Diagnostik und Prim�rtherapie des Hodentumors

Abstract

In cases of suspected testicular germ cell cancer, the first diagnostic steps include scrotal sonography, ultrasound of the retroperitoneum and abdomen, determination of serum tumor markers (AFP, betaHCG, LDH), and inguinal orchiectomy with contralateral scrotal testicular biopsy. Histology of the orchiectomized testis is essential for the patient's further treatment options. For synchronous or metachronous bilateral testis cancer or germ cell cancer in a single testis, organ-sparing surgery with resection of the (small) tumor (<2 cm) is possible. After these initial steps, further diagnostic procedures include computed tomography of the abdomen/pelvis and lung. In cases of hematogeneous spread of the disease, bone scan and CT or MR of the brain are performed additionally. The determination of serum tumor markers after orchiectomy is mandatory. Treatment of testicular cancer is based on exact knowledge of the histological type and stage of the disease. In metastatic testis cancer treatment modalities are defined according to the prognosis of the tumor (defined by the IGCCCG). In cases of testicular intraepithelial neoplasia (TIN) of the contralateral testis or in residual testicular tissue after tumor enucleation, three available treatment options can be discussed with the patient: orchiectomy, radiotherapy, or surveillance. The decision depends on the individual situation of the patient. Radiotherapy with 20 Gy is accepted as standard treatment. In general, treatment of testis cancer is associated with gonadal toxicity. Therefore, prior to further treatment, aspects of family planning, wish for children, and the option to cryopreserve semen (in cases of azoospermia cryopreservation of testicular tissue) have to be discussed.