Metastatic Testicular Cancer

Prognosis and Treatment

Testicular Cancer

There are many different types of testicular cancer. The majority originate in the testicles from the cells that form sperm and other components of the reproductive system. When the cancer has left the testicle, it is said to have spread or metastasized. Metastasis may already be apparent at time of diagnosis or may be discovered several years after initial treatment of the primary tumor.

32% of all testicular cancers have spread outside of the testicle at diagnosis1.

How Does Testicular Cancer Spread?

The majority of testicular cancers metastasize through lymphatic vessels and nodes. There are hundreds of lymph nodes throughout the human body and they are connected by lymphatic vessels. The purpose of the lymphatic system is to filter body fluid from the interstitial spaces (i.e. the space between cells) and return it to the heart for recirculation. Unfortunately, this provides a channel for the passage and spread of cancer cells. Less commonly, certain types of testicular cancer can travel and spread via the blood vessels.

Where Does Testicular Cancer Typically Spread?

Due to the fact that it travels primarily through lymphatic vessels, the first place testicular cancer typically spreads is to a group of lymph nodes known as the retroperitoneal lymph nodes. The peritoneum is the membrane that lines the cavity that houses the bowels.

This space is known as the intraperitoneum. Therefore, the zone behind the bowel is known as the retroperitoneum (literally, behind the peritoneum). It is this region that contains the largest blood vessels of the body: the aorta and vena cava. The lymphatic vessels and nodes are near these major blood vessels.

 

The second most common place for spread is the lungs. It may also spread to lymph nodes outside of the retroperitoneum. It is able to metastasize to other sites, which are more rare, including the central nervous system (brain), bones and liver.

How is it Treated?

Treatment is determined by two major factors: testicular cancer stage and type.

Stage I testicular cancer is confined to the testicle. Stage II involves retroperitoneal lymph nodes. Stage III is the most advanced stage and involves spread beyond the retroperitoneal lymph nodes to other locations like the lungs and beyond.

Testicular cancer subtype does not typically make a big difference in treatment of stage III disease. Stage III of either type is treated with different types and doses of chemotherapy. However, cancer type can make a big difference in treatment with stage II disease. For example stage II seminoma testicular cancer can be treated with radiation therapy or chemotherapy. Stage II nonseminoma testicular cancer can be treated with retroperitoneal lymph node dissection or chemotherapy.

Retroperitoneal lymph node dissection involves the surgical removal of the cancerous lymph nodes in the retroperitoneum.

What's the Prognosis?

Testicular cancer is one of the shining successes of the field of oncology. Many solid tumor cancers (solid tumor cancers are most cancers other than leukemias and lymphomas) are incurable once they have spread from their primary site. Testicular cancer is an exception. Lance Armstrong is a perfect example.

The ability to cure testicular cancer once it has spread depends on a number of factors. Prognosis is worse if tumor markers are significantly elevated or if the cancer has spread to locations other than the retroperitoneal lymph nodes or lungs. If neither of these negative factors are present, cure rates are around 90%, which can be as low as 50% or below if they are present.

1. http://seer.cancer.gov/statfacts/html/testis.html

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