Seminoma of the testicle: causes, symptoms and treatment
Malignant tumors of the testes occupy only a small percentage (up to 1%) of all neoplasms found in men. But over the past half century, the incidence has almost doubled, and testicular cancer (OC) is found more often in young people aged 20-30. Seminoma is the most common and most aggressive type of testicular cancer. What are the causes of this pathology? How to detect and treat it in time? We will talk about this in this article.
Seminoma of the testicle is a malignant formation that occurs only in men. It belongs to germinative tumors, that is, it develops from cells involved in the production of spermatozoa. Oncology of the testicles usually affects men 20-40 years old, but there are cases of the disease in children, as well as the elderly.
A nonseminar germ cell tumor of the testicle is the second group of tumors, it differs only in the characteristics of the tissues, it can contain seminoma components.
According to the structure, seminoma is a dense node or several nodes that are delimited from the testicle. Necrosis and hemorrhages are not typical for this type of cancer.
The development of testicular cancer is expressed by the appearance of a thickening, which, as a rule, does not cause painful sensations. As the tumor grows, the testicle grows and deforms. The size of the node reaches 5 cm or more. Basically seminoma one-sided. The defeat of the two testicles is rare (2% of cases).
Metastasizes such a tumor by the lymphogenous and hematogenous route. The first to suffer are the iliac, inguinal and paraaortic lymph nodes, then the abdominal organs. Among the distant - metastases in the bones, lungs and kidneys. Predominantly common in the right testicle.
Symptoms of the disease
In the early stages, symptoms of testicular symenoma may be absent. The first sign is the appearance of a palpable tumor in the scrotum (or in the stomach with cryptorchidism) and an increase in the testis. Such education can be painless. For these reasons, seals are often found by chance by the man himself or the doctor during the examination.
Symptoms of the disease
With the progression of seminoma, the following symptoms appear:
- acute pain It occurs when a tumor grows and metastasizes. The pain can go to the groin, abdomen and lower back. These symptoms are the result of metastases in the inguinal, paraaortic or retroperitoneal lymph nodes. Severe pain can be a sign of testicular infarction or hemorrhage caused by high blood pressure,
- feeling of heaviness in the testicle
- violation of urination (due to compression of the urinary canals),
- leg swelling (due to pressure on the vena cava),
- hormonal disorders. In adults, they manifest as impotence and reduced libido, in children - premature puberty (body hair, voice change)
- discoloration of the skin.
In the later stages of testicular cancer in men, the patient's condition worsens, he feels weak, tired, he is plagued by headaches, his body temperature is elevated.
Distant metastases cause various symptoms that depend on which organ is affected. If the liver is affected, ascites, jaundice develops, the organ increases. With metastases in the lungs, a cough with blood and shortness of breath appear, and pain and aches in the bones.
Testicular seminoma: stages and classification
Seminoma is divided into:
- Classic (diagnosed in 85% of cases).
- Anaplastic (10% of all by seed). This species is more malignant, there is a pronounced polymorphism in the cells and nuclei of such a tumor, there is a large number of mitoses (divisions). Components of anaplastic seminoma may be present in a typical variant or its metastases.
- Spermatocyte (5%). Also more dangerous than the classic version. It consists of 3 types of cells, sometimes with cysts and areas of hemorrhage. Reaches the big sizes (15 cm). It occurs mainly in men after 50 years.
Spermatocytic and anaplastic Simenoma aggressive, treat them much harder, but they are rare.
Stages of seminoma of the testicles:
- In the first stage, the tumor is located within the testicle. Metasases are not observed. The prognosis is very good: 95% recovery.
- The tumor is growing. There are adjacent metastases in the retroperitoneal lymph nodes.
- At the third stage, seminoma grows beyond the testicle, it is deformed, metastasis spreads to distant lymph nodes or organs.
Determining the stage of cancer plays a very important role. Tactics of treatment depends on how much the tumor has spread. Diagnosis must pass quickly, because testicular cancer can progress rapidly, and in just a few months it can move from the first stage to the second and third.
Diagnosis of testicular seminoma
The doctor first examines and palpates to determine the nature and size of the tumor. Also important is accurate history taking.
To confirm the diagnosis of seminoma of the right testicle or seminoma of the left testicle, scrotal ultrasound is used. Ultrasound examination allows you to get a layer-by-layer image of the testicle, where you can see the tumor, its location and exclude other diseases with similar symptoms (for example, dropsy). To determine the metastasis in nearby organs, lymph nodes and blood vessels, urography, lymphography and venokavagraphy are performed.
In rare cases, a testicle biopsy is performed, during which a needle is punctured and the tumor biomaterial is collected. Then he is sent to a laboratory for research, where the presence and type of cancer are determined with accuracy. A biopsy is used only when it is not possible to obtain accurate results by other means, since it is quite dangerous in this pathology.
An abdominal ultrasound scan is done after confirming the diagnosis in order to see possible metastases. If you suspect distant cancer, you will also need to have a chest x-ray, computed tomography of the liver, MRI and other studies, depending on which organ may be affected.
Another necessary test is a blood test for tumor markers. It allows you to detect the presence of a certain type of cancer. All these procedures are aimed at accurately determining the stage and prevalence of the disease in order to select the appropriate treatment method based on the results obtained. It also depends on whether a seminoma or non-seminomeric testicular tumor was found, since the tactics for each species are different.
Treatment of testicular seminoma
The first stage of treatment of testicular cancer in men is surgical removal of the tumor. During surgery, an orphiductomyctomy excised testicle with an appendage, a cord and shells. It happens and bilateral orchiectomy, it is done, if the tumors are in both testicles. In the presence of indications remove the approximate lymph nodes or nodes of the abdominal cavity.
