Topic 16. Radiotherapy as a Treatment Modality in Seminoma Testis
Seminoma is a malignant germ cell tumor of the testis arising from primitive germ cells. It is the most common pure germ cell tumor and usually affects men between 30 and 45 years of age. Usually uniltateral.
Seminoma is characterized by:
- Slow growth
- High radiosensitivity
- High chemosensitivity
- Excellent prognosis, even in advanced stages
The standard initial treatment is radical inguinal orchiectomy, after which radiotherapy may be used in selected patients.
- Excellent cure rate (>95% in Stage I)
3. Risk Factors
- Cryptorchidism (undescended testis)
- Family history
- Previous testicular cancer
- Testicular dysgenesis
- Infertility
Clinical Features
Patients usually present with:
- Painless testicular swelling or mass
- Enlarged, firm testis
- Feeling of heaviness in the scrotum
- Mild scrotal discomfort
- Back pain (retroperitoneal lymph node metastases)
- Rarely gynecomastia
Diagnosis
Clinical Examination
- Testicular mass
- Enlarged painless testis
Investigations
Scrotal Ultrasound
First- line imaging.
Shows:
- Solid intratesticular lesion
- Tumor size
Serum Tumor Markers
- β- hCG: May be mildly elevated
- AFP: Normal in pure seminoma
- LDH: lactate dehydrogenase- (nonspecific marker of tissue or cell damage).
Imaging
- CT abdomen and pelvis
- Chest CT
- PET/CT (selected residual masses after chemotherapy)