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INFO PORTAL Biotracing
GENERAL INFORMATION
Malign testicular tumors are comparatively rare making up for only 1% of all cancer cases. But mostly young men between the ages of 20 to 45 are affected. In this age group it is the most common malign tumor type, cases rising especially in industrial countries.
Because the survival rate for this disease is extremely high (96% after 5 years, 95% after 10 years compared to general population, source: Leitlinienprogramm Onkologie, 2020) it is especially important to consider short- and long-term toxicity of radiotherapy and chemotherapy.
ORIGIN
Testicular tumors develop mostly through faulty ripening of primordial germ cells, which are produced in the testicles.
The result is uninhibited cell division and production which can lead to tumor development. The accumulation of these cells is called germ cell neoplasia in situ (GCNIS).
Because testicular tumors origin in 95% of cases from germ cells the terms “testicular tumor”, “testicular cancer” (TC) and “germ cell tumor” (GCT) are often used synonymously.
In rare cases scattered testicular tissue somewhere else in the body can be affected. In this case there is no tumor at the testicles but at another location in the body. This type of tumor is called extragonadal germ cell tumor.
CAUSES
Although the causes for testicular tumors are largely unknown there are certain risk factors which can make this type of tumor more likely to occur.
These are among others:
- Undescended testicles
- Family disposition
- Testicular cancer at one of both testicles in the past
- Infertility
- Klinefelter syndrome
- Germ cell neoplasia in situ (GCNIS)
CLASSIFICATION
Testicular tumors can be classified according to the type of cell they origin from into seminoma and non-seminoma. Mixed tumors are also classified as non-seminoma.
The classification is an important factor for treatment decisions.
DIAGNOSTICS Biotracing
SYMPTOMS
Most patients have a suspicion due to an abnormality discovered through a self-examination of the testicles and decide to go for a check-up. Symptoms can be but are not limited to:
- palpable, pain free, hard swellings or knots on or at the testicle
- a heavy or pulling sensation at the testicle or the groin
- In rare cases: pain, back pain, dyspnoe (troubled breathing, shortness of breath), weight loss, headaches, gynecomastia (enlarging of mammary gland) or hyperthyroidism
- For more facts around self-examination see: www.testicularcancerawarenessfoundation.org
PRIMARY DIAGNOSTICS
The diagnostics are usually based on a guideline like the European Guideline on Testicular Cancer (see Links).
First steps are a visual examination, palpation of the testicle by a general practitioner or urologist to determine size and firmness of the abnormality, followed by an ultrasound examination. For further diagnostics blood is collected from the patient to determine the classical serum markers AFP, beta-HCG and LDH. At this point M371 supports the primary diagnosis.
The blood profile is completed by measuring testosterone, FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels.
If the suspicion of a testicular tumor or germ cell tumor is hardening further diagnostic measures like a CT scan of the thorax, abdomen, and pelvis as well as examinations for brain or bone metastasis can be started.
For the final diagnosis suspicious testicle tissue is extracted and examined.
A sperm analysis as well as cryopreservation can be discussed with a doctor if the patient desires to have children later on and a potentially fertility impairing therapy is planned.
THERAPY Biotracing
THERAPY
Therapy decisions must be made individually.
The therapy decisions are usually orientated on a guideline like the European Guideline on Testicular Cancer (see Links). In most cases an orchiectomy must be conducted. This means surgically removing the tumor tissue and tissue that is affected. In many cases one testicle is fully removed. The patient is under full anesthesia for the procedure.
If the disease is initially already advanced and acutely life-threatening a chemotherapy can be considered as a first treatment step followed by the orchiectomy.
After the surgery further treatment steps must be discussed between patient and doctor and depend on the stage of the disease.
If there are no further metastasis present at that moment an adjuvant chemotherapy can be considered to reduce the risk of relapse. It is important to discuss pros and cons of this step with your doctor.