After orchiectomy, they again conduct research on tumor markers, perform CT scan of organs and X-rays. This is necessary to determine the results of the operation: it is important to know whether the tumor and metastasis were completely removed.
The second stage of treatment is chemotherapy or radiation therapy. These methods are used to destroy residual cancer cells and prevent its spread. In some cases, in the first stage, it is sufficient to perform a total orchiectomy without additional treatment.
Postoperative therapy is selected depending on the stage of seminoma and the size of metastases.
The курс and ΙΙ stages are usually prescribed a course of radiation in the groin and abdominal lymph nodes. May also include the area of paraaortic and iliac lymph nodes. If radiation therapy did not produce results (and this happens only in 5% of cases with the first stage, and 25% with the second), then an additional chemotherapy is prescribed.
Chemotherapy for testicular seminomine is recommended for patients with extensive cancer and distant metastases. Patients need 4 courses. Complete regression at the end of treatment is observed in 75% of patients. In some patients with metastases greater than 10 cm, it is not possible to completely destroy the tumor.
Chemistry with Simenoma is more effective than radiotherapy, but it has a devastating effect not only on the tumor cells, but also on the organism as a whole. Therefore, doctors try to prescribe the use of such drugs only in extreme cases, when it is really necessary. Any treatment of seminoma of the testes is carried out according to different schemes and is prescribed strictly individually.
After all the manipulations should be regularly examined within 5 years. Patients take a blood test for tumor markers every 2 months (the first year after surgery), the next year - once in 3 months, and then less often. Also, periodically, you need to do ultrasound and CT, in order to constantly monitor the patient's condition, and in time to detect a relapse.
In men who have undergone surgery to remove the testicle, testosterone levels may decrease, due to which the sex drive decreases, the person becomes more irritable, and gains weight. To restore testosterone levels, hormone replacement therapy is prescribed.
Seminoma of the testicle in the early stages is successfully treated, so it must be detected in time. This is more difficult because the symptoms of testicular seminoma are absent in many cases, and patients often complain that signals the presence of metastasis. To prevent this, it is important to undergo a regular examination, especially for people who are at risk.
Prognosis of testicular seminoma
How many people live after treatment of testicular seminomus? People with Ι and ΙΙ stage who underwent total orchiectomy, live in another 5 years in 90% of cases, 80% of patients live for up to 10 years. But this indicator is also influenced by the type of tumor: if it is an annaplastic seminoma, then 10-year survival is observed in only 70% of patients. For the stage, this percentage is much less - about 60-70% of the five-year survival after undergoing therapy.
Relapses do not occur often (from 5 to 20%), their probability depends on the size of the metastasis.
The prognosis of seminoma of the testicles in relation to the probability of having children is quite good: in most cases, after surgery to remove one testicle, the man maintains a reproductive function and he can lead a normal sex life, since one testicle can cope with these functions. But such consequences as infertility or erection problems are not excluded, therefore it is desirable to preserve the sperm for later storage before starting treatment.
For an aesthetic appearance, during surgery, a prosthesis may be inserted under the skin at the site of the removed testicle.
What can be done to prevent testicular cancer?
- Timely treatment of cryptorchidism. This will reduce the risk of cancer.
- Independent probing, and if you find any seals - contact your urologist.
- Avoid injury to the scrotum.
It is impossible to predict the occurrence of testicular cancer, since the exact causes of its appearance are unknown. The only thing that can be done is to regularly (once a year) be examined and respond in time when signs of seminoma appear. These simple actions can significantly prolong your life!
Features of the disease
Seminoma under the microscope
A tumor is formed from germ cells (pluripotent). The main area of damage is the structure of the testicle. Most often, the neoplasm develops in men at young and middle age. In exceptional cases, pathology can occur in men in old age and in young children.
Seminoma is considered a common pathology, as it accounts for about 40% of all tumors that occur in the testicles. Neoplasms forming on testicular tissue make up 90% of all tumor formations in men.
The main risk is a neoplasm diagnosed as a cancer. Timely diagnosis and treatment play a major role in the prognosis of the disease. Testicular seminoma is treatable, but with the development of a malignant pathological process, there may be greater risks to the patient's life.
The cause of the pathology can be germ cell tubular neoplasia. In the process of changes, mutating cells are activated, provoking the development of a cancer. A characteristic feature of the seed is the ability to relapse, even after the neoplasm has been completely removed by surgery.
At the doctor
The disease is inherited. In the majority of patients, one of the relatives had previously suffered from a seminoma tumor. This is the most common reason. The type of genetic inheritance of the propensity to pathology can be different. Not always the disease is transmitted from generation to generation. Hereditary cell mutation can occur over several generations.
The occurrence of the disease is often detected with cryptorchidism. How these two pathologies are interconnected is not certain. Some experts believe that common diseases include common pathogenetic and etiological factors. Others suggest that common between these diseases is a causal relationship.
Reasons such as smoking and trauma are not supported by scientists. Most likely, the provoking factors are the diseases listed above and genetic predisposition.
Depending on the clinical picture and the features of seminoma, the tumor is divided into three types. What type of tumor the patient has is determined individually.
There are the following types of testicular tumor:
The first type is detected in 85% of patients. It occurs in men aged 20 to 40 years. The provoking factor is cryptorchidism. The tumor is presented as a single node (rarely several nodes). The color of the tumor is white with a slight sheen. Tuberculosis granulomas are not always diagnosed.
