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ABSTRACT
Year : 2016  |  Volume : 8  |  Issue : 5  |  Page : 74-77  

Testicular Cancer


Date of Web Publication18-Dec-2015

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How to cite this article:
. Testicular Cancer. Urol Ann 2016;8, Suppl S1:74-7

How to cite this URL:
. Testicular Cancer. Urol Ann [serial online] 2016 [cited 2020 Jun 2];8, Suppl S1:74-7. Available from: http://www.urologyannals.com/text.asp?2016/8/5/74/172185

Testicular cancer at aramco's dhahran health center

Sami Rabadi, Faris Ayyat, Moheb Milad


Department of Urology, Aramco Dhahran Health Center, Dhahran, Saudi Arabia

Fourteen cases of testicular cancer were diagnosed and treated at Dhahran Health Center between January 1981 and December 1988. Nine seminomas and five non-seminomatous testicular cancer (NSTC). Three patients had cryptorchidism; one unilateral and two bilateral. For seminomas the median age was 38 years (range 27-59). Eight had clinical stage I, and one stage IID. All stage I patients were treated with radical orchiectomy and postoperative lymph node irradiation. With a median follow up of 24 months (6-75 months range) all had no evidence of disease recurrence (NED). The stage IID patients died of his disease 34 months from his orchiectomy. He was non-compliant. Of the five NSTC patients, three adults and two children. Their ages were 54, 36, 34, 2 1/2 and 1 1/2 years. The stages were IIIA L3, IVCH+, pathologic IIA, clinical IIA and unknown respectively. All were treated with radical orchiectomy and cisplatinum based combination chemotherapy. Adequate follow up duration is available for four patients (72, 28, 12 and 60 months). All remained NED. Although the number of patients is small, our treatment results are excellent and suggest that testicular cancer even when advanced is a highly treatable solid tumor.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Ultrasound scanning in scrotal disorders: Correlation of clinical and operative findings

S. D. Shetty, A. Ibrahim, M. F. Omojola, K. P. Patil, R. Awad


Departments of Urology and Radiology, King Saud University, College of Medicine and Asir Central Hospital, Abha, Saudi Arabia

73 patients presenting with or suspected to have a scrotal pathology were investigated by scrotal ultrasonography (SUS) using greyscale real time ultrasound scanner with high frequency curved array transducer (5 MHz). The patients were divided into 3 groups; group I comprised 21 patients who underwent subsequent scrotal surgical exploration, group II included 40 patients who were treated conservatively, and in group III there were 12 patients with extrascrotal pathology who underwent SUS to exclude testicular involvement. SUS correlated extremely well with the operative findings in group I and with the clinical diagnosis in group II. It was also reliable in excluding testicular pathology in group III.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Compliance of Saudi patients with testicular cancer on surveillance

H. Al Zahrani, E. Bogmi, E. Lindstedt, S. Kattan, A. H. Kardar, T. Merdad, A. Peracha, M. Aslam, S. Bazarbashi 1 , K. Hanash


Departments of Urology and 1 Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Objective: Testicular cancer is uncommon yet one of the most curable malignancies with multidiscipline treatment. Surveillance as a treatment strategy has been adopted for clinical Stage I, non-seminoma germ cell tumors (NSGCT) with controversy about its cost effectiveness and patient's compliance. We retrospectively reviewed the compliance of patients who were placed on the surveillance protocol at KFSH & RC.

Materials and Methods: during the period 1992-1997, 79 patients were diagnosed with NSGCT at KFSH & RC. Forty cases were pure seminoma and 39 cases were NSGCT. Out of these, 7 patients had clinical Stage I NSGCT and were placed on the surveillance protocol in our institution.

Results: There were 6 Saudis and I Syrian patient. Their mean age was 29.5 years (23-43). The tumors were all unilateral and involved the right testicle in 4 and the left one in 3. The histopathology was mixed in 5, embryonal in 1 and yolk sac in 1. One patients has vascular invasion. They all had T1 N0 M0 Stage. The mean follow up was 29 months (9-38). One patient had tumor recurrence after 8 months of being on the protocol and has vascular invasion on his initial pathology. None of the patients complied with their planned protocol schedule. Two patients were lost to follow up prematurely.

Conclusion: Saudi patients with testicular cancer are not well compliant with the surveillance protocol. Although this strategy may spare patients surgery or chemotherapy, it should be cautiously offered to this young population who find difficult to comply with the strict required follow up evaluation.

