Testicular cancer

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Prognosis and survival for testicular cancer

If you have testicular cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. 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.

A prognostic factor is an aspect of the cancer 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. They both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic factors for testicular cancer.

Where the cancer started

Non-seminomas that start in the testicle or in the back of the abdomen (called the retroperitoneum) have 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 (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 (such as where it started and the level of tumour markers) are also important for these tumours.

Spread to retroperitoneal lymph nodes

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 (recur) when:

  • fewer 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)

Tumour marker levels

Doctors will consider the levels of certain tumour markers in the blood when they estimate prognosis for non-seminomas. High tumour marker levels are linked with a poor prognosis with a non-seminoma. Tumour marker levels are not considered for seminomas.

International Germ Cell Cancer Consensus Group (IGCCCG) classification system

The International Germ Cell Cancer Consensus Group (IGCCCG) 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.

IGCCCG divides testicular germ cell tumours into 3 prognosis groups:

Prognosis groupSeminomaNon-seminoma

good

The tumour has only spread to the abdominal lymph nodes or the lungs or both.

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

The primary tumour is only in the testicle or in the back of the abdomen.

The tumour has only spread to the abdominal lymph nodes or the lungs or both.

All tumour markers are normal or mildly elevated.

intermediate

The tumour has spread to organs other than the lungs.

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

The primary tumour is only in the testicle or in the back of the abdomen.

The tumour has only spread to the abdominal lymph nodes or the lungs or both.

At least one tumour marker level is moderately high.

poor

There is no poor prognosis grouping for seminoma testicular cancer.

At least one of the following must be true:

  • The primary tumour is in the area between the lungs.
  • The tumour has spread to organs other than the lungs.
  • At least one tumour marker level is very high.

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