Cancer Testicular

Guidelines on

Testicular
Cancer
P. Albers (chairman), W. Albrecht, F. Algaba,
C. Bokemeyer, G. Cohn-Cedermark, K. Fizazi,
A. Horwich, M.P. Laguna

© European Association of Urology 2011

TABLE OF CONTENTS

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1.

BACKGROUND
1.1
Methodology

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2.

PATHOLOGICAL CLASSIFICATION

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3.

DIAGNOSIS
3.1
Clinical examination
3.2
Imaging of the testis
3.3
Serumtumour markers at diagnosis
3.4
Inguinal exploration and orchidectomy
3.5
Organ-sparing surgery
3.6
Pathological examination of the testis
3.7
Diagnosis and treatment of testicular intraepithelial neoplasia (TIN)
3.8
Screening

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4.

STAGING
4.1
Diagnostic tools
4.2
Serum tumour markers: post-orchidectomy half-life kinetics
4.3
Retroperitoneal,mediastinal and supraclavicular lymph nodes and viscera
4.4
Staging and prognostic classifications
4.5
Prognostic risk factors
4.6
Impact on fertility and fertility- associated issues

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5.

GUIDELINES FOR THE DIAGNOSIS AND STAGING OF TESTICULAR CANCER

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6.

TREATMENT: STAGE I GERM CELL TUMOURS
6.1
Stage I seminoma
6.1.1
Surveillance
6.1.2
Adjuvantchemotherapy
6.1.3
Adjuvant radiotherapy
6.1.4
Retroperitoneal lymph node dissection (RPLND)
6.1.5
Risk-adapted treatment
6.2
Guidelines for the treatment of seminoma stage I
6.3
NSGCT stage I
6.3.1
Surveillance
6.3.2
Primary chemotherapy
6.3.3
Risk-adapted treatment
6.3.4
Retroperitoneal lymph node dissection
6.4
CS1S with (persistently) elevated serum tumour markers
6.5Guidelines for the treatment of NSGCT stage I

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7.

TREATMENT: METASTATIC GERM CELL TUMOURS
7.1
Low-volume metastatic disease (stage IIA/B)
7.1.1
Stage IIA/B seminoma
7.1.2
Stage IIA/B non-seminoma
7.2
Advanced metastatic disease
7.2.1
Primary chemotherapy
7.3
Restaging and further treatment
7.3.1
Restaging
7.3.2
Residualtumour resection
7.3.3
Quality of surgery
7.3.4
Consolidation chemotherapy after secondary surgery
7.4
Systemic salvage treatment for relapse or refractory disease
7.4.3
Late relapse (> 2 years after end of first-line treatment)
7.5
Salvage surgery
7.6
Treatment of brain metastases
7.7
Guidelines for the treatment of metastatic germ cell tumours

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UPDATE MARCH 2011

8.

FOLLOW-UP AFTER CURATIVE THERAPY
8.1
General considerations
8.2
Follow-up: stage I non-seminoma
8.2.1
Follow-up investigations during surveillance
8.2.2
Follow-up after nerve-sparing RPLND
8.2.3
Follow-up after adjuvant chemotherapy
8.3
Follow-up: stage I seminoma
8.3.1
Follow-up after radiotherapy
8.3.2
Follow-up duringsurveillance
8.3.3
Follow-up after adjuvant chemotherapy
8.4
Follow-up: stage II and advanced (metastatic) disease

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9.

TESTICULAR STROMAL TUMOURS
9.1
Background
9.2
Methods
9.3
Classification
9.4
Leydig cell tumours
9.4.1
Epidemiology
9.4.2
Pathology of Leydig cell tumours
9.4.3
Diagnosis
9.4.4
Treatment
9.4.5
Follow-up
9.5Sertoli cell tumour
9.5.1
Epidemiology
9.5.2
Pathology of Sertoli cell tumours
9.5.2.1 Classification
9.5.3
Diagnosis
9.5.4
Treatment
9.5.5
Follow-up
9.6
Granulosa cell tumour
9.7
Thecoma/fibroma group of tumours
9.8
Other sex cord/gonadal stromal tumours
9.9
Tumours containing germ cell and sex cord/gonadal stromal (gonadoblastoma)
9.10
Miscellaneous tumours of the testis9.10.1 Tumours of ovarian epithelial types
9.10.2 Tumours of the collecting ducts and rete testis
9.10.3 Tumours (benign and malignant) of non-specific stroma

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10.

REFERENCES
10.1
Germ cell tumours
10.2
Non-germ cell tumours

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11.

ABBREVIATIONS USED IN THE TEXT

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