Presented at the: 13 th Saudi Urological Conference

Riyadh Armed Forces Hospital

14-17 February 2000

(09-12 Dhu Al Qa'dah 1420)

Testis cancer: Management stage by stage

Michael A. S. Jewett


Department of Surgical Oncology, Division of Urology, University Health Network (Princess Margaret Hospital), University of Toronto, Ontario, Canada

Germ cell tumours constitute the majority of testis cancer, which is the most common malignancy in men aged 15-35. Its overall incidence is low (0.8 to 10.5/100000 men/year), however it has been increasing significantly over the past half-century. Approximately 45% are pure seminomas and the remainder are non-seminomas and one third of patients with NSGCTs present without evidence of metastases and are therefore clinical stage I disease. Postorchiectomy management options for stage I testis cancer include retroperitoneal lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, and initial active surveillance. It is accepted that all treatment modalities for stage I testis cancer demonstrate clinical equipoise in terms of equivalent or near equivalent survival which approaches 100%. Management is often dictated by other factors and may be risk-adapted.

Stage I NSGCT is associated with a 30% risk of progression when initial management is by active surveillance. Most patients who progress require 3 courses of chemotherapy. It is possible to identify patients at higher and lower risk of progression. Most centres would now recommend active surveillance for low risk men who have no histological evidence of lymphovascular infiltration or who have a low percentage of embryonal carcinoma in the primary tumour. The proportion of high risk patients varies by report but approximately 40% of men will exhibit features that put them at a >50% risk of progression. It is appealing to treat these men preemptively. Surgery with retroperitoneal lymphadenectomy will sterilize the retroperitoneum (RP) in almost all patients who have occult nodal disease (99%) and reducing or eliminating imaging of the RP simplifies follow up. However, a high proportion of these patients who undergo initial surgery will require chemotherapy as well. Many will relapse with distant metastases despite a thorough procedure suggesting pre existing occult mets and mot centres will recommend adjuvant chemotherapy if nodes are positive. Primary chemotherapy is therefore appealing as it is curative in almost all cases and avoids double therapy. It should be acknowledged however that relapses after chemotherapy may be drug resistant and there is risk of chronic drug related toxicities. Stage II NSGCT is managed by primary retroperitoneal lymphadenectomy (RPL) or primary chemotherapy. The decision is dictated by the extent of tumour and the marker levels. Surgery has been perfected to include sparing or grafting of the retroperitoneal postganglionic sympathetic nerves to preserve ejaculation. The technique will be described. Laparoscopic approaches are being used but have not yet gained wide acceptance. If resected nodes are positive, adjuvant chemotherapy is usually but not always administered. Stage II seminoma is almost universally managed by radiation unless there is bulky nodal disease. Post chemotherapy retroperitoneal and intrathoracic NSGCT is resected if visible on imaging. Techniques are demanding but late relapse as well as early future is often related to incomplete resection or to delaying surgery by additional chemotherapy when maximal response has been achieved. Post radiation or chemotherapy residual seminoma is more difficult to recommend treatment for as there may be delayed response. These and related issued will be described.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006

(21-24 Muharram 1427)

Clinical outcome of post chemotherapy retroperitoneal lymph node dissection

K. Al Othman, A. Mokhtar, H. Al Hello, A. Al Zahrani


Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Aim of Work: The clinical outcome of post chemotherapy retroperitoneal lymph nodes dissection (PC RPLND) is variable and difficult to predict. It will be useful to identify clinical or pathological parameters which can help us to define the group of patients with higher risk of having viable germ cell cancer in the residual mass after receiving chemotherapy.

Patients and Methods: A retrospective review of patients underwent PC RPLND done. Different clinical and pathological parameters were reviewed.

Results: 16 patients with available medical records were identified between 1994 and 2005. Median age 25 years (16-41). Only one patient had history of cryptorchidism. The pathological examination result was: 2 patients (13%) have viable germ cell cancer in residual mass. 8 patients (50%) have fibrosis and 6 patients (37%) have teratoma. The two patients with viable germ cell cancer in residual mass have high risk clinical or pathological parameters that could be defined pre operatively.

Conclusion: Preoperative clinical and pathological data may help to define the risk of presence of viable germ cell cancer in post chemotherapy residual mass.

Presented at the: 20 th Saudi Urological Conference

King Fahad Hospital of the University - Tabuk

18-20 March 2008

Testicular tumors: King Fahd specialist hospital, Dammam experience

Fadi Darwiche, Mohamed A. Gomha, Riad Al-Mousa, Ibrahim Al-Oraifi, Amr Jad, Irfan Khan, Adel Al-Dayel


Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Introduction: Testicular cancer is relatively rare tumor. We reviewed our experience in management of this kind of tumor.

