Testicular cancer
| Classification according to ICD-10 | |
|---|---|
| C62.- | Malignant neoplasm of the testicle |
| ICD-10 online (WHO version 2019) | |
As testicular cancer or testicular cancer , a malignant testicular tumor is called, which mainly affects young men in the age group of 20 to 40 years. Testicular cancer is the most common cancer in this age group . It is mostly discovered by self-scanning.
Epidemiology
Compared to other cancers, testicular cancer is rather rare. It only accounts for about one to two percent of all malignant tumors. In the age groups of 2 to 4 year olds and 15 to 19 year old boys, however, it is the most common cancer. On average, eight to ten out of 100,000 men become ill. In Germany, ten out of 100,000 male residents fall ill every year. There are around 4,000 diagnoses and around 150 men die of the disease. The incidence of germ cell tumors of the testicle has increased in the US and Europe. In the United States, 5.7 out of 100,000 men over the age of 15 developed testicular cancer in 1992, compared with 6.8 in 2009. The proportion of seminomas was age-dependent: 29% between the ages of 15 and 26, 78% in those over 40 years of age. The European " EUREG database" also found an increase in the testicular cancer rate in 15 out of 19 countries.
The greatest risk factor for testicular cancer is undescended testes ( Maldescensus testis ). The testicle has remained in the groin area or migrates back there and does not remain in the scrotum as usual .
Men over 1.95 m in height may have an increased risk of developing the disease.
clinic
The classic main symptom of testicular tumor is the painless increase in size of the testicle with a palpable nodule formation within the testicle. Any enlargement of the testicle is suspect and must be examined by a doctor.
Classification: seminom - non-seminom
Malignant neoplasms of the testicle are basically classified according to the tissue from which they arise. 95% of the degenerated cells are germ cells , the remaining five percent of the tumors are formed from the connective and supporting tissue. The majority in the second group are Leydig cell tumors . The germ cell tumors are in turn divided into seminomas and non- seminomas .
| Type | Age peak | most important therapy | Chances of recovery T1 / 2 | in distant metastases |
| Seminomas | 37th year of life | radiotherapy | 95-100% | 85% |
| Non-seminomials | 27. year of age | chemotherapy | > 95% | 50-90% |
The prognosis is generally better for seminomas because the tendency to metastasize is less pronounced in seminomas than in non-seminomas. As with most malignancies , early detection is important , as this is the most important factor for a better chance of recovery.
WHO classification, ICD-o coding
In the S3 guideline "Germ cell tumors of the testes" from 2018, it is recommended to carry out a pathological classification of testicular tumors according to the WHO classification by Moch and colleagues (2016). Here is the German translation.
Germ cell tumors arising from a germ cell neoplasm in situ
Non-invasive germ cell tumors
- 9064/2 Germ cell neoplasia in situ, specific forms of intratubular germ cell neoplasia
The tumor cells reside in the seminiferous tubules.
Tumors of a histological type (pure forms)
- 9061/3 Seminoma: tumor from degenerate sperm cells
- Seminoma with syncytiotrophoblastic giant cells: Special form of the seminoma with giant cells
Non-seminomatous germ cell tumors
The yolk sac is an evolutionary remnant of our egg-laying ancestors and is used for early blood formation.
Trophoblastic tumors
- 9100/3 chorionic carcinoma: the degenerated cells are similar to the cells of a placenta.
- Non-Chorionic Carcinomatous Trophoblastic Tumors
- 9104/1 Trophoblastic placental tumor
- 9105/3 Epithelial Trophoblastic Tumor
- Cystic trophoblastic tumor
9080/3 post-pubertal type teratoma
- 9084/3 Teratoma with development of somatic neoplasms: "miraculous tumors" with various tissues and organ structures.
Non-seminomatous germ cell tumors of more than one histological type
- 9085/3 mixed germ cell tumors
Germ cell tumors of the unknown type
- 9080/1 Regressed germ cell tumors
Germ cell tumors that do not arise from a germ cell neoplasm in situ
- 9063/3 Spermatocytic tumor: cells resemble spermatocytes , which can develop into seminal filaments .
