Testicular Cancer

Pathologic Subtypes (partial list)

  • Germ Cell Tumors
    • Seminoma
    • Embyronal Carcinoma
    • Yolk Sac Tumor
    • Choriocarcinoma
    • Teratoma: dermoid cyst, epidermoid cyst, etc
  • Sex Cord/Gonadal Stromal Tumors
    • Leydig Cell Tumor
    • Sertoli Cell Tumor
    • Granulosa Cell Tumor
    • Thecoma
    • Fibroma
  • Other
    • Gonadoblastoma
    • Carcinoid
    • Serous Carcinoma
    • Mucinous Cystadenoma
    • Mucinous Cystadenocarcinoma
    • Brenner Tumor
    • Nephroblastoma
    • Paraganglionoma

Clinical

  • Metastases to Lungs: hematogenous
    • Epidemiology
      • Lungs can appear as a first site of metastasis
      • Lung is the only site of metastasis in 27% of cases
    • Diagnosis
      • CXR/Chest CT: lung nodule
    • Clinical

Treatment

  • Chemotherapy
    • Residual masses after treatment: occur in 40% of cases with advanced disease and negative tumor markers
      • 50% are necrotic tissue
      • 25% are residual cancer (up to 50% are then cured by surgery)
      • 25% are mature teratomas, that may grow (90% are then cured by surgery)
  • Pulmonary Metastasectomy: indicated for patients with control of primary disease and lack of other pulmonary or non-pulmonary mets (mortality <2%/ morbidity: 10%)
    • Prognostic Factors for Metastasectomy
      • Number of resected mets: no difference (but all mets must be resected/ >50 can be resected at a time)
      • Tumor aggressiveness: no association between disease-free interval (between diagnosis and occurrence of pulmonary mets) and survival (except in breast cancer), although tumor-doubling time <20 days has poorer outcome
      • Type of malignancy: better outcome with malignancies that metastasize almost solely to lungs (sarcoma)
      • Tumor chemo-responsiveness: no prognostic advantage/disadvantage
    • Five-Year Survival after Metastasectomy (uncontrolled trials)
      • Testicular/germ cell cancer: 50%
      • Breast cancer: 36-45%
      • Osteosarcoma: 25-50% (with resection of all lung mets)
      • Soft tissue sarcoma: 20-35%
      • Melanoma: 25%
      • Renal cell cancer: 60%
      • Colon/Rectal cancer: 45%
    • Complications
      • Persistent Air-Leak
      • Infection: increased incidence with recent chemo pre-op
      • ARDS: increased incidence with extensive use of chemo, XRT pre-op and high FiO2 post-op

References

  • xxx