The management of testis cancer

Publication date: Available online 28 August 2019Source: Surgery (Oxford)Author(s): Noel W. Clarke, Áine M. HaranAbstractTestis cancer is the most common solid malignancy in young men and represents a clinically and pathologically diverse disease. Between 90% and 95% of tumours are germ cell tumours (GCTs) that are categorized into seminoma and non-seminomatous germ cell tumours (NGSCTs). Testis cancer typically presents as a painless testicular mass and must be investigated with ultrasound imaging and tumour marker assay before being treated urgently with radical inguinal orchidectomy if suspicion persists. Disease localized to the scrotum is curable with surgery alone in most cases, but high-risk features in clinical stage I disease predict failure in a significant proportion. Such cases need close surveillance or adjuvant intervention therapy following primary surgery. More advanced disease (clinical stage II or greater) requires treatment with combination platinum based chemotherapy, usually including bleomycin, etoposide and platinum (BEP). Post chemotherapy tumour masses are resected surgically when this is possible. Metastatic disease is sub-stratified into low-, intermediate- and high-risk categories based on the extent and location of metastases on cross-sectional imaging and on the level of specific tumour markers according to the International Germ Cell Cancer Collaborative Group (IGCCCG) criteria. This enables use of risk stratified treatment regimens tailored to...
Source: Surgery (Oxford) - Category: Surgery Source Type: research