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{{CMG}}
__NOTOC__
 
{{CMG}}; {{AE}} {{G.D.}}, {{SC}}
{{Testicular cancer}}
{{Testicular cancer}}


==Overview==
==Overview==
Before 1970, the young man with recurrent testicular cancer was destined to have rapid progression and death from disseminated disease. Currently, although 7000 to 8000 new cases of testicular cancer occur in the United States yearly, only 400 men are expected to die of the disease.  Much of this improvement is due to advances in adjuvant therapy.
The predominant therapy for testicular cancer is [[surgical resection]]. Adjunctive [[chemotherapy]] and [[radiation therapy]] may be required.


Due to the risk of subsequent metastasis, post-surgical adjuvant therapy may be offered to the patient following orchiectomy.  The type of adjuvant therapy depends largely on the [[histology]] of the tumor and the stage of progression at the time of surgery.  These two factors contribute to the risk of recurrence, including metastasis.  Adjuvant treatments may involve chemotherapy, radiotherapy or careful surveillance by frequent CT scans and blood tests by oncologists.
==Medical Therapy==
===Germ cell tumors===
[[Seminoma]]:


The three basic types of treatment are [[surgery]], [[radiation therapy]], and [[chemotherapy]].
[[Seminoma]] is sensitive to [[radiotherapy]] and [[chemotherapy]].


Surgery is performed by [[urologist]]s; radiation therapy is administered by [[radiation oncologist]]s; and chemotherapy is the work of medical [[oncologist]]s.
Stage IA and IB<ref name="OliverDieckmann2005">{{cite journal|last1=Oliver|first1=T.|last2=Dieckmann|first2=K.-P.|last3=Steiner|first3=H.|last4=Skoneczna|first4=I.|title=Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma|journal=Journal of Clinical Oncology|volume=23|issue=16_suppl|year=2005|pages=4572–4572|issn=0732-183X|doi=10.1200/jco.2005.23.16_suppl.4572}}</ref>
*Surveillance for pT1-T3 [[tumors]] or
*Single agent [[carboplatin]] for 1 or 2 cycles followed with [[chest x-ray]] and [[CT scan]] of the [[abdomen]] and [[pelvis]]. <ref name="pmid27618772">{{cite journal |vauthors=Chovanec M, Hanna N, Cary KC, Einhorn L, Albany C |title=Management of stage I testicular germ cell tumours |journal=Nat Rev Urol |volume=13 |issue=11 |pages=663–673 |date=November 2016 |pmid=27618772 |doi=10.1038/nrurol.2016.164 |url=}}</ref><ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref>
* [[Radiation therapy]]
Stage IS
*Recheck the [[serum]] [[marker]] and the [[Chest X-rays|chest X-ray]] and [[Ct scan]] of [[abdomen]] and [[pelvis]].
Stage IIA
*[[Bleomycin]], [[etoposide]], and [[cisplatin]] for 3 cycles or [[etoposide]], and [[cisplatin]] for 4 cycles.
*Low dose of [[radiation]] [[therapy]] is preferred over [[chemotherapy]].


==Therapies==
Stage IIB or IIC
*[[Bleomycin]], [[etoposide]], and [[cisplatin]] for 3 cycles or [[etoposide]], and [[cisplatin]] for 4 cycles.
*Combined [[chemotherapy]] is recommended over [[radiation therapy]].
===Radiation therapy===
===Radiation therapy===
[[Radiation]] may be used to treat stage II seminoma cancers, or as [[adjuvant]] (preventative) therapy in the case of stage I seminomas, to minimize the likelihood that tiny, non-detectable tumors exist and will spread (in the inguinal and para-aortic [[lymph nodes]]). Radiation is never used as a primary therapy for [[nonseminoma]] because a much higher dose is required and chemotherapy is far more effective in that setting.
* [[Radiation therapy]] works best for [[seminoma]]. [[Nonseminoma|Non-seminoma]] do not respond well to [[radiation therapy]].
* [[External beam radiotherapy|External beam radiation]] may be used for stage I and most stage II [[Seminoma|seminomas]] after [[orchiectomy]].<ref name="pmid22436787">{{cite journal |vauthors=Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ |title=Radiotherapy treatment planning for testicular seminoma |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=83 |issue=4 |pages=e445–52 |date=July 2012 |pmid=22436787 |doi=10.1016/j.ijrobp.2012.01.044 |url=}}</ref>
* [[Radiation therapy]] after [[orchiectomy]] including the [[Paraaortic lymph nodes|para-aortic]] and ipsilateral [[iliac lymph nodes]] for stage IIA [[Seminoma|seminoma.]]<ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref>
* [[Radiation therapy]] in selected non bulky (3 cm or < 3 cm) including the [[Paraaortic lymph node|para-aortic]] and ipsilateral [[iliac lymph nodes]] for [[Seminoma|stage IIB seminoma]].<ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref><ref name="pmid12637477">{{cite journal |vauthors=Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R, Weinknecht S, Köhrmann KU, Bamberg M |title=Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial |journal=J. Clin. Oncol. |volume=21 |issue=6 |pages=1101–6 |date=March 2003 |pmid=12637477 |doi=10.1200/JCO.2003.06.065 |url=}}</ref>
* [[Radiation]] [[treatments]] are usually given once a day, 5 days a week, for 2–4 weeks.


