Testicular cancer

As a testicular cancer or testicular carcinoma a malignant testicular tumor is called, which mainly affects young men in the age group of 20 to 40 years. Testicular cancer is the most common cancer in this age group. It is usually discovered by self- sampling.

Epidemiology

In comparison to other cancers of the testis, cancer is rare. It accounts for only about one to two percent of all malignant tumors. In the age groups of 2-4 and 15 -19- year-old boy, it is the most common cancer. On average, eight to ten sick of 100,000 men. Approximately 4000 diagnoses are made ​​each year in Germany, around 150 men die from the disease. The greatest risk factor for testicular cancer is the undescended testicle ( undescended testis). The testicle is left in the groin or wanders back then and does not remain as usual in the scrotum. Maybe wear men from 1.95 m at an increased risk of disease.

Clinic

Classic symptom of testicular tumor is painless increase in size of the testis with a palpable nodules within the testis. Any enlargement of the testis tumor is suspected and must be medically examined.

Classification

Malignant neoplasms of the testis always conform to the tissue from which they are divided. 95% of the malignant cells germ cells, and the remaining five percent of the tumors formed from the connective and supporting tissue. The largest part in the second group represent the Leydig cell tumors. The germ cell tumors, in turn, are divided into seminomas and Nichtseminome.

The overall prognosis is better in seminomas, because the tendency of metastasis is less pronounced in seminomas than in the non- seminomas. Importantly, as with most malignancies, early detection, since this is the most important factor for better chances of recovery.

Surgical treatment

The semicastration ( here orchiectomy and testis ablation ), the removal of one of both testes, is the first therapeutic step in the diagnosis of testicular cancer. Fertility of the patient is not limited solely by the removal of one testis usually. Nevertheless, it is a seed - storage (similar to how it is practiced in sperm donors ) come before the procedure - especially the below-described retroperitoneal lymphadenectomy can in some cases lead to infertility, the chance of their own children is the professionally stored seeds then obtained. It is important to measure the testosterone level before the first operation. Thus it can be reinstated in the case of a ( rare ) occurrence of the normal two-sided mirror. Subsequently, a matched to the tumor histology as well as the respective stage, adjuvant therapy. This can mean an active surveillance, chemotherapy, radiotherapy or a combination of radiation and chemotherapy. After a surgical orchiectomy a testicular prosthesis can be used.

The retroperitoneal lymphadenectomy ( RLA ), in which the lymph nodes are removed in the abdomen, is sometimes performed before chemotherapy. The lymph nodes are removed, because the metastasis of testicular cancer in almost all cases runs over them. Thus, lymph nodes are on the one hand eventually removed, on the other hand the tumor dissemination basis is withdrawn.

For an existing testicular tumor is a risk of precancerous lesions ( testicular intraepithelial neoplasia) and the contralateral testis. Since the frequent postoperative chemotherapy cures the cancer precursor in seven percent of cases, a testicular biopsy of the opposite side is recommended only after completion of a possible chemotherapy. After chemotherapy, a testicular intraepithelial neoplasia be cured by irradiation of the testis.

Chemotherapy

Chemotherapy is for non- seminomas the treatment of choice in seminomas it is usually only at advanced stages used because seminomas are almost always sensitive to radiation, so respond well to irradiation.

In almost all cases comes as a chemotherapy drug combination " PEB " is used. This consists of the cytotoxic drugs cisplatin ( P), etoposide (E) and bleomycin (B). Bleomycin has a negative effect on lung function, so that it is replaced by ifosfamide about high-performance athletes or divers (PEI combination) or omitted. The administration of the combination used is carried out over one to four cycles, usually at least two cycles are performed. As a cycle of the treatment period of 21 days, is referred to; a treatment regimen determines the exact medication for each day. Via a set at the beginning of each cycle the peripheral or central venous catheter ( CVC ), spread throughout the day, an infusion of large amounts of liquid ( hyperhydration ). A therapy carried out a total of four cycles, the infusion can be preferably administered via an implanted port. Primarily, one cycle of a daily infusion of drugs cisplatin and etoposide in the first five days. Central is the infusion of the drug cisplatin, which is accompanied by a pre-and post-rinsing with Ringer's solution and brine. In addition, a strong remedy for nausea ( antiemetic ) is administered via the infusion. On days 1, 8 and 15 bleomycin is injected, which can cause a metallic-like taste in the mouth.

Side effects of these chemotherapy keep relatively limited. Hair loss takes place at the end of the first cycle, depending on the type a little later. Nausea is often present to some extent, but relatively rarely leads to vomiting. Food intake is usually, though with certain aversion well possible.

Other therapeutic strategies

As an alternative to the above methods, a wait - and-see strategy or " watchful waiting " ( Waiting with close follow-up ) can be chosen in early stages.

In 1996, the German Cancer Society at the " interdisciplinary working group Testicular tumors " ( IAH) diagnostic and treatment guidelines in order to improve the quality of care and treatment success. For the first time, a standard for the treatment urologist has been set, which is updated since then steadily.

In order for the small number of cases ( approximately 4000 urologists in Germany about 4,000 cases) in addition to stamp out the treatment experience of practicing physicians, the urological section of the German Study Group testicular tumors has launched in 2006 a second opinion project to life. Under " zm- hodentumor.de " physicians to document their patient cases and treatment proposals and will promptly by a physician with a strong experience ( CIMIC doctor ) a one-time consultation, the so-called second opinion, on this proposal.