case, before treatment you should consult andrologist, to pass semen analysis, and at risk of infertility, output can be cryopreservation of the seminal fluid, which for many years can be used in assisted reproductive technologies.
The prognosis of seminoma egg quite good, but only if early detection of diseases and timely treatment. At the first stage of complex therapy allows to achieve full recovery at 90-95% of patients. Procrastination and tumor progression reduce this figure.
Without treatment, the first stage seminoma threatens to escalate into a third in a matter of months, and in advanced stages the treatment will be more palliative in nature. In advanced metastatic patients are, as a rule, not more than a year.
If you remove the egg with seminomas I-II stage, the prognosis is considered to be favourable, recovering the vast majority of patients, many of them unable to realize the reproductive function. The risk of recurrence and metastasis necessitates regular monitoring by an oncologist with periodic radiographic examination of the lungs, ultrasound, CT scans of the abdomen and lymph nodes, monitoring of tumor markers and hormonal status.
It is important to remember that seminoma of the testicle is among the treatable types of malignant tumors, therefore, the vigilance men, self-examination and early visits to the doctor – the key to timely diagnosis and successful treatment of the disease.