===Chemotherapy===
===Chemotherapy===
As an [[adjuvant]] treatment, use of [[chemotherapy]] as an alternative to radiation therapy is increasing, because radiation therapy appears to have more significant long-term side effects (for example, internal scarring, increased risks of secondary malignancies, etc.). Two doses of [[carboplatin]], typically delivered three weeks apart, is proving to be a successful [[adjuvant]] treatment, with recurrence rates in the same ranges as those of [[radiotherapy]].
'''Standard-dose chemotherapy'''<ref name="pmid9053482">{{cite journal |vauthors= |title=International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group |journal=J. Clin. Oncol. |volume=15 |issue=2 |pages=594–603 |date=February 1997 |pmid=9053482 |doi=10.1200/JCO.1997.15.2.594 |url=}}</ref><ref name="pmid18936476">{{cite journal |vauthors=Garcia-del-Muro X, Maroto P, Gumà J, Sastre J, López Brea M, Arranz JA, Lainez N, Soto de Prado D, Aparicio J, Piulats JM, Pérez X, Germá-Lluch JR |title=Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study |journal=J. Clin. Oncol. |volume=26 |issue=33 |pages=5416–21 |date=November 2008 |pmid=18936476 |doi=10.1200/JCO.2007.15.9103 |url=}}</ref>
* The most common [[chemotherapy]] combinations used to treat testicular cancer are:
:* [[Bleomycin]], [[etoposide]], and [[cisplatin]]
::* It is usually given IV every 3 weeks for 3 months for 3 cycles for [[metastasis]] to [[brain]], stage IIA, IIB, IIC, and good risk stage III [[seminoma]] as well as good risk stage IIA, IIB, and stage IIC, IIIA [[Nonseminoma]].
:* [[Etoposide]] and [[cisplatin]] are given for 4 cycles for [[metastasis]] to [[brain]], stage IIA, IIB, IIC and good risk stage III [[seminoma]] as well as good risk stage IIA, IIB, and stage IIC, IIIA [[Nonseminoma]].<ref name="pmid2446132">{{cite journal |vauthors=Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Brunner KW, Jacobs EM, Spaulding JT |title=Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer |journal=N. Engl. J. Med. |volume=317 |issue=23 |pages=1433–8 |date=December 1987 |pmid=2446132 |doi=10.1056/NEJM198712033172303 |url=}}</ref>
::* It is used when [[bleomycin]] affects the [[lungs]] or there is a high risk that it will cause [[lung]] damage.
:* [[Bleomycin]], [[etoposide]], and [[cisplatin]] or [[etoposide]], [[mesna]], [[ifosfamide]], and [[cisplatin]]  are given for 4 cycles for intermediate risk stage III [[seminoma]] and intermediate and poor risk stage IIIC [[Nonseminoma]].
::* [[Bleomycin]], [[etoposide]], and [[cisplatin]] for 1 cycle for stage I [[nonseminoma]] with and without [[risk factors]].<ref name="pmid19875756">{{cite journal |vauthors=Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR |title=Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy |journal=Ann. Oncol. |volume=21 |issue=6 |pages=1296–301 |date=June 2010 |pmid=19875756 |doi=10.1093/annonc/mdp473 |url=}}</ref>
 
* If testicular cancer does not respond to the above [[drugs]] or if it recurs, the following [[chemotherapy]] combinations may be used. These are sometimes called salvage, or second-line, [[chemotherapy]].
:* [[Paclitaxel]], [[ifosfamide]] and [[cisplatin]]
::* It is given IV every 3 weeks for 3 months, or 4 cycles.
:* [[Etoposide]], [[ifosfamide]] and [[cisplatin]]
::* It is given IV every 3 weeks for 3 months, or 4 cycles.
:* [[Etoposide]] or [[vinblastine]], [[ifosfamide]] and [[cisplatin]]
::* It is given IV every 3 weeks for 3 months, or 4 cycles.


Chemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage II or III).  The standard [[chemotherapy protocol]] is three to four rounds of [[Bleomycin]]-[[Etoposide]]-[[Cisplatin]] (BEP). This treatment was developed by Dr. [[Lawrence Einhorn]] at Indiana University. An alternative, equally effective treatment involves the use of four cycles of [[Etoposide]]-[[Cisplatin]] (EP).
'''High-dose chemotherapy'''
* High-dose [[chemotherapy]] with [[carboplatin]] and [[etoposide]] may be used if testicular cancer recurs after it is treated with standard-dose [[chemotherapy]].