The decision between adjuvant therapy and surveillance strategy must be made on an individual basis.
If patient and doctor decide for an adjuvant therapy, either a cycle of chemotherapy or radiotherapy can be used.
FOLLOW-UP
After the surgery
The classical serum marker levels as well as M371 can be compared pre- and post-surgery for clues about the success of the surgery and if tumor tissue still resides in the body.
In the following years ...
About 5-10% of GCT patients need a relapse or salvage therapy at some point in their life. The main goal of monitoring is to detect and diagnose relapses as early as possible, especially in the first years after primary diagnosis. The diagnostic tools for monitoring are similar as for primary diagnosis from ultrasound examination to serum markers, radiology, or extended blood profiles.
In the later years after primary diagnosis the monitoring also covers the effects of late toxicity of the primary treatment of the tumor. A specific monitoring plan is set up for each patient which depends on original tumor state, age, and more factors.
WEBSITES Biotracing
LINKS
www.onkopedia.com
Website of the „Deutsche Gesellschaft für Hämatologie und Onkologie e.V.“ (German Society for hematology and oncology). Contains detailed information on germ cell tumors of men.
www.hodencheck.de
Information on testicular cancer specifically how to self-examine by the "Deutsche Gesellschaft für Urologie" (German Society for urology).
(This site is in German only)
www.hodenkrebs.de
Information and advice on how to live with testicular tumors for patients, relatives and medical professionals by the German interdisciplinary working group on testicular tumors.
(This site is in German only)
hodentumor.zweitmeinung-online.de
Platform where medical professionals can exchange opinions on their patients’ diagnostics and treatment.
(This site is in German only)
www.leitlinienprogramm-onkologie.de/leitlinien/hodentumoren
German guideline for the treatment of germ cell tumors.
(This site is in German only)
www.pate-hodenkrebs.de
German project for prevention and education about testicular diseases, directed especially towards young men.
(This site is in German only)
www.testicularcancerawarenessfoundation.org
Nonprofit organization informing about self-exams, support, and guidance for patients.
www.urologyhealth.org
Website by the Urology Care Foundation, powered by the American Urological Association offers further information on urological health including testicular cancer.
www.nhs.uk/conditions/testicular-cancer
The UK’s biggest health website powered by the British national health service. Offers further information on testicular cancer and treatment.
uroweb.org/guideline/testicular-cancer
Download the EAU Guideline on Testicular Cancer, powered by European Association of Urology.
GLOSSARY Biotracing
GLOSSARY
A
Abdomen
stomach, trunk
Ablatio testis
The complete removal of one or both testis. See orchiectomy
Adjuvant Therapy
Treatment that is given after primary therapy to lessen the chance of cancer coming back.
AFP
Alpha-Fetoprotein. A tumor marker that can indicate testicular tumors in particular non-seminoma tumors. The comparison of pre- and post-operative levels can give an indication if the surgery was successful.
B
Benign
A benign growth is not infiltrating the surrounding tissue, grows slowly and is not likely to be harmful.
Beta HCG
Human chorionic gonadotropine. Tumor marker measured in the blood serum of patients with suspected testicular tumors. Comparison of pre- and post-operative values can provide indications of the success of therapy. Used primarily to support the diagnosis of seminoma.
Bilateral
both sided
Biopsy
Diagnostic method for which tissue is removed and microscopically examined. Used for the diagnosis of cancer.
C
Carcinoma
Tumor disease originating from the surface tissue (epithelial cells). Makes up for approx. 80% of all malignant tumors.
Chemotherapy
Drug treatment for cancer in which cytostatic drugs are used.
Cisplatin
Cytostatic drug
Clinical study
Experimental investigation of a treatment method under specific conditions.
Computed tomography
Imaging procedure with which various body structures, for example the abdomen, can be depicted through X-rays. This procedure can be used to determine whether metastases are present in the body.