Methods: Patients diagnosed with testicular cancer between September 2006 and December 2009 at KFSHD were identified. The medical records of these patients were reviewed as regards to clinical presentation, diagnosis, pathology, staging, treatment and outcome. 19 patients were identified with adequate clinical and pathologic data with mean age ± SD of 34.8 ± 11. The stage of the tumor was determined according to the AJCC TNMS staging system.

Results: Patients presented with scrotal mass in 11, hydrocele in 1, abdominal mass in 5 (3 with undescended testis), abdominal and scrotal masses in 1 and incidentally discovered during ultrasound in 1. Right side was involved in 9 patients (47.4%) and left side in 10 patients (52.6%). Initial management was orchiectomy in 16, biopsy from abdominal testis or retroperitoneal lymph nodes in 3. Pathology was seminoma in 9 (classical in 8 and spermatocytic in 1), non-seminoma in 9 (2 mixed with seminoma) and primary testicular lymphoma in 1. Based on CT findings, tumor markers (B-HCG, alpha-fetoprotein), and local pathologic stage, the tumor stage was Ia in 5, Ib in 3, Is in 3, Ila in IIa in 1, IIb in 2, IIc in 3, IIIa in 1 and IIIb in 1. Among patients with stage I seminoma, one with spermatocytic type received no further therapy, one is under surveillance (stage Ia), 2 received radiotherapy to the para-aortic lymph nodes (stage Ib) and one received carboplatin one cycle (stage Ib). All patients with stage II seminoma (2 IIb, 2 IIc) received chemotherapy (4 cycles of BEP). 2 of these 4 received additional radiotherapy (30 cGray) for residual masses < 3cm; another one needed excision of residual lymph node mass 3.5cm and tumor in abdominal testis. Among 9 patients with non-seminoma, 5 had stage I (3 Is, 2 Ia) and were treated by BEP chemotherapy (2-4 cycles). The remaining 4 patients (stage II, III) were initially treated by 4 cycles of BEP. One of these 4 (stage IIa) had no residual masses while the other 3 required surgery for residual masses (20 cm, 17 cm, 8 cm) after chemotherapy. 2 of these last 3 had complete excision by RPLND and pathology showed viable tumor in one (received VIP chemotherapy after excision) and necrotic tissue in one. While the third one with growing teratoma syndrome had incomplete excision due to multiple organ infiltration. Patient with primary testicular lymphoma was treated with chemotherapy. Patients were followed up with a mean period of 14.4 ± 10 month. All patients had no evidence of relapse (CT, tumor markers) except the patient who underwent incomplete excision of teratoma and now under salvage chemotherapy.

Summary and Conclusion: Patients with primary testicular tumors, even high stage, have excellent outcome after appropriate treatment based on multimodal therapy of platinum based chemotherapy, radiotherapy and surgery, in a specialized cancer center. Growing teratoma syndrome is still a difficult disease to treat.

Presented at the: 22 nd Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

15-18 March 2010

Testicular cancer at KFSH&RC - Jeddah, Saudi Arabia: Importance of clinical features

Ghassan A. Barayan 1,2 , Hassan Farsi 1,2 ,

Anmar Nassir 1,2 , Rami Salawi 1,2 , Hesham Saada 1,2


1
Department of Urology, King Faisal Specialist Hospital,

2 Umm Al-Qura University, Jeddah, Saudi Arabia

Background: In Saudi Arabia, around 40 new cases of testicular cancer are reported annually. Although it is the most common malignancy in young male, it represents only about 1.3% of all male malignancies in the country. Such rarity has made a study of a large series difficult. Detailed epidemiological and clinical information is required to optimize the diagnostic and treatment modalities of this disease. We aim to present some important features of this disease in our population.

Methods: We reviewed, retrospectively, the files of all patients treated at our institution for testicular cancer from 2000 till 2007. The information regarding: presenting features, histopathological pattern, stage at presentation, modality of treatment, and complications of treatment were collected and analyzed.

Results: Twenty patients were found in our records. Average age was 29.7 (± 9.3 SD), ranging between 19 and 60. Of the 20 patients, 11 had Mixed Germ Cell Tumor and 9 had seminoma. Eleven (11) patients presented with stage 1, 5 patients presented with stage III disease. Post radical orchidectomy, 11 patients required chemotherapy, 3 patients received radiation therapy, and 4 patients underwent RPLND.

Two patients were on surveillance, one of them required chemotherapy one year later. The average follow up was 35 months, ranges between 5 to 91 months. Four patients were lost during follow up. Among the rest, the overall survival is 95%.

Conclusion: Testicualr tumor is an important disease with good prognosis if treated properly. Multicenter study is strongly required to better understand the behavior