Dr. Saima Mushtaq made the lecture testicular cancer by following the medical book Harrison’s Principles of Internal Medicine for medical students. This sqadia.com medical video lecture aims to elaborate primary germ cell tumors along with their pathology and putting forward an overview of tumor markers. Staging and treatment strategies have also been described in-depth. In addition to that, chemotherapy and other treatment regimens have been shed light upon.
Primary germ cell tumors
Testicular cancer occurs due to the malignant transformation of the primordial germ cells in the testis. Cryptorchidism presents a higher risk for the development of GCTs. In addition to this, testicular feminization syndrome, Klinefelter’s syndrome and isochromosomes predispose an individual to testicular cancer. Staging evaluation can be carried out by the determination of serum levels of alpha fetoprotein.
Pathology and tumor markers
Broadly, the germ cell tumors of the testis can be classified as either nonseminomas or seminoma type. The former further has four histologies named as embryonal carcinoma, teratoma, choriocarcinoma and endodermal sinus tumor. Each present with distinct clinical features. There are various prognostic indicators like AFP, hCG and LDH. These tumor markers can be determined both before and after orchiectomy and can thus, be serially assayed. The stages include pT1-pT4.
Staging and Treatment
Stage I nonseminoma demonstrates normal or declined levels of AFP and hCG. It can be treated via nerve-sparing retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy and orchiectomy alone. On the other hand, stage II includes ipsilateral retroperitoneal adenopathy which can be alleviated by either surveillance or two cycles of adjuvant chemotherapy.
Chemotherapy can be carried out for advanced germ cell tumors. Doses of cisplatin, etoposide either with or without bleomycin can be done. However, certain toxicities can be associated with chemotherapy. In addition to that, risk-directed chemotherapy can also be adopted. This involves the classification of patients into good, intermediate and poor-risk groups. Treatment varies based upon the tumor site and presence or absence of nonpulmonary visceral metastasis.
Other Treatment Options
Besides chemotherapy alone, post chemotherapy surgery can also be adopted. This involves either the usage of bilateral RPLND or less frequent thoracotomy or neck dissection. The residual retroperitoneal disease can be either excised surgically or treated via complete RPLND. Salvage chemotherapy can also be done. On the other hand, extragonadal germ cell tumor is also a medical condition, the prognosis of which depends upon the tumor histology and site of origin.