Spermatocytic seminoma is diagnosed in only 5-10% of patients. Its peculiarity is that the disease develops in most cases in men older than 50 years. The surface of the tumor has a yellow tint and is covered with mucus. When the incision can be detected hemorrhage, as well as necrosis or cyst. Granulomas are absent.
Anaplastic seminoma is detected only in 5-10% of patients, as well as spermatocytic. Her character is more aggressive. The shape of the cells of pathological tissues may be different. The severity of the neoplasm is weak. Granulomas are not detectable.
The extent of tumor spread in the body is estimated by the degrees used to diagnose cancer.
- First: the formation of tumors, in which the testicle has not yet been deformed, and the protein shell is intact.
- Second: the seminoma is local, the protein membrane is affected, the testicle is deformed.
- Third: the spread of metastases to lymph nodes is added to existing pathological processes.
- Fourth: the overall clinical picture is complicated by the defeat of metastases of the internal organs.
It is worth noting that the tumor may have a benign character. In this case, the classification of the development of the disease according to stages is not taken into account, since the pathology progresses not according to the described scheme.
Symptoms of seminomics
Problems with potency
Symptomatology of seminoma may be absent during the course of the disease. Only in some cases, patients experience discomfort and pain in the groin area. It is possible to diagnose a neoplasm only by assessing the condition of the organ. In pathology, the testicle is enlarged and thickened.
In exceptional cases, it is noted:
- potency disorder
- hormonal fund disorder
- earlier puberty
With the growth of the tumor to the maximum size (30 cm), hemorrhage may occur in the testicle or heart attack.
Observed symptoms of the disease at the third stage of development. At this stage, the spread of metastasis begins, which lead to disruption of the work of other organs, and as a result, the appearance of signs of the disease.
Symptoms of metastasis
Depending on the area in which metastases occur, the patient has certain symptoms:
- Retroperitoneal lymph nodes: pain in the lumbar region
- Paraaortal lymph nodes: pain in the abdomen and leg swelling
- Intra-abdominal lymph nodes: abdominal pain and intestinal obstruction
- Liver: enlarged liver, jaundice and ascites
- Lungs: cough, shortness of breath and hemoptysis
- Skeleton: pain in the bones
The more the pathological process progresses, the more the patient's condition worsens. In the third stage, weight loss, nervousness, anemia and weakness are noted. External signs include asymmetry of the scrotum.
Diagnosis of the disease
In most cases, patients go to a medical institution with complaints when there are already metastases.
To diagnose the disease at this stage is easy. In order to determine the clinical picture and establish the diagnosis, conduct a series of diagnostic studies:
- patient survey and examination
- collection of analyzes
- hardware examination
It is possible to reveal a neoplasm with the help of an ultrasound of the scrotum and adjacent organs. To detect metastases, the doctor sends the patient to undergo a hardware diagnostic:
- chest x-ray
- Liver mri
- Abdominal CT
- skeletal bone tissue scan
Могут быть назначены и дополнительные методы обследования в зависимости от стадии патологии и особенностей организма.
Mandatory step is the delivery of tests for tumor markers. It is this study that determines whether a tumor is malignant.
A tumor that develops on the testicle is being treated. But a major role is played by the pathology stage at which the disease was diagnosed. In the initial stages of progression, the disease can be cured completely.
In the first two stages, a therapeutic method of exposure. However, therapy is carried out by means of radiation or chemical radiation. At the third stage surgery is possible.
The most dangerous seminoma in the third and fourth stage, when metastases do not just penetrate into the lymph nodes and other organs, but also begin to grow. It is the malignant form of the disease that increases the risk of death. In some cases, the patient is rescued by removal of the affected organ, as well as tissues with metastases. The treatment is carried out on an individual basis, since a large number of factors affect the scheme of the whole therapy.
Chemotherapy is necessarily carried out after the removal of the tumor. Also, the technique is used for several months after surgery. Chemical exposure is the only treatment option that prevents the spread of metastases and the growth of cancer cells.
Treatment by stages
Semenoma testicles develops in the male body in stages. Accordingly, the treatment of pathology is carried out depending on the stage at which the disease was detected. Naturally, the treatment at the first stage is carried out more successfully, besides, the body is not exposed to the strong effects of medical intervention.
The neoplasm affects only the testicle, so all the actions of doctors are aimed at eliminating the tumor, until it began to progress further. The treatment is carried out after the passage of the patient a full diagnosis.
At the first stage of the pathology, radiation therapy is performed to which the groin lymph nodes are exposed from the side of tumor formation, as well as retroperitoneal lymph nodes. Irradiation of the supraclavicular region and mediastinal lymph nodes may be indicated.
In most cases, at the first stage, seminoma stops progressing after several courses of radiation therapy. But according to statistics, in 5% of patients the neoplasm continues to grow. Then combined chemotherapy with drugs (platinum) is applied.
The growth of the tumor and the development of metastasis in the lymph nodes (retroperitoneal). Treatment in the second stage depends on the size and number of metastatic formations. If the patient has an education less than five centimeters, then the radiation method of therapeutic treatment of the inguinal and iliac lymph nodes is most often prescribed. After the end of treatment, relapses occur only in rare cases.
If more than five centimeters are detected as a result of diagnostics of formations, radiation therapy does not give the same high percent of a positive prognosis. The recurrence rate is more than five times.
Therefore, experts prefer to recommend chemotherapy to patients.
