Seminoma [flickr euthman]

Seminoma in a radical orchiectomy specimen from a 27-year-old man
Image by Ed Uthman (CC BY 2.0)

Seminoma is the most common form of cancer that occurs in the testicles. The peak age of incidence is between 20 and 35 years and it is more common in men with undescended testes. They are usually detected as a lump in the testicle that may or may not be painful or tender.

Initial investigation is by an ultrasound scan, but follow up CT scans are normally performed to detect any spread to the lymph nodes in the pelvis or groin. An alpha-fetoprotein blood test may also be useful as a marker of disease progression.

Treatment involves surgical removal of the affected testicle and adjacent lymph nodes with follow up radiotherapy. In stage one of the disease (cancer is localised to the testicle) the cure rate is 97%, and even when the seminoma has spread beyond the testicle to surrounding lymph nodes (stage two) a 90% cure rate can be expected. In the rare stage three cancers, with extensive spread to form a large mass in the abdomen, a greater than 80% cure rate can be expected with the addition of chemotherapy such as cisplatin, vinblastine and bleomycin.

Long term regular follow up of the unaffected testicle by physical examination, blood tests and ultrasound scan are necessary.

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