Assessing the Currently Used Diagnostic and Therapeutic Modalities in Patients with Testicular Cancer

Original article


Muftah Elgarba, Adel Basioney, Hassan Ebolenein

Department of Surgery, Urology Unit, Faculty of Medicine,Omar Elmokhtar University, Libya

JMJ Vol.7, No.3 (Autumn 2007):201-205


Objectives: To analyse the characteristics, natural behaviour, diagnostic modalities and treatment protocols of testicular cancer and their effect on prognosis .
Patients and Methods: Forty patients with testicular cancer were admitted to Mansoura Urology and Nephrology Centre in Egypt between 1993 and 2006. All patients were subjected to history taking, systemic and local examination , laboratory tests either routine or specific tumour markers evaluation, e.g Alpha-fetoprotein (AFP ) and B – human chronic gonado tropin ( BHCG ) and radiological examination e.g scrotal U/S, abdominal U/S, Intra- venous urography, computed tomography and x-ray and tomography. All patients were subjected to high inguinal orchiectomy and after histopathologic examination and staging; patients were subjected to radiotherapy, chemotherapy or retroperitoneal lymph node dissection (RPLND). Then all patients were followed up for a mean duration of 3.1± 0.9years either clinically, by laboratory or radiologicaly. Results: 24 patients out of 40 presented with testicular swelling. Other cases presented with manifestations of metastasis. Four patients had history of undescended testis, another four patients had a history of infertility (but no other risk factors could be detected). All cases examined preoperatively for AFP and BHCG had elevated levels except only four cases of stage I seminoma had normal levels of AFP. Scrotal U/S showed that all seminomatous tumours were hyperechogenic and circumscribed while non seminomatous tumours were hyperechogenic ± transonic areas. 16 patients had paraoratic lymph nodes in CT scanning of the abdomen and 12 of them were non-seminomatous type . Histopathology of the tumours after inguinal orchiectomy revealed 16 of them were seminomatous and 24 were non seminomatous type .12 of the seminomatous tumours were stage I and four were stage II , while only four of seminomatous type were stage I and the rest were stage II and III . All seminoma cases had postoperative radiotherapy while nonseminoma cases had chemotherapy regimen ± RPLND. During follow up all stage I cases showed normalization of AFP and BHCG levels while other cases showed decreased levels but not to normal values. Follow up abdominal CT of seminoma cases was free, teratocarcinoma stage III had post treatment CT. Endodermal seminomatous and embryonal carcinoma showed post treatment decrease in sizs of mass . Mixed germ cell tumour showed no change in the size of mass after chemotherapy. Post treatment CXR and CT showed that positive cases of teratocarcinoma became free after chemotherapy while chest metastasis in mixed germ cell tumour and embryonal were persistant after chemotherapy . Conclusion: The early detection of risk factors, early presentation of the patient, accuracy of the currently used investigations, early recognetion of treatment failure and ability to treat such failures make testicular tumours the most common curable cancer in young males.

Keywords: Testicular tumours, Radiotherapy, Chemotherapy, Retroperitoneal lymph node dissection