Causes of seminoma development
The causes of the disease are not precisely established. Researchers point out a number of factors contributing to the development of seminomas. Germ cell tumors often occur on the background of a previous precancerous process - intra-tubular germ cell neoplasia. Modified tissue contains mutated cells, which, in an unfavorable scenario, can give rise to a malignant tumor. Seminomas can also occur again, some time after the radical surgical removal of the primary tumor.
Adverse heredity is essential - according to studies, blood relatives of a seminoma are diagnosed more often than the population average. In this case, the type of inheritance can be any, so the tumors often develop not with relatives, but with distant relatives or are detected after several generations. Experts also note the connection of seminoma with hyperestrogenism, including due to genetic abnormalities, for example, Klinefelter syndrome. In such cases, seminoma extragonadal localization is often detected.
This pathology is often diagnosed with cryptorchidism, but the relationship between diseases has not yet been clarified. Some researchers suggest that seminoma and cryptorchidism have a number of common etiological and pathogenetic factors. Others believe that there is a causal relationship between diseases. Some scientists point to a possible increase in the risk of developing seminoma with the constant use of large quantities of dairy products. The link between germ cell tumors and smoking is absent. The version of the increased likelihood of a seminoma after traumatic injury is not supported by the results of research.
At the third stage of development, seminoma is treatable, but its distribution affects several types of lymph nodes and internal organs. In order to cope with the main tumor and metastasis, it is necessary to undergo chemotherapy courses. The duration of the full course is determined individually. In most cases, the patient must undergo four courses of chemotherapy with an interval of three weeks.
In this case, the tumor may spontaneously shrink or disappear. A similar outcome of treatment is observed in 70% of patients. In some patients with large metastases, residual masses of neoplasms may remain, leading to a relapse. Surgery to remove a seminoma is shown in only 15% of patients with a residual tumor mass.
The last stage is considered the most dangerous, since in most cases it is not operable. Chemotherapy and additional treatment is carried out in order to maintain the life of the patient. Surgical intervention is performed in exceptional cases. In the fourth stage, metastasis affects too large an area.
Treatment of the last stage of tumor progression is carried out in accordance with all methods of cancer treatment, including the use of narcotic painkillers and a chemotherapy course. The life span of a patient depends on many factors.
Seminoma is a dangerous form of the disease. However, with the right treatment, the probability of resorption of the neoplasm is high. Repeated therapy is carried out in case of recurrence or detection of tumor markers.
All patients with a diagnosis of seminoma should be monitored regularly by a doctor for five years. This period is given to the probability of re-development of the disease. According to statistics, relapse is detected only in 10% of patients. In order to increase the chances of recovery, it is necessary to undergo a regular check-up with a doctor, at the first signs to contact specialists and not to self-medicate.
On average, the prognosis of survival in seminome is not as favorable in the presence of a cancer. Five-year survival statistics, is only 40%. In benign form - from 90%. These data indicate a general situation; these figures cannot be applied to an individual case.
The earlier a tumor is found in the human body, the more chances it has for a long and full life. It is possible to identify a patient during examination by a urologist, who should be visited at least once every six months. It is an examination by a specialist that can help determine the progressing disease in time.
In the presence of pathology should not resort to the use of folk remedies. Alternative medicine can only be used with the permission of the doctor and not to the detriment of drug treatment. Even in the absence of positive results, there is no need to reject medical methods. Elimination of such a dangerous disease as the seminoma of the testicle, should be dealt with by qualified specialists with experience in dealing with the pathologies of the human body.
What is developing
Semenomas testicles develop against the background of the following predisposing pathologies:
- Testicular atrophy.
- Disruption of the hormonal balance in the body.
- Cryptorchidism. This pathology is characterized by undescended testicle in the scrotum area.
- Precancerous process (germ cell intratubal geoplasia).
- Hereditary predisposition: mutation of cellular structures occurs mainly in 2-3 generations.
- Genetic abnormalities (for example, Klinefelter’s disease). In this case, there is a development of education that has an extragonadal region of location.
Some experts argue that testicular seminoma may develop as a result of mechanical damage or on the background of bad habits. This fact has not been confirmed scientifically. The most likely causes are genetic predisposition and the diseases listed above.
Due to the fact that seminoma and non-seminomic tumors in the testicle do not give early symptoms, patients go to the clinic already in the late stages of disease progression, which are difficult to treat, as they are accompanied by metastasis.
When symptoms appear, full diagnosis is required.
In order to eliminate the likelihood of such complications, it is necessary to undergo diagnosis as soon as possible. To determine the presence of a tumor, you can use an ultrasound scrotum. To determine the metastases are assigned X-rays, MRI of the liver and CT of the peritoneum, as well as bone scintigraphy. Among the additional measures of diagnosis should be distinguished blood test for tumor markers to determine the malignancy of the formation.
Education in the field of the testicle with timely treatment to the doctor undergoes treatment.
The prognosis for this disease depends on the stage of the pathological process. In the initial stages of development, the disease can be completely cured. It is important to conduct a differential diagnosis, as testicular dysgerminoma has similar symptoms. In this case, a completely different treatment tactic is needed.
After removal of the formation, chemotherapy treatment is mandatory. This method is used for 2-4 months after the surgical removal of the tumor. Radiation therapy is necessary in order to stop the spread of metastases and prevent the development of relapses.
