Prognosis and survival for testicular cancer
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.
The doctor will look at certain aspects of the cancer (such as where the cancer started, the type of germ cell tumour and tumour marker levels). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.
Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.
The following are prognostic and predictive factors for testicular cancer.
Where the cancer started
Most germ cell tumours start in the testicle, but in rare cases they can start outside of the testicle, such as in the back of the abdomen (retroperitineum) or the chest (mediastinum). These rare testicular cancers that start outside of the testicle are called extragonadal germ cell tumours. Some extragonadal germ cell tumours have a different prognosis than germ cell tumours that start in the testicle.
Type of germ cell tumour
Seminomas often respond better to treatment than non-seminomas. As a result, seminomas usually have a better prognosis.
Spread to the bone, liver or brain
Testicular cancer that has spread (metastasized) to the bone, liver or brain has a worse prognosis than testicular cancer that has only spread to the lymph nodes or lungs.
Spread to retroperitoneal lymph nodes
Testicular cancer that has spread to the retroperitoneal lymph nodes is linked to a worse prognosis than cancer that is only in the testicle, but prognosis is still very good. When doctors estimate prognosis, they consider how many retroperitoneal lymph nodes have cancer cells in them and how big those lymph nodes are.
Tumour marker levels
Certain tumour marker levels are an important prognostic factor for germ cell tumours because the levels help doctors predict whether cancer is likely to come back (recur)
A higher than normal level of alpha-fetoprotein (AFP) is linked to a worse prognosis than a normal level of AFP for non-seminoma testicular tumours. AFP is not a reliable prognostic factor for seminomas because seminomas don’t make AFP.
A higher than normal level of beta-human chorionic gonadotropin (b-hCG) is linked to a worse prognosis than a normal level of b-hCG. Higher levels of b-hCG are more commonly seen in non-seminomas than seminomas, but they are possible for either type of tumour.
Prognosis group
The International Germ Cell Cancer Consensus Group developed a classification system based on prognostic factors. It describes 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.
The classification system divides non-seminoma germ cell tumours into 3 prognosis groups: good, intermediate and poor. Seminoma germ cell tumours are divided into 2 prognosis groups: good and intermediate.
|
Type of testicular cancer |
Prognosis group | Clinical factors | 5-year survival |
|---|---|---|---|
|
non-seminoma
|
good |
The primary tumour is only in the testicle or in the back of the abdomen. The tumour has spread only to the abdominal lymph nodes or the lungs or both. All tumour marker levels are normal or mildly elevated. |
96% |
| intermediate |
The primary tumour is only in the testicle or in the back of the abdomen. The tumour has spread only to the abdominal lymph nodes or the lungs or both. At least one tumour marker level is moderately high. |
89% | |
| poor |
At least one of the following is true:
|
67% | |
| seminoma | good |
The tumour has spread only to the abdominal lymph nodes or the lungs or both. The AFP level is normal. Other tumour markers can be any level. |
95% |
| intermediate |
The tumour has spread to organs other than the lungs. The AFP level is normal. Other tumour markers can be any level. |
88% |
Survival statistics for testicular cancer
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