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Testicular cancer

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Prognosis and survival for testicular cancer

Men with testicular cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.

Prognostic factors

The following are prognostic factors for testicular cancer.

Where the cancer started

Testicular cancer that starts in the testicle or an extragonadal germ cell tumour that starts in the back of the abdomen (called the retroperitoneum) has a better prognosis than an extragonadal germ cell tumour that starts in the middle of the chest between the lungs (called the mediastinum).

Type of germ cell tumour

Seminomas often respond better to treatment than non-seminomas. As a result, seminomas usually have a better prognosis.

Where the cancer spreads

Testicular cancer that has spread, or metastasized, to organs other than the lungs usually has a poor prognosis. Where the cancer has spread is the main prognostic factor for seminomas. Doctors will also consider where non-seminomas spread, but other prognostic factors are more important for these tumours.

Spread to retroperitoneal lymph nodes

The retroperitoneal lymph nodes are at the back of the abdomen (called the retroperitoneum). When doctors estimate prognosis, they consider how many retroperitoneal lymph nodes have cancer cells in them and how big those lymph nodes are.

There is less chance that testicular cancer will come back, or recur, when:

  • less than 6 retroperitoneal lymph nodes have cancer cells in them
  • none of the retroperitoneal lymph nodes are bigger than 2 cm in diameter
  • the cancer hasn’t grown through the capsule to the outside of any lymph node (called extranodal tumour extension)

Serum tumour marker levels

Doctors will consider the levels of certain tumour markers in the blood (called serum tumour markers) when they estimate prognosis for non-seminomas. Higher serum tumour marker levels are linked with a poor prognosis in men with a non-seminoma. Serum tumour marker levels are not considered for seminomas.

Lymphovascular invasion

Lymphovascular invasion is when cancer cells are in small lymph and blood vessels. Testicular cancers with lymphovascular invasion have a higher risk of recurrence, and so they have a poor prognosis.

International Germ Cell Cancer Consensus Group classification system

The International Germ Cell Cancer Consensus Group (IGCCCG) developed a classification system based on prognostic factors. It indicates how well the cancer is expected to respond to treatment. This system helps doctors make decisions about treatment for advanced germ cell tumours. It also helps researchers design clinical trials.

IGCCCG divides testicular germ cell tumours into 3 prognosis groups:

Prognosis groupSeminomaNon-seminoma

good

There are no distant metastases other than to the lungs.

Alpha-fetoprotein (AFP) is normal and other serum tumour markers can be any level.

The primary tumour is in the testicle, or a primary extragonadal tumour is in the retroperitoneum.

There are no distant metastases other than to the lungs.

All serum tumour markers are normal (S0) or slightly above normal levels (S1).

intermediate

There are distant metastases to organs other than the lungs.

AFP is normal and other serum tumour markers can be any level.

The primary tumour is in the testicle, or a primary extragonadal tumour is in the retroperitoneum.

There are no distant metastases other than to the lungs.

At least one serum tumour marker level is high (S2).

poor

This group isn’t used for seminomas.

One of the following applies:

  • There is a primary extragonadal tumour in the mediastinum (the area between the lungs).
  • There are distant metastases in organs other than the lungs.
  • At least one serum tumour marker level is very high (S3).

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