Treatment measures are taken depending on what stage the disease is at:
The prognosis is favorable. The disease does not threaten the life of the patient, but requires the adoption of drastic measures. Symptoms are practically absent. Therapeutic actions are aimed at removing the tumor in order to prevent further progression of the disease. Therapy is prescribed on the basis of the results of the diagnosis and involves radiation therapy in the area of the retroperitoneal lymph nodes and from the site of neoplasm localization. Most often, these measures are enough to stop the progression of the disease. Several courses of radiation therapy stop tumor growth in the primary stage of the disease in 95% of cases. In the remaining patients, testicular seminoma continues to increase in size. This is corrected using combination chemotherapy, which is based on drugs containing platinum.
In the second stage of the disease, radiation therapy is used.
Symptoms of the disease are mild. Tactics of treatment depends on whether the tumor is benign or malignant. If the testicular tumor is less than 5 cm, then the iliac and inguinal lymph nodes are irradiated. After treatment, relapses are quite rare. If the tumor is more than 5 cm, then there is little benefit from radiotherapy. A positive forecast in this case is not given, and the probability of relapse increases more than 5 times. That is why in this case, chemotherapy. Almost all patients in the second stage of progression of the disease are completely cured.
Symptoms give the patient a lot of discomfort. At this stage of progression, seminoma is still treatable, despite the fact that it extends to some internal organs and lymph nodes. In this case, chemotherapy is mandatory. The duration of treatment depends on the individual characteristics of each patient. Most often there is a need to undergo 4 courses of treatment, between which they take a break of 3 weeks.
At the third stage, the formation can independently decrease in size and disappear altogether. Such an outcome is observed in 70% of cases. If in this case residual masses of the tumor remain, which are formed during metastasis, then the probability of relapse is very high. Surgical removal is shown only in 20% of cases, if there is residual metastasis.
This stage of progression of the seminoma in the testicle is the most dangerous. Such education in most cases is inoperable. All that can be done to help the patient is to provide treatment for life support. Chemotherapy is prescribed for this purpose. In isolated cases, an operation is performed, which, as a rule, gives a small result, since metastases affect very large areas.
The fourth stage of the disease is the most dangerous
At stage 4 of the progression of seminoma there is a need to use narcotic painkillers. Chemotherapy is mandatory.
And finally, consider the prognosis of the disease. Despite the fact that seminoma is a dangerous disease, with proper and timely treatment, the tumor may disappear completely. Given the statistics, we can conclude that the re-development of the disease occurs in 10% of patients. Patients who are diagnosed with seminoma should regularly visit a specialist for 5 years. During this period, there are risks of recurrence. In order to eliminate the likelihood of complications, you do not need to self-medicate.
The prognosis of survival in the seminoma of the testicle is not very favorable if there is a malignancy of the tumor. About 40% is 5-year survival. With a benign tumor - more than 90%.
At the seminoma of the testicle, the man may remain disabled. Disability is calculated according to the following criteria:
Group I - the formation is in the thickness of the testicle, without causing its deformation, while the protein membrane is not damaged. Metastases are absent.
I I A group - the testicle is deformed, the tumor grows through the protein shell, there are no metastases.
I I B group - the testicle is deformed, the tumor grows through the protein shell, there are single distant metastases.
I I I A group - education grows into the appendage, there is effusion between the membranes, there are no metastases.
I I I B group - the tumor has many regional metastases and can simultaneously affect two testicles.
Group IV A - an extensive testicular tumor disintegrates, grows into the spermatic cord or scrotum, there are no metastases.
IV B group - the tumor is extensive, regional metastases are not removable.
When seminoma testicles are often assigned disability
Practically all patients who have a disease are diagnosed and primary treatment measures do not give the expected result.
Seminoma is a dangerous disease that can be treated in the early stages of progression.
Do not pull on a visit to the doctor when symptoms of the disease. The prognosis of seminoma of the testicle depends on the timeliness of treatment and the competence of a specialist.
Symptoms and causes of the disease
Knowing what is testicular seminoma, one should understand the signs of pathology. The diagnostic process is complicated by the implicitness of the symptoms - a slight increase in the size of the testicle does not cause much concern. As you grow, there are unpleasant pain in the affected area. A distinctive feature in the development of pathology is a large organ tumor, in medicine there are facts of growth up to 30 cm.
Sometimes the disease for a long time proceeds covertly, sprouting into nearby structures and causing an increase in intracranial pressure, which provokes heart attacks, hemorrhages in the testicles. After that, patients come to the clinic with complaints of acute intense pain in the lesion focus.
The primary appeal to the doctor in 10 cases out of 15 is already observed during tumor metastasis to lymph nodes, distant organs.
Seminal seminoma, symptoms:
- Low back pain - with the defeat of the retroperitoneal nodes,
- Abdominal pain, swelling of the lower extremities - due to metastasis and compression of the vena cava,
- Violation of urination associated with squeezing of the ureters,
- Intestinal obstruction
- Liver damage, increase in size, development of ascites - a consequence of metastasis to the liver, jaundice is sometimes possible,
- The defeat of the lungs is expressed in shortness of breath, coughing, hemoptysis,
- Bone pain - affected patient skeleton.
The progression of pathology leads to increased symptoms. Patients become unstable emotionally, quickly tired, manifested apathy, depression.
External signs of seminoma:
- явная асимметрия мошонки в сторону пораженного органа,
- пальпация определяет опухоль в области яичка, при крипторхизме яйцо отсутствует, узел обнаруживается в области живота,
- кожа мошоночного мешочка меняет цвет на желтоватый, серый.
At the initial stage of development, palpation of the node does not cause pain, but the growth of education leads to persistent or acute pain syndrome. In this case, the pain gives in the groin, abdomen. There are signs of intoxication: fever, headache, nausea, and sometimes loss of consciousness.
