GuidelinesEAU Guidelines on Testicular Cancer: 2011 Update
Introduction
Testicular cancer is a relatively rare cancer that accounts for about 1–1.5% of male cancers and mainly affects younger men in the third or fourth decade of life [1], [2], [3]. It can be classified into three categories: germ cell tumours (90–95%), cord stromal tumours, and miscellaneous germ cell/sex cord stromal tumours (Table 1) [4].
The cure rates for low and intermediate risk testicular tumours are excellent, which is mainly due to careful staging at the time of diagnosis; adequate early treatment based on chemotherapeutic combinations, with or without radiotherapy and surgery, and very strict follow-up and salvage therapies.
In testicular cancer, the choice of treatment centre is of utmost importance. Although early stages can be successfully treated in a nonreference centre, the relapse rate is higher [5]. In poor-prognosis nonseminomatous germ cell tumours (NSGCTs), overall survival within a clinical trial depended on the number of patients treated at the participating centre (worse survival with fewer than five patients enrolled) [6]. Similarly, the likelihood of residual tumour resection following chemotherapy has been associated with perioperative mortality and overall survival [7], [8].
Section snippets
Evidence acquisition
A multidisciplinary team of urologists, medical oncologists, radiotherapists, and a pathologist were involved in producing this document, which is based on a structured review of the literature from January 2008 until December 2010 for both the germ cell tumour and non–germ cell sections. Also, data from meta-analysis studies, Cochrane evidence, and the recommendations of the European Germ Cell Cancer Consensus Group Meeting in Amsterdam in November 2006 have been included [9], [10], [11].
Diagnosis of testicular cancer
The epidemiologic, pathologic, and clinical risk factors for testicular cancer are well known [13], [14] (Table 2). Diagnosis of testicular cancer is based on (1) clinical examination of the testis, (2) general examination to exclude enlarged nodes or abdominal masses, and (3) ultrasound to confirm a testicular mass.
Staging of testicular tumours
To determine the presence of metastatic or occult disease, the half-life kinetics of serum tumour markers must be assessed, the nodal pathway screened, and the presence of visceral metastases ruled out [10], [11].
Guideline recommendations for diagnosis and staging
Table 6 lists the guidelines for the diagnosis and staging of testicular cancer.
Stage I testicular cancer seminoma
According to modern staging methods, about 15–20% of patients with stage I seminoma have subclinical metastatic disease, usually in the retroperitoneum, and relapse after orchidectomy alone [33].
Metastatic germ cell testicular carcinoma
The treatment of metastatic germ cell tumours depends on the histology of the primary tumour and prognostic groups as defined by the IGCCCG (Table 5).
Follow-up after curative treatment
The aims of follow-up are to detect the relapse of testicular cancer as early as possible and to monitor the contralateral testis. The following principles should be applied following treatment aimed at cure or prolonging life:
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Ensure that the interval between examinations and duration of follow-up is consistent with the time of maximal risk of recurrence.
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The choice of follow-up tests will depend on the increased risk of second malignancy, both at the primary site and in other tissues that may
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