Seminomas are a type of germ cell tumor, primarily developing in the testes. These tumors originate from the cells that would normally mature into sperm. While a form of testicular cancer, seminomas are characterized by their relatively slow growth and high rate of successful treatment.
Understanding Seminomas
Seminomas arise from germ cells, the reproductive cells responsible for forming sperm. There are two main types: classic seminoma and spermatocytic seminoma. Classic seminoma is the more common type, accounting for about 95% of cases, and usually affects men aged 25 to 45. This type generally does not cause elevated levels of alpha-fetoprotein (AFP), a protein that can be a tumor marker for some cancers.
Spermatocytic seminoma is rarer, making up about 5% of cases, and typically occurs in men aged 50 and older. This type often grows more slowly and has a lower likelihood of spreading. While most seminomas are found in the testes, they can rarely develop in other areas, such as the mediastinum (between the lungs) or the retroperitoneum (back of the abdominal cavity). Seminomas are distinct from non-seminomatous germ cell tumors (NSGCTs), which behave differently and often spread more quickly.
Signs and Diagnosis
Seminomas are often discovered through physical changes. A common sign is a painless lump or swelling in one of the testicles. Other indications include a feeling of heaviness in the scrotum or groin, or a dull ache in these areas. Rarely, pain may occur. Prompt medical attention is important if any testicular changes are observed.
Diagnosis begins with a physical examination. An ultrasound of the scrotum is the primary imaging tool to evaluate suspicious lumps. Blood tests check for tumor markers like human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH), which can be elevated in seminoma cases. It is important to note that alpha-fetoprotein (AFP) levels are generally not elevated in pure seminomas. A definitive diagnosis is established through a biopsy, involving surgical removal of the entire testicle (radical inguinal orchiectomy), rather than a needle biopsy, to prevent potential cancer cell spread.
Treatment Options
Radical inguinal orchiectomy is the primary treatment for seminomas. This operation removes the affected testicle and the spermatic cord through an incision in the groin. This surgical approach prevents potential spread of cancer cells to nearby lymph nodes. The removed testicle is analyzed to determine cancer type and stage.
After surgery, additional treatments, known as adjuvant therapy, are determined based on the cancer’s stage. For early-stage seminomas (stage I), active surveillance is a common and effective option. This involves regular monitoring through physical exams, blood tests for tumor markers, and imaging scans like CT scans, typically every three to six months for the first year.
Radiation therapy is another option, particularly for localized disease or if the cancer has spread to nearby lymph nodes, as seminomas are sensitive to radiation. Chemotherapy is used for more advanced stages or when the cancer has spread beyond regional lymph nodes. Common chemotherapy approaches for advanced stages include regimens like three cycles of bleomycin, etoposide, and cisplatin (BEP), or four cycles of etoposide and cisplatin (EP). Treatment plans are individualized, considering the cancer’s stage and other patient-specific factors.
Prognosis and Post-Treatment Care
Seminomas generally carry a favorable prognosis, especially when detected early, with very high cure rates. The specific stage at diagnosis is a significant factor influencing the long-term outlook. Following treatment, consistent follow-up care is important to monitor for recurrence.
Regular follow-up appointments typically include physical examinations, blood tests for tumor marker levels, and imaging scans like CT scans, to ensure the cancer has not returned. These checks are usually conducted periodically, with frequency decreasing over time. If the remaining testicle does not produce sufficient testosterone, testosterone replacement therapy might be necessary to address hormone deficiencies. Discussions about fertility preservation, such as sperm banking, are often held before treatment begins, as treatments can impact future fertility.