The apparent cause of the disease has not yet been established. However, there are a number of factors contributing to the development of pathology:
- precancerous processes in the testes - intratubular neoplasia, other mutations,
- cryptorchidism (not letting the testicles into the scrotum) - with this indicator, the risk of developing oncology increases 5 times and does not decrease after the operation to lower the testicles,
- hormonal imbalance,
- atrophy of the testicles,
- endocrine type diseases
- genetic predisposition
- testicle injury
Important! It is important to know about the diagnosis of seminoma, that this is a disease that can be repeated. That is, when a tumor is removed on one testicle, there is a possibility of pathology on another..
Stages of pathology
Testicular cancer is usually distinguished as follows:
- Classic - diagnosed in 85% of cases. Characterized by all the listed signs.
- Annaplastic - takes 10% of cases and is considered the most malignant, characterized by pronounced polymorphism in cells. Components of anaplastic cancer can be detected in a typical form or with metastasis.
- Spermacytic (5%) is an even more dangerous variant, in which there are three types of cells. Often accompanied by cystosis, hemorrhages, the tumor reaches a size of 15 cm or more. It occurs in age patients from 50 years.
Spermatocytic and anaplastic cancer are aggressive forms of oncology that are difficult to completely eliminate. However, this seminoma is extremely rare.
Different stages of cancer:
- I - the tumor is localized within the testicle, no metastases, predictions of recovery 95%,
- II - tumor proliferation, metastases affect the retroperitoneal lymph nodes,
- III - the stage at which the seminoma goes far beyond the limits of the testicle, deforming the organ, the cancer cells grow into distant organs.
Important! Treatment depends on the degree of damage, the size of the tumor and the individual characteristics of the patient. Diagnostic measures should take place in a fast manner, since the oncology of the testicles can take an aggressive form and in a few months go toII-Stage III. Diagnostic tests of any type are aimed at separating benign from malignant tumors - the implicit symptomatology requires a particularly accurate approach to instrumental and other methods of examining a patient..
Treatment and Prevention
Knowing what a seminoma is and how dangerous a disease is, you should not despair. At the first stage of surgical treatment - the tumor is removed, along with the testicle, appendage, spermatic cord, membranes. If the pathology affects both testicles, a bilateral orchiectomy is performed, and the proximal lymph nodes are removed.
After surgery, tests for tumor markers, CT scan of organs and radiography are taken. Studies allow to determine the effectiveness of the intervention, to identify the complete removal of the tumor and metastasis.
The second stage is irradiation. Used chemotherapy, radiation therapy. In this way, residual cancer cells are destroyed and the process of spreading mutated cells is prevented. Sometimes it is enough to have an orchiectomy, without additional irradiation.
Postoperative therapy is selected depending on the degree of damage and the size of metastases. At stage I-II, treatment is supplemented by irradiation of the inguinal, retroperitoneal lymph nodes. In the absence of effect, chemotherapy may be prescribed.
Important! Chemotherapy is carried out with extensive organ damage, the presence of distant metastasis. Patients are advised to conduct 4 courses of therapy, which increases the success rate of complete healing in 75%, however, in patients with metastases more than 10 cm, removal of the tumor is a longer process. Chemotherapy is believed to be a more effective method than radiotherapy. But chemistry has a negative effect not only on cancer cells, but on the whole organism, therefore, the prescription requires weighing the risks for the patient’s health..
Patients after treatment should be examined for 5 years: once in 2 months to pass oncomarkers (in the first 12 months after surgery), then once a quarter, then much less often. At appropriate intervals, the doctor prescribes ultrasound and CT to prevent the development of malignant cells and their spread.
Sometimes a man may feel a decrease in libido due to a decrease in testosterone production, a person becomes irritable, gaining weight. This patient is recommended to undergo a course of hormone replacement therapy - this will help to resume the production of hormones and normalize the condition.
With regard to the effectiveness of the cure, the prognosis for patients undergoing surgery at stage I-II is favorable: 90% step over the threshold of 5 years, 80% - the threshold of 10 years. The consequences of the positive outcome of the intervention are affected: the patient's lifestyle, type of oncology. In particular, if annaplastic oncology is detected, then the 10-year survival threshold is observed in 70%, for the third stage of the disease, the five-year survival rate is 60%. The occurrence of relapse is observed in 5-20% of cases, it all depends on the size of metastases, areas of organ damage.
After removing the disease, patients can have children, the function of fertilization is preserved in full. However, there is a risk of impotence and infertility, therefore, it is reasonable to preserve sperm before an operation if a man wants to be confident in his offspring.
Prevention of oncology is the timely referral to a specialist with the slightest sign of discomfort, compaction in the testicles. Injuries to the scrotum should be avoided and if there is a predisposition, for example, after the treatment of cryptorchidism, do not forget about a regular examination by a urologist.
The disease occurs infrequently. The proportion of testicular cancer among the malignant tumors that affect men is about 2%. However, there is a trend of growth over the past decades, which causes serious alertness among doctors.
The causes of the development of seminoma of the testicle, as well as of any malignant formation, are not fully known. Among the predisposing factors, heredity and cryptorchidism (undescended testicle into the scrotum during the period of embryonic development) are considered to be the most significant. A number of patients had a history of genital trauma, endocrine pathologies were noted.
Symptoms and course
At a seminoma there is pain, swelling and an increase in testicle size.
The clinical manifestations of testicular seminomus depend on the stage of the disease.
In the initial period, patients independently detect the induration of the testicle and the presence of a solid formation on it. In the future, there is pain in the testicle and scrotum, swelling of the testicle and an increase in its size.
