The optimal treatment for low stage disease is largely patient driven with surgery, surveillance and chemotherapy considered the primary treatment modalities. In low volume non-seminomatous germ cell cancer, (clinical stage A/B1) retroperitoneal lymph node dissection has maintained its therapeutic benefit while minimizing morbidity with the reduction of the surgical template from a full bilateral dissection to a unilateral nervesparring surgery. In the post chemotherapy population, patients with complete radiographic resolution of retroperitoneal disease are typically observed as the relapse rate in this population is ~ 5%. Residual masses after chemotherapy should be resected. A modified post chemotherapy dissection is adequate in carefully selected patients with low volume disease restricted to the primary landing zone of the affected testicle. A full bilateral RPLND remains standard template for larger volume disease. In chemorefractory disease, aggressive surgery provides a 5-year survival of 31% for patients with active cancer. Excluding chemo-naïve patients, late relapse disease is managed surgically with 50% being cured of disease. The vast majority (approximately 90 to 95%) of neoplasms of the testis are of germcell origin because these cells are mitotically very active and therefore most prone to developing DNA mutations (1). The supporting cells of the testis, Sertoli cell and Leydig cells, have low proliferative rates, and consequently tumors derived from these cells are unusual, comprising fewer than 4% of all testicular tumors (2). Germ cell tumors are composed of five basic cell types: seminoma, embryonal cell carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Classic seminoma is the most common tumor of the testis accounting for approximately 35% to 55% of all germ-cell neoplasms. The focus of this chapter is the management of non-seminomatous germ-cell tumors.
|Original language||English (US)|
|Title of host publication||Essentials and Updates in Urologic Oncology (2 Volume Set)|
|Publisher||Nova Science Publishers, Inc.|
|Number of pages||28|
|State||Published - Dec 1 2012|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)