Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Testis Tumors 1411

■III: Chest CT pos; Abd CT pos or neg; markers pos or neg

■Seropositive: only markers pos; all else neg

differential diagnosis

■secondary testis tumors: lymphoma, leukemia

■rare benign testis tumors: Leydig cell, gonadal stromal

■benign or malignant paratesticular tumors: adenomatoid, rhab-

domyosarcoma, leiomyosarcoma

■other benign scrotal masses (see preceding section)

management

n/a

specific therapy

■Refer to a urologist

■inguinal orchiectomy is first step

■initiation of chemotherapy in proven advanced disease (measurable

metastasis and positive markers) may precede orchiectomy as timing

critical due to rapid tumor growth

■seminoma is radiosensitive

■all cell types are chemosensitive: platinum, etoposide, bleomycin

(PEB) most common regimen

■highly successful multimodal therapy allows a variety of Rx

approaches; nuances of specific choice are beyond the scope of this

article

■acceptable treatment options for each clinical stage:

➣Stage I: retroperitoneal lymph node dissection (RPLND): Open

RPLND remains the standard, but experience with laparoscopic

RPLND also is evolving; surveillance; primary chemotherapy

(platinum, etoposide, bleomycin) 2 courses; retroperitoneal

radiation therapy (pure seminoma only)

➣Stage II, limited: RPLND; PEB chemotherapy 3–4 courses

➣Stage II, advanced, and Stage III: PEB chemotherapy 3–4 courses;

possible debulking RPLND after chemotherapy

➣Seropositive: PEB chemotherapy 2–4 courses

follow-up

■90% of relapse is within 12 months

■95% of relapse is within 24 months

■general guideline: interval extent and duration of evaluation vary by

initial stage and extent of treatment

■for good-risk patients (low stage, low tumor volume):