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Testicular Tumours Part 2

Testicular Tumours Part 2. Vinod Jain 16.09.2014. Clinical Staging (Boden and Gibbs – 1971). Stage I (A) – confined to testis with no spread through capsule or spermatic cord Stage II (B) – Clinical or radiological evidence of spread beyond testis but with in regional L.N. B 1 -<2cm

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Testicular Tumours Part 2

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  1. Testicular TumoursPart 2 Vinod Jain 16.09.2014

  2. Clinical Staging (Boden and Gibbs – 1971) • Stage I (A) – confined to testis with no spread through capsule or spermatic cord • Stage II (B) – Clinical or radiological evidence of spread beyond testis but with in regional L.N. • B1 -<2cm • B2 -2-5cm • B3 - >5cm • Stage III (C) - Disseminated above diaphragm / visceral disease

  3. Treatment • Modalities • Surgery • Radiotherapy • Chemotherapy • Stage wise protocol • Care of fertility

  4. Treatment Modalities – Surgery Radical orchiectomy Organ sparing orchiectomy Hemiscrotectomy RPLND (retroperitoneal lymph node dissection - Boundaries) Modified RPLND with surveillance - modification Testicular implants (Silicon or saline)

  5. Treatment Modalities – Radiotherapy Tele-Cobalt RT – 2500 cGy within 3 weeks to paraortic, precaval, bilateral common iliac and external iliac Inguinal – depending on indication

  6. Treatment Modalities – Chemotherapy First line – BEP – Bleomycin, Etoposide and cis-Platinum Second line – Ifosfamide + BEP = Salvage CT Third line – High dose CT with autologous Bone Marrow transplantation

  7. Stage wise protocol – Seminoma (SGCT) Stage I- Radical orchiectomy + 2500 cGy RT in para aortic area Stage II/ B1, B2 – Radical orchiectomy + RT – para aortic + paracaval + Bilat common iliac + ipsilateral ext. iliac. If previous opn/orchiopexy – contralateral inguinal LN with testicular shield Stage II/B3 and stage III – CT x 4 cycles (contd.)

  8. CT x 4 cycles Complete Remission Follow up <3 cm >3 cm Follow up CT Surgical excision / RT Residual retroperitoneal LN

  9. Stage wise protocol – Non Seminoma (NSGCT) Stage I- Radical orchiectomy + RPLND or modified RPLND with surveillance Stage II/B1, B2 – Radical orchiectomy + RPLND (Boundaries) II/B1 – No CT II/B2 – CT x 2 cycles Stage II/B3 and III – CT (BEP) x 4 cycles

  10. CT (BEP) x 4 cycles Tumour marker normalizes Salvage CT (BEP) + ifosfamide Residual mass No residual Mass Remission No remission Always Excision Follow up Follow up Autologous BM transplant + high dose CT or stem cell support Tumour marker increased

  11. Follow Up schedule • 3 monthly x 2 years – then • 6 monthly x 5 years – then • Yearly • Look for • Other testis • Abdomen / L.N. • Haematological Examination • Tumour markers • Chest X-ray • CT scan

  12. Organ sparing surgery Younger age with organ confined tumour of <2 cm size Polar tumours occurring in solitary testis or with contra-lateral tumour (Partial orchiectomy is done)

  13. Let us revise Classification Incidence Etiology Spread of tumour Clinical Staging Clinical features Differential Diagnosis Investigations ---------------------------------------------------------------------------------- Treatment Follow up schedule

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