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.
B1 -<2cm
•

B2 -2-5cm
•

B3 - >5cm
•

•
Stage III (C) - Disseminated above
diaphragm / visceral disease
2
 Treatment
•
Modalities
Surgery
–

Radiotherapy
–

Chemotherapy
–

•
Stage wise protocol
•
Care of fertility
 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)
Treatment Modalities – Radiotherapy
Tele-Cobalt RT – 2500 cGy within 3 weeks to
paraortic, precaval, bilateral common iliac
and external iliac
Inguinal – depending on indication
 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
 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.)
 CT x 4 cycles

Residual Complete Remission

retroperitoneal LN

Follow up
<3 cm >3 cm

Follow up Surgical
CT excision / RT
 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
 CT (BEP) x 4 cycles

Tumour marker increased Tumour marker normalizes

Salvage CT (BEP) + ifosfamide

Residual mass No residual Mass

Remission No remission Always Follow up

Excision
Follow up Autologous BM
transplant + high
dose CT or stem
cell support
 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
•
 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)

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