As the disease progresses, pain appears in the groin and back. This is due to the spread of metastases in the regional lymph nodes. Swelling of the legs may develop due to squeezing of the veins. Significantly enlarged metastatic conglomerates in the groin can sometimes squeeze the ureter, leading to urinary retention. Distant metastases usually affect the lungs. At the same time cough with blood and an asthma joins. If metastases have spread to the liver, jaundice, pain in the right hypochondrium, ascites (fluid in the abdominal cavity) develops. With the localization of metastases in the bones, intense breaking pain occurs in them.
Typical symptoms of cancer intoxication, characteristic of any type of oncology - general weakness, weight loss, asthenia, lethargy, are also typical for testicular seminome, especially during progression.
Timely treatment of cryptorchidism is the prevention of the development of cancer education.
Speaking about the prevention of primary seminoma of the testicle, you should pay attention to the timely treatment of cryptorchidism. Patients who underwent an operation to lower the testicle into the scrotum require close observation throughout their lives, since, according to statistics, it is they who most often develop a tumor. You should also avoid injuries of the genital organs and timely treat inflammatory diseases of the genital area.
Patients undergoing surgery to remove seminomies require constant monitoring. In the first year after discharge, a general examination is necessary, including blood for tumor markers, once every 2 months. In the second year, patients are observed at least once every three months. Next year - 1 time per quarter. In the future, depending on the condition of the patient, the examination is carried out 1 time in half a year or less.
Stage 1 With early diagnosis and timely comprehensive treatment, the prognosis is quite favorable. Patients with the first stage of the disease after surgery, as a rule, fully recover (up to 95%) and lead a full life, including having children.
Stage 2 In the second stage of the disease, against the background of a generally favorable outcome, there is a higher risk of recurrence (15-20% of patients are at risk of becoming ill again within the next five years). Such patients require close observation during this period.
3-4 stage. The prognosis for the third and fourth stages depends on the size of the tumor, the prevalence of metastases and the degree of damage to vital organs and body systems.
Thus, the key to the recovery of the patient is the earliest diagnosis of the disease and timely proper treatment.
Prognosis and prevention of seminom
Five-year survival rate at stage I of the disease is 93.7%, at stage II - 90%, at stage III - 57.9%. Up to 10 years after the end of treatment, more than 80% of patients with stage I-II seminars live. Relapses during the first five years after radical surgery occur in 15–20% of patients with seminoma. The likelihood of recurrence depends on the size of the tumor and the presence or absence of damage to the membranes of the testicle. 70% of relapses are diagnosed in the first 2 years after surgery. Recurrent neoplasms are most often found in the subphrenic lymph nodes.
During the first year after the end of the treatment of seminoma, a clinical examination, chest X-ray and blood tests for tumor markers are performed once every 2 months, for the second - once every 3 months, during the third - once every 4 months. Subsequently, the frequency of examination depends on the stage of cancer. The frequency of abdominal ultrasound and CT scan of the abdominal cavity and pelvic organs are also planned based on the seminoma stage. If any suspicious symptoms occur, the examination plan is determined individually.
Causes and stages of the disease
Observations show that testicular seminoma most often develops in certain age periods, which is associated with the causes that provoke the tumor. The peak of the disease falls on:
- Childhood to 10 years,
- The average age is from 20 to 40,
- Old age after 60.
In children, the cause of seminoma may be teratoma, which was formed in the prenatal period. This tumor may be initially benign, but malignancy occurs in the first decade of life. Teratoma causes about 90% of all "children's" seminom.
In middle-aged men, seminoma causes are more diverse. Among them:
- Damage to the scrotum,
- Endocrine pathology with sexual disorders,
- Chromosomal abnormalities (Klinefelter syndrome).
Cryptorchidism and its stages
Cryptorchidism - “undescended” testicles in the scrotum is the most common cause of cancer, increasing its probability by about 10 times. The gonad, which is not in the scrotum, is constantly affected by elevated temperature, due to which metabolic processes and spermatogenesis are disturbed, there are prerequisites for malignant transformation of the epithelium, therefore, during cryptorchidism, an operation to return the organ to the scrotum is always shown.
There are and hereditary mechanisms tumor development. If close blood relatives (father, brother) are sick or have a seminoma, then its likelihood among other members of the male family is increased.
Seminoma is more often diagnosed in Europeans, especially in the Scandinavian countries, Germany, while in Asia and Africa, the incidence rate is very low.
Stage seminoma is determined on the basis of its size, the ratio with the tissues of the reproductive gland, metastasis:
- Stage I, when neoplasia is located within an organ, does not metastasize,
- II - the tumor does not go beyond the boundaries of the tunica, but the size and shape of the testicle,
- at stage III, the tumor is embedded in the shell of the organ, appendage,
- at stage IV, seminoma grows into surrounding tissues.
In case of seminoma of the 1 st degree, the neoplasm is limited to the tissues of one gland and does not metastasize, therefore, the treatment efficiency is the highest, and the prognosis for such a tumor is favorable. Further growth of seminoma leads to damage to surrounding tissues, lymph nodes, internal organs, which requires more active treatment and gives significantly less chances for recovery or at least stopping tumor growth.
Manifestations and methods for the diagnosis of testicular seminoma
Symptoms of testicular tumors are absent at first, the tumor does not bother the patient. As the seminoma grows larger in the gonad, a nidus appears in the form of a nodule that does not bring pain. In some cases, the tumor can become quite early painful, especially if it squeezes or germinates the structures of the spermatic cord.