While treatment success depends on the stage, the average survival rate after five years is around 95%, and stage I cancers cases (if monitored properly) have essentially a 100% survival rate (which is why prompt action, when testicular cancer is a possibility, is extremely important).
'''Palliative chemotherapy'''
* [[Palliative therapy]] is given to relieve [[symptoms]], rather than to treat the [[cancer]] itself. [[Gemcitabine]] may be given with [[oxaliplatin]], [[paclitaxel]] or both as [[palliative]] treatment for [[Seminoma|seminomas]] or [[Nonseminoma|non-seminoma]].
===Sex cord stromal testicular tumors===
*Most [[sex cord]] stromal testicular tumors may not respond to [[chemotherapy]] and [[radiation]].<ref name="pmid16097561">{{cite journal |vauthors=Conkey DS, Howard GC, Grigor KM, McLaren DB, Kerr GR |title=Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature |journal=Clin Oncol (R Coll Radiol) |volume=17 |issue=5 |pages=322–7 |date=August 2005 |pmid=16097561 |doi= |url=}}</ref><ref name="pmid10971169">{{cite journal |vauthors=Farkas LM, Székely JG, Pusztai C, Baki M |title=High frequency of metastatic Leydig cell testicular tumours |journal=Oncology |volume=59 |issue=2 |pages=118–21 |date=August 2000 |pmid=10971169 |doi=10.1159/000012147 |url=}}</ref>
*[[Adjuvants]] are not helpful nor effective.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 15:13, 28 May 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]

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Overview

The predominant therapy for testicular cancer is surgical resection. Adjunctive chemotherapy and radiation therapy may be required.

Medical Therapy

Germ cell tumors

Seminoma:

Seminoma is sensitive to radiotherapy and chemotherapy.

Stage IA and IB[1]

Stage IS

Stage IIA

Stage IIB or IIC

Radiation therapy

Chemotherapy

Standard-dose chemotherapy[8][9]

  • The most common chemotherapy combinations used to treat testicular cancer are:
  • It is usually given IV every 3 weeks for 3 months for 3 cycles for metastasis to brain, stage IIA, IIB, IIC, and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.
  • It is used when bleomycin affects the lungs or there is a high risk that it will cause lung damage.
  • If testicular cancer does not respond to the above drugs or if it recurs, the following chemotherapy combinations may be used. These are sometimes called salvage, or second-line, chemotherapy.
  • It is given IV every 3 weeks for 3 months, or 4 cycles.
  • It is given IV every 3 weeks for 3 months, or 4 cycles.
  • It is given IV every 3 weeks for 3 months, or 4 cycles.

High-dose chemotherapy

Palliative chemotherapy

Sex cord stromal testicular tumors

References

  1. ↑ Oliver, T.; Dieckmann, K.-P.; Steiner, H.; Skoneczna, I. (2005). "Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma". Journal of Clinical Oncology. 23 (16_suppl): 4572–4572. doi:10.1200/jco.2005.23.16_suppl.4572. ISSN 0732-183X.
  2. ↑ Chovanec M, Hanna N, Cary KC, Einhorn L, Albany C (November 2016). "Management of stage I testicular germ cell tumours". Nat Rev Urol. 13 (11): 663–673. doi:10.1038/nrurol.2016.164. PMID 27618772.
  3. ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
  4. ↑ Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ (July 2012). "Radiotherapy treatment planning for testicular seminoma". Int. J. Radiat. Oncol. Biol. Phys. 83 (4): e445–52. doi:10.1016/j.ijrobp.2012.01.044. PMID 22436787.
  5. ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
  6. ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
  7. ↑ Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R, Weinknecht S, Köhrmann KU, Bamberg M (March 2003). "Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial". J. Clin. Oncol. 21 (6): 1101–6. doi:10.1200/JCO.2003.06.065. PMID 12637477.
  8. ↑ "International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group". J. Clin. Oncol. 15 (2): 594–603. February 1997. doi:10.1200/JCO.1997.15.2.594. PMID 9053482.
  9. ↑ Garcia-del-Muro X, Maroto P, Gumà J, Sastre J, López Brea M, Arranz JA, Lainez N, Soto de Prado D, Aparicio J, Piulats JM, Pérez X, Germá-Lluch JR (November 2008). "Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study". J. Clin. Oncol. 26 (33): 5416–21. doi:10.1200/JCO.2007.15.9103. PMID 18936476.
  10. ↑ Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Brunner KW, Jacobs EM, Spaulding JT (December 1987). "Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer". N. Engl. J. Med. 317 (23): 1433–8. doi:10.1056/NEJM198712033172303. PMID 2446132.
  11. ↑ Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR (June 2010). "Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy". Ann. Oncol. 21 (6): 1296–301. doi:10.1093/annonc/mdp473. PMID 19875756.
  12. ↑ Conkey DS, Howard GC, Grigor KM, McLaren DB, Kerr GR (August 2005). "Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature". Clin Oncol (R Coll Radiol). 17 (5): 322–7. PMID 16097561.
  13. ↑ Farkas LM, Székely JG, Pusztai C, Baki M (August 2000). "High frequency of metastatic Leydig cell testicular tumours". Oncology. 59 (2): 118–21. doi:10.1159/000012147. PMID 10971169.


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