Current principles of diagnostics and therapy of seminoma (40% of all testicular cancers) are reviewed. The 3 pathological types of seminoma are the classical (most frequent), anaplastic, and spermatocytic (rare) variants. Suspected malignancy based on positive results of testicular US investigation calls for obligatory radical orchiectomy through an inguinal incision. The most noteworthy prognostic factor in the clinical course is the tumor burden (in the resected testis and both nodal and distant regions), and exact determination of the anatomical extent of the disease is therefore of paramount importance. The nodal staging is performed by using CT (MRI), which (in conjunction with the chest X-ray) is one of the methods to search for distant metastases. A positive abdominal lymph node finding makes chest/mediastinal CT (MRI) mandatory. Currently, delineation of the extent of the viable tumorous tissue is promoted by PET. The indication, the extent of the irradiated lymph node region(s) and the dosage of postoperative lymphatic irradiation depend on the stage of the disease. During follow-up, the imaging methods as the most important diagnostic tools must be supplemented by physical examination and laboratory investigations (LDH, NSE, β-HCG, AFP, urine analysis and renal function tests). Tumorous dissemination is treated by combined-modality chemotherapy (VPB, BEP and VIP) typically with a curative intention. Establishment of the 95 % mean probability of the long- term cause-specific survival of the adequately treated and followed-up patients is hampered by an incidence of about 5% of radiation-induced, extratesticular secondary tumours and a 2-5 % risk of the appearance of the independent contralateral seminoma. An increased use of prognostic molecular pathological markers, a wider application of 'watch and wait' policy and a more frequent use of adjuvant chemotherapy to the detriment of adjuvant radiotherapy are the predictable trends in the future of diagnosis and therapy of seminoma.
|Translated title of the contribution||Modern diagnostics and therapy of seminoma|
|Number of pages||12|
|Publication status||Published - jan. 1 1999|
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