- 9084/0 Teratoma of the prepubertal type
- Dermoid cyst: cavity with skin and skin appendages ( hair , sebum glands )
- Epidermoid cyst
- 8240/3 Highly differentiated neuroendocrine tumor (monodermal teratoma): cells resemble those of the autonomic nervous system
- 9085/3 Mixed tumor: teratoma with yolk sac tumor of the prepubertal type
- 9071/3 Yolk sac tumor of the prepubertal type
Germ-cord / stroma tumors
Pure tumors
- 8650/1 Leydig cell tumor: normal Leydig cells produce hormones.
- 8650/3 Malignant Leydig cell tumor
- 8640/1 Sertoli cell tumor: normal Sertoli cells supply germ cells with their development into sperm.
- 8640/3 Malignant Sertoli cell tumor
- 8642/1 Large-cell calcifying Sertoli cell tumor
- 8643/1 Intratubular large cell hyalinizing Sertoli cell neoplasia
Granulosa cell tumor
- 8620/1 Adult granulosa cell tumor: Granulosa cells normally occur in the female ovary during egg follicle formation.
- 8622/1 Juvenile granulosa cell tumor
- 8600/0 Tumors of the Fibrom-Thekom group: Theca cells occur in the cracked egg follicle of the female ovary
Mixed and unclassified stromal tumors
- 8592/1 Mixed stromal tumors: Stroma is the undifferentiated connective tissue of the testes and ovaries
- 8591/1 Unclassified stromal tumors
Tumors that contain germ cells and parts of the germ line
- 9073/1 gonadoblastoma
Note: The ICD-O is the histological classification of tumors. It is used worldwide by all pathologists to classify examined tissue. The last digit 1 is reserved for benign tissue changes, the 2 stands for non-invasive tumors (in-situ carcinoma) and the last digit 3 denotes malignant tumors.
Operative treatment
The semicastration (here orchiectomy also ablatio testis ), the removal of one of the two testicles, is the first treatment measure in the diagnosis of testicular cancer. The patient's fertility is usually not affected by the removal of a testicle alone. Nevertheless, it is advisable to store semen (similar to the practice with sperm donors) before the procedure - in particular the retroperitoneal lymphadenectomy described below can lead to infertility in some cases, and the properly stored semen gives you the chance to have your own children. It is important to measure the testosterone level before the first operation. In the event of a (rare) occurrence on both sides, the normal mirror can be set again. This is followed by adjuvant therapy adapted to the histology and the respective tumor stage. This can mean active monitoring, chemotherapy, radiation therapy or a combination of radiation and chemotherapy. After a surgical testicle removal, a testicular prosthesis can be inserted.
The retroperitoneal lymphadenectomy (RLA), in which the lymph nodes in the abdomen are removed, is sometimes performed before chemotherapy. The lymph nodes are removed because testicular cancer metastasis passes through them in almost all cases. On the one hand, any affected lymph nodes are removed and, on the other hand, the tumor is deprived of the basis of its spread.
With an existing testicular tumor, there is a risk of precancerous stages ( testicular intraepithelial neoplasia ) also from the contralateral testis. Since the frequent postoperative chemotherapy cures the precancerous stage in seven percent of the cases, a testicular biopsy of the opposite side is only recommended after completion of any chemotherapy. After chemotherapy, testicular intraepithelial neoplasia can be cured by irradiating the testicle.
chemotherapy
Chemotherapy is the therapy of choice for non-seminomas; for seminomas it is usually only used in advanced stages, as seminomas are almost always radiation-sensitive, i.e. they respond well to radiation.
In almost all cases, the active ingredient combination "PEB" is used as chemotherapy. This is made up of the cytostatics cisplatin ( P ), etoposide ( E ) and bleomycin ( B ). Bleomycin has a negative effect on lung function, so that ifosfamide is replaced by ifosfamide (PEI combination) , for example in high-performance athletes or divers (PEI combination), or is omitted. The combination used is administered over one to four cycles , with at least two cycles usually being carried out. The treatment period of 21 days is referred to as the cycle; a therapy schedule defines the exact medication for each day. A peripheral or central venous catheter ( CVC ) placed at the beginning of each cycle is used to infuse large amounts of fluid ( overhydration ) throughout the day . If therapy is given over a full four cycles, the infusion can preferably be administered through an implanted port . A cycle consists primarily of a daily infusion of the active ingredients cisplatin and etoposide for the first five days. Central is the infusion of the active ingredient cisplatin, which is accompanied by a pre- and post-rinse with Ringer's solution and saline. In addition, a strong anti-nausea drug (anti- emetic ) is administered via the infusion . On days 1, 8 and 15, bleomycin is injected, which can cause a metal-like taste in the mouth.
Side effects of the chemotherapy mentioned are relatively limited. Hair loss occurs at the end of the first cycle, depending on the type, a little later. Nausea is common to some extent, but relatively rarely causes vomiting. Food intake is usually quite possible , albeit with certain aversions .
The combination therapy with cisplatin against testicular cancer was developed by Lawrence H. Einhorn from the 1970s .
Other therapeutic strategies
As an alternative to the above methods, a wait-and-see strategy or “watchful waiting” can also be selected in the early stages .
In 1996 the German Cancer Society commissioned the "interdisciplinary working group testicular tumors" (IAH) with diagnostic and therapy guidelines in order to improve the quality of care and therapeutic success. This was the first time that a therapy standard for urologists was set that has been continuously updated ever since.
In 2006, the urological section of the German Study Group for Testicular Tumors launched a second opinion project in order to express the treatment experience of resident doctors with the small number of cases (there are around 4,000 urologists in Germany). At "zm-hodentumor.de", doctors can document their patient cases and therapy proposals and immediately receive one-off advice, the so-called second opinion, on this proposal from a doctor with extensive experience (ZMZ doctor).
Web links
- hodenkrebs.de Interdisciplinary working group testicular tumor
- www.zm-hodentumor.de Project second opinion testicular tumor
- Information on testicular cancer. krebsdaten.de, Center for Cancer Registry Data at the Robert Koch Institute
Individual evidence
- ^ Hautmann, Huland: Urology. 3. Edition. Springer Verlag, 2006, p. 219 f.
- ↑ Hautmann, Gschwend: Urology. 5th edition. Springer Verlag, 2014, p. 208
- ↑ Testicular cancer. Center for Cancer Registry Data (ZfKD)
- ↑ a b Manas Nigam, Briseis Ash Brook Kilfoy, Sergey Shikanov, Scott Eggener: Increasing incidence of testicular cancer in the United States and Europe between 1992 AND 2009 . In: World Journal of Urology . tape 33 , no. 5 , 2015, ISSN 1433-8726 , p. 623-631 , doi : 10.1007 / s00345-014-1361-y , PMID 25030752 .
- ↑ The risk of cancer increases with height . Abendblatt.de
- ^ Leading professional society (s) German Society for Urology e. V. (DGU): S3 guideline for diagnosis, therapy and aftercare of germ cell tumors of the testes, long version 0.1 (consultation version), 2018 AWMF registration number: 043 / 049OL. Oncology guideline program (German Cancer Society, German Cancer Aid, AWMF), accessed on August 15, 2019 .
- ↑ Holger Moch, Antonio L. Cubilla, Peter A. Humphrey, Victor E. Reuter, Thomas M. Ulbright: The 2016 WHO Classification of Tumors of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumors . In: European Urology . tape 70 , no. 1 , July 2016, ISSN 1873-7560 , p. 93-105 , doi : 10.1016 / j.eururo.2016.02.029 , PMID 26935559 .
- ↑ Anja Lorch, Peter Albers, Jörg Beyer, Richard Cathomas, Christoph Oing, Rainer Souchon, Herbert Stöger, Carsten Bokemeyer: Germ cell tumors of men. Onkopedia, 2016, accessed August 15, 2019 .
- ↑ D. Manski: Online textbook of urology. urologielehrbuch.de