A large tumor causes not only soreness, but also a feeling of heaviness in the scrotum and even abdominal pain. Over time, the tumor becomes noticeable to the naked eye, deforms the scrotum, leads to swelling of tissues.
In addition to local symptoms, at the stage of metastasis, signs of damage to the lymph nodes and internal organs appear. Metastasis to the lymphatic apparatus of the retroperitoneal space provokes back pain, compression of the intestinal loops can cause intestinal obstruction.
Violation of lymphatic drainage from the lower half of the body, compression of the inferior vena cava appear as edema of the legs, expansion of the subcutaneous venous network. If metastases overpress the ureters, then there is a risk of hydronephrosis with urine stagnation in the renal pelvis system, which inevitably leads to organ failure.
Distant metastasis is possible in mediastinal lymph nodes, then the patient is concerned about coughing and shortness of breath. When the seminoma is running, symptoms of intoxication increase, the patient loses weight dramatically, appetite disappears, weakness increases, and a constant fever appears.
With the appearance of any compaction, even painless, the majority of men in the scrotum tend to get to the doctor faster, because the testicles are not only an organ that provides sexual activity, but also an element of the reproductive system, so their health is extremely important for patients of young and mature age.
It is possible to assume a tumor of the genital glands already at the stage of the initial examination, when the doctor has the opportunity to feel the organ. In addition to palpation of the testicle, lymph nodes of the groin area, supraclavicular zone, and abdomen are necessarily examined to exclude metastatic changes.
The next diagnostic step becomes diaphanoscopy - Translucent scrotal tissue. The method is simple, cheap, does not require complex equipment, but allows you to distinguish a tumor from cystic changes.
From instrumental methods for suspected testicular tumor, apply ultrasound, allowing to determine the exact location, the size of the neoplasia, the presence of germination in the surrounding tissue (invasion). Distinguish seeds from other types of testicular cancer allows MRI.
An important step in the diagnosis of seminoma is a laboratory study on the subject tumor markers. At this tumor, alpha-fetoprotein, chorionic gonadotropin, enzymes (LDH, alkaline phosphatase) are determined. More than half of patients with seminoma, these indicators are increased, but their normal level does not exclude the presence of a tumor.
Fordiagnosis of metastases X-ray and ultrasound methods are used to study the lungs, abdominal organs, kidneys, CT, MRI, radioisotope bone scanning are possible.
The most accurate diagnosis allows you to put biopsy - examination of tumor tissue under a microscope. Biopsy taken through the inguinal access with local anesthesia. If seminoma is confirmed, then the gonadal itself and the spermatic cord must be removed.
Treatment of testicular tumors
In the treatment of germ cell tumors of the testicle, an integrated approach is used, including surgical removal of the tumor, radiation, and chemotherapy. In each case, the scheme is developed individually, taking into account the age of the patient and the stage of the disease.
Removal of the tumor is performed during the operation of orchofuniculectomy, when the affected testicle with the spermatic cord is excised. The incision is made in the groin area, not the scrotum, since in the latter case the probability of postoperative metastasis to the lymphatic vessels sharply increases. This intervention is considered radical. Если есть метастазы в лимфоузлах, то их тоже необходимо удалить. Распространение метастазов обычно происходит в забрюшинные лимфоузлы, поэтому проводится retroperitoneal lymphadenectomy by median laparotomy.
surgical treatment of testicular seminoma
Given that testicular cancer is most common among young men, the possibility of organ-sparing surgery is very important. Indications for her consider:
- Single testicle or synchronous growth at once in both testicles,
- The first stage of the tumor without metastasis,
- Peripheral localization of neoplasia in the testicle.
Radiation therapy can be carried out before the operation, in order to reduce the size of the tumor and facilitate the process of its removal, as well as after orchofuniculectomy, to destroy cancer cells that can become a source of relapse. The lymph nodes affected by the metastatic process can be irradiated, which is especially important if it is impossible to remove them radically.
Systemic chemotherapy justified, starting with the third stage of the disease. The most effective schemes include platinum (cisplatin), bleomycin, etoposide.
When two genital glands are removed at once, the testosterone level decreases, which adversely affects the general health and sexual function of the man, and therefore, hormone replacement therapy with testosterone is indicated in the postoperative period.
Treatment of testicular cancer significantly affects the reproductive function of men, perhaps not only temporary, but also persistent irreversible infertility. This fact must be taken into account in young patients who want to have children in the future. In this case, you should consult an andrologist before starting the therapy, pass sperm analysis, and if there is a risk of infertility, cryopreservation of seminal fluid, which for many years can be used with assisted reproductive technologies, can be the way out.
The prognosis for testicular seminomine is quite favorable, but only on condition of early detection of neoplasia and timely treatment. At the first stage, complex therapy allows achieving a complete cure in 90-95% of patients. Delay and progression of the tumor reduces this figure.
Without treatment, the first stage of the seminoma threatens to develop into the third within a matter of months, and in the advanced stage the treatment will be more likely palliative. With widespread metastasis, patients usually live no more than a year.
If the testicle is removed from the stage I-II seminoma, the prognosis can be considered favorable, the vast majority of patients recover, many of them can realize genital function. The risk of recurrence and metastasis necessitates regular monitoring by an oncologist with periodic x-ray examination of the lungs, ultrasound, CT of the abdominal organs and lymph nodes, control of tumor markers and hormonal status.
It is important to remember that testicular seminoma is among the treatable varieties of malignant tumors, so the man’s vigilance, self-examination and an early visit to the doctor are the key to timely diagnosis and successful treatment of the disease.