Metastatic seminoma is a form of testicular cancer that has spread from the testicle to other areas of the body. Seminoma is a common type of germ cell tumor, originating in the cells that produce sperm. While a diagnosis of cancer that has spread can be concerning, seminoma is known for being highly responsive to treatment.
The Spread of Seminoma
Seminoma spreads through a predictable pathway involving the lymphatic system. The lymphatic vessels from the testicle drain to the retroperitoneal lymph nodes, located in the back of the abdomen. This is often the first place the cancer travels to, and if these nodes are affected, it can cause a persistent, dull ache in the lower back or abdomen.
From these lymph nodes, cancer cells can travel through the lymphatic system or enter the bloodstream to reach distant parts of the body. The lungs are a common site for distant metastasis, which might lead to symptoms like a persistent cough, shortness of breath, or coughing up blood. The liver is another potential site of spread, and advanced involvement can lead to abdominal pain or jaundice.
Less frequently, seminoma can metastasize to the bones or the brain. Bone metastases can cause localized pain that does not go away with rest. If the cancer reaches the brain, it can result in a range of neurological symptoms, including headaches, dizziness, seizures, or weakness in parts of the body.
Diagnosis and Staging
The diagnostic process for metastatic seminoma uses several procedures to confirm the cancer’s presence and determine its extent. It begins with blood tests that measure proteins called tumor markers. For pure seminomas, doctors look for elevated levels of lactate dehydrogenase (LDH) and sometimes human chorionic gonadotropin (hCG), while alpha-fetoprotein (AFP) is normal. Persistently high tumor markers after the testicle is removed indicate the disease has spread.
To visualize where the cancer has traveled, physicians use detailed imaging scans. A computed tomography (CT) scan of the chest, abdomen, and pelvis is standard for checking for enlarged lymph nodes or tumors. A positron emission tomography (PET) scan may be used for a more comprehensive picture of the cancer’s activity. The definitive diagnosis of seminoma comes from the microscopic examination of the testicle after its surgical removal, an operation known as a radical inguinal orchiectomy.
Once diagnosed, the cancer is staged to classify its severity and help plan treatment. Doctors use a risk stratification system that categorizes the disease into good, intermediate, or poor risk groups based on where the cancer has spread. Good-risk disease involves metastasis limited to the lymph nodes or lungs. Intermediate or poor-risk disease is defined by metastases in organs other than the lungs, such as the liver or brain.
Treatment Protocols
After the radical inguinal orchiectomy confirms the diagnosis and removes the primary tumor, the focus of treatment shifts. For metastatic disease, the main goal is to eliminate cancer cells that have traveled to other parts of the body.
Chemotherapy is the standard treatment for cancer that has spread beyond the testicle. The most common regimen is a combination of drugs known as BEP, which includes Bleomycin, Etoposide, and Platinol (cisplatin). Another combination is EP (Etoposide and Platinol), often chosen for patients at higher risk for lung-related side effects from bleomycin. These drugs are administered in cycles, with the number of cycles depending on the risk category.
Radiation therapy can also play a role when metastasis is confined to the retroperitoneal lymph nodes. Because seminomas are very sensitive to radiation, this approach can effectively destroy cancer in these specific regions. Following chemotherapy, some patients may have residual masses visible on imaging scans. In these cases, surgery to remove the remaining tumors might be recommended.
Prognosis and Post-Treatment Surveillance
The prognosis for metastatic seminoma is very favorable, with a high overall cure rate. The outcome is closely tied to the risk category determined during staging. For individuals in the good-risk group, the five-year survival rate is high. Even for those with more extensive disease that has spread to distant organs, treatment is often successful, although the prognosis is more guarded.
After treatment is completed, a structured follow-up plan is put into place to monitor for any recurrence. The schedule involves regular visits with an oncologist and blood tests to check that tumor marker levels remain normal. These appointments are more frequent in the first few years after treatment, when a recurrence is most likely to happen.
Imaging scans, such as CT scans of the abdomen and chest, are also a routine part of the surveillance plan. These scans help doctors look for any new growths or changes that could indicate the cancer has returned.