A decade of progress, current problems and future perspectives in testicular cancer.
The author resumes the basic progress achieved in the classification, staging and treatment of testicular cancer in the last 10 years. It is already possible to evaluate with precision the extent of non-seminomatous tumours of the testicles by using serum and intra-cellular tumoral markers (immunoperoxydase and anti-peroxydase peroxydase technique), ultrasonography and CT scan. It should be possible to selective scan the metastases with anti-alpha-foeto protein and anti HCG antibodies. Greater precision is necessary in the staging of tumors than is generally admitted. Local invasion of blood vessels and lymphatics. Invasion of the cord. The number of invaded retro-peritoneal lymphnodes (greater than or less than 5). The size of the lymphnodes (2 cm). For stage I tumours: A. Good prognosis. Wait and see without lymphnode dissection or chemiotherapy. Year 1--monthly check-ups. Year 2--quarterly check-ups. Then annual check-ups. B. Poor prognosis. Limited biopsic retroperitoneal lymphnode dissection subsequently extended following the result of the frozen section histology. For stage II tumours (with histologic proof of lymphnode invasion) the author recommends radical lymphnode dissection, except in the case of very large tumours. Subsequently: Where the excision is complete and the prognosis good (number and size of lymphnodes) no immediate chemotherapy. The author prefers to save it should the patient suffer a relapse (same follow-up as for stage 1A). Where the excision is incomplete or where it is complete but the lymphnodes are numerous (greater than 5) or large (greater than 2 cm) chemiotherapy is recommended. Where the lymphnodes are bulky. The author recommends chemiotherapy initially to be followed by retroperitoneal radical dissection. The presence of persisting tumoral tissue would imply additional chemiotherapy. In advanced tumours, a bone-marrow sampling would precede very aggressive chemiotherapy followed by surgery for residual tumoral tissue, reinjection of the bone marrow and an additional course of chemiotherapy.
D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000556:secondary; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
D000970:Antineoplastic Agents