Part I: testicular cancer--management of early disease.
For patients diagnosed with early-stage testicular cancer radical orchidectomy is the primary therapeutic intervention. The major pathological types of testicular cancer are seminoma and non-seminomatous germ-cell cancer. After orchidectomy, most patients with seminoma receive adjuvant radiotherapy as standard of care, although surveillance and adjuvant chemotherapy protocols are being developed. For patients with non-seminomatous tumours there are three therapeutic options; surveillance, adjuvant chemotherapy, or retroperitoneal lymph-node dissection. These patients are classified into groups with high-risk or low-risk of recurrence by presence of vascular invasion in the surgical specimen. After orchidectomy, about 50% of patients with high-risk disease will relapse but this risk is reduced to less than 5% with adjuvant therapy. Surveillance of patients with low-risk disease is acceptable because testicular cancer is still curable if metastatic recurrence occurs. There is no consensus about the management of early non-seminomatous testicular cancer because survival is almost 100% irrespective of the initial treatment decision.
Jones
Robert H
RH
Cancer Research UK Molecular Oncology Group, Department of Pathology and Microbiology, School of Medical Sciences, University Walk, Bristol, UK. robjonesuk@hotmail.com
Vasey
Paul A
PA
D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D009919:Orchiectomy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*