Contra indication
Factor that speaks against a particular therapy
Contralateral
On the opposite side of the body
Contrast medium
Used to improve the visualization of heavily perfused tumors or inflammation on CT or MRI.
Curative
Healing
Cytostatic
Natural or synthetic substances that slow down or stop cell growth which are used in chemotherapy.
Cytotoxicity, cytotoxic
Toxicity of a substance to living cells or tissues
D
Diagnostics
Doctrine that refers to the making of diagnoses. All examinations that lead to the determination of a disease.
Discordant
At odds, differing
Dissection
Surgical procedure
DNA (cf, c)
DNA = deoxyribonucleic acid. The molecule that carries genetic material. Consists of building blocks called nucleotides, each of which consists of one of four bases. DNA belongs to the nucleic acids and is usually present in double strands. DNA is usually located in the cell nucleus, but there are also other forms such as circulating free DNA or cfDNA (=cell free DNA), which originates, for example, from dead cells or tumor cells whose DNA is released into the bloodstream. cDNA = complementary DNA = DNA that is formed complementary to RNA.
Dyspnoea
Shortness of breath
E
Embryonic carcinoma
Category of germ cell tumors, see non-seminoma
Endothelium
Thin layer of cells lining blood vessels
Enucleation
Organ-preserving surgery on the testicle in which only part of the testicle is removed as opposed to ablatio testis.
Expression
= Gene expression. Process that leads from the genetic information (DNA) to the finished product, such as proteins, but also various RNA products.
Ex-situ
Outside of the body
Extragonadal
Not at the testes, located somewhere else in the body.
Extragonadal germ cell tumor
In rare cases, testicular tissue, i.e. germ cells, may be located outside the testes in other parts of the body. A tumor that develops from these tissues is called extragonadal germ cell tumor.
F
First-line therapy
The preferred and first treatment options initiated for a condition.
Follow-up
The scheduled follow-up of patients after a completed (cancer) treatment. The aim is, among other things, to monitor recurrence, complications and management of the disease in everyday life.
FSH
Follicle stimulating hormone. Hormone that is produced in the brain and influences the development and maturation of sperm.
G
Germ cell
Cells produced in the reproductive organs and used for reproduction.
Germ Cell Neoplasia in situ (GCNis)
Cell change in a testis that often precedes a testicular tumor.
Germ cell tumor
Arises from defective maturation of primordial germ cells. In 95% of cases the tumor arises from germ cells in the testes, therefore the term "testicular tumor" is often used synonymously with "germ cell tumor". A small fraction of testicular tumors origin from other cells, for example Leydig cell tumors or Sertoli cell tumors. In rare cases, germ cell tissue may be scattered in other parts of the body from which a tumor may develop, see extragonadal germ cell tumor.
Gonads
Part of the sexual organ in which sex hormones and germ cells are produced. In men: testicles
Granulocytes
Subgroup of white blood cells (leukocytes) and part of the immune system.
Gray
unit for radiation
Growing Teratoma Syndrome (GTS)
A syndrome which manifests as growing teratoma during or after chemotherapy.
H
Histology
Branch of biology, medicine and pathology. Diagnosis diseases through e.g. microscopic examination of tissue sections.
Hypogonadism
Hormonal dysfunction of the gonads. In men: Missing or reduced hormonal activity of the testicles.
I
Immunohistology, Immunohistochemical
Method for examining biological tissue by staining cell or tissue structures.
Infertility
Inability of a male or female to reproduce naturally, for example, due to impaired sperm production.
Inguinal
Of the groin
Inguinal testicles
A form of undescended testes in which the testes is located in the inguinal canal area.
In-situ
In the natural position in the body, located within the body
Intermediate
Located in between
International Germ Cell Cancer Collaborative Group (IGCCCG)
Provides the prognostic classification of metastatic germ cell tumors by which medicine is guided. (IGCCCG. 1997. International Germ Cell Consensus Classification: a staging system based on prognostic factors for metastatic germ cell carcinomas. International Germ Cell Cancer Collaborative Group, J Clin Oncol, 15(2):594-603)
Intraepithelial
Between the epithelial layer (cells)
Invasive
Intervening in something, for example in the body
Ipsilateral
Lying on the same side of the body
J
K
Klinefelter Syndrome
Genetic disorder in which an extra X chromosome is present in the cells of the male body (XXY instead of XY).
L
Late relapse
Tumor recurrence after more than 2 years since first-line therapy.
LDH
Lactate dehydrogenase. Tumor marker measured in the blood serum of patients with suspected testicular tumors. Comparison of pre- and postoperative values can provide indications of tumor burden.
Lesion
Damage, injury or disorder of an organ, tissue or body part.
LH
Luteinizing Hormone. Hormone that is produced in the brain and stimulates the production of testosterone in the testes.
Liquid Biopsy
Examination of body fluids, e.g. blood, for certain markers that can give an indication for a specific disease. For example tumor-derived nucleic acids that may be present in the form of circulating tumor cells, free DNA (cfDNA), or miRNA.
Lymphography
Imaging procedure in which the lymph nodes and lymphatic channels are visualized with the aid of X-rays and contrast medium.
M
Magnetic resonance imaging (MRI)
Medical imaging technique used especially for imaging soft tissues and organs. It uses magnetic fields, magnetic field gradients and radio waves. It does not use X-ray or ionizing radiation which makes it less harmfull than CT scans.
Malign
Describes, among other things, the growth behaviour of a tumor. Tumors that invade and destroy the tissue around them and possibly develop metastases.
Malignancy
Malignant growth/tumor
Mature Teratoma
Type of germ cell tumor, subtype of teratoma
Metastasis, metastatic
Arise from cancer cells that have secreted from the original tumor. They form new daughter tumors in other parts of the body, which are called metastases.
microRNA (miRNA)
Short RNA molecules that are involved in the regulation of gene expression and can suppress certain genes (gene silencing).
miRNA-371a-3p
miRNA expressed by germ cell tumors in men, thereby providing a tumor marker for them.
Monitoring
Following a patient closely after treatment.
Morbidity
Describes the frequency of a disease.
N
Nephrotoxicity
The property of a substance to have a harmful effect on the kidney.
Neurotoxicity
The property of a substance to have a harmful effect on the nerves/nervous system.
Non-seminoma
Category of germ cell tumors. Also includes all mixed forms that are not pure seminomas, e.g. embryonal cell carcinoma, teratoma, chorionic carcinoma and others.
Nucleic acid
Nucleic acids consist of nucleotides and carry genetic information. They can exist as DNA or RNA.
O
Occult
hidden
Oligozoospermia
Means low sperm count in the ejaculate and may limit fertility.
Oncology
Field of medicine that deals with tumor diseases.
Orchiectomy
The removal of one or both testicles. Medical intervention for the treatment of testicular tumors.
P
Palpation
Examination by touching and feeling of organs located just below the surface of the body, in the case of testicular tumors, the testicles.
Pathohistological, Histopathology, pathohistological
Branch of pathology, study of pathological tissue changes.
Pathology
The study of diseases and their causes. Diagnoses are made by examining tissues and cells.
PEB
Chemotherapy with multiple cytostatic agents.
Persistent
Staying the same over a long period of time
Positron emission tomography (PET)
Medical imaging procedure in which lightly radioactive substances are absorbed into the body, making an image of metabolic processes visible earlier and more accurately in the body than other procedures. Often combined with CT.
Post-operative
After a surgery
Pre-operative
Before a surgery
Primary diagnostics
Examinations that may contribute to the initial diagnosis of a disease.
Primary tumor
An original tumor that precedes metastases.
Q
qPCR
Quantitative polymerase chain reaction, sometimes also referred to as real-time PCR. Molecular method in which DNA can be amplified and quantified.
R
Radiology
In radiology, diseases are diagnosed by means of imaging procedures. These include X-rays, computed tomography, magnetic resonance imaging, ultrasound examinations and others.
Radiotherapy
Also called radiation therapy. Medical treatment which uses ionizing radiation to treat cancer and kill malignant cells.
Re-evaluation
Re-evaluation of a patient's disease or condition as the disease progresses.
Regredient
In the case of disease progression, refers to the subsiding or regression of symptoms.
Relapse
Recurrence or relapse after initially successful treatment of a disease.
Remission
Attenuation of symptoms, signs of disease. Distinction between partial and full remission.
Resectate
Organ or tissue removed during resection/surgery.
Resection
Surgery in which an organ or tissue is removed.
Residual tumor
Part of the tumor that remains in the patient's body after treatment, since the tumor cannot be completely removed but only reduced.
Restaging
Evaluation of the patient's condition after all therapy procedures are initially completed to assess their effectiveness and side effects.
Rete testis-Infiltration
See Vascular invasion
Retroperitoneal Lymphadenectomy (RLA), laparoscopic RLA
Method of treatment for germ cell tumors. Can be the surgical removal of lymph nodes in the posterior abdominal cavity, but also diagnostic surgery. In the case of diagnostic surgery, the procedure can be performed laparoscopically and minimally invasive.
retroperitoneal, Retroperitoneum
Located in the anatomical space behind the peritoneum.
RNA (mi, m)
RNA = ribonucleic acid. Like DNA, it consists of nucleotides, which in turn are made up of four different bases. Unlike DNA, one of the bases, thymine, is swapped for uracil. RNA is usually, but not always, single-stranded. In the human body, RNA has many functions, for example, it serves as a messenger (mRNA) as a regulator of genes (miRNA) and is involved in the proteinbiosynthesis.
S
Salvage Therapy
Means "rescue therapy" and refers to the treatment of patients who have limited therapeutic options because, for example, they do not respond to primary chemotherapy.
Scrotal
Concerning or belonging to the scrotum
Seminoma
Category of germ cell tumors. Germ cell tumor that develops from the spermatogonia. The distinction between seminoma and non-seminoma is of importance for the further course of therapy.
Sensitivity
Sensitivity of a test indicates in how many diseased patients the respective disease can be detected by this test. The higher the sensitivity, the more reliably a disease is detected.
Serum
Clear liquid that separates from the solid components of blood after centrifugation.
Serum marker
Specific molecule or substance in serum that can provide information about whether a patient has a certain disease.
Somatic
Body related
Sonography
Ultrasound examination. Fast, effective diagnostic imaging procedure that is also without side effects and painfree. The procedure is based on the different densities of tissues and organs. Testicular tumors can often be visualized in this way.
Specificity
The specificity of a test indicates how likely it is that healthy people who have no disease will be identified as healthy by a test.
Staging investigation
Examination to assess the extent of tumor disease.
T
Teratoma
Category of germ cell tumors, subtype of non-seminomas. Originates from pluripotent germ cells and therefore may have different tissue types.
Testosterone
Steroid hormone with a variety of functions in the body. Produced in the testes, ovaries and adrenal cortex.
Thorax
Anatomical term for the chest area
Tumor marker
Molecules or substances in the body whose presence indicate a tumor disease. They can support primary diagnostics and therapy monitoring. Tumor markers can be proteins, nucleic acids or hormones, for example, and can be measured in a blood sample.
Tumor
Growth or a new formation (of tissue) caused by a misregulation of cell growth. Tumors can be benign or malignant.
U
V
Vascular invasion
The invasion of tumor cells into the (testicular) vessels.
W
Watch-and-wait Strategy
Therapeutic approach in which surgery is initially avoided completely and the patient is only monitored. This is also referred to as the "surveillance strategy".
watchful waiting
Close monitoring after therapy.
X
Y
Yolk sac tumor
Category of germ cell tumors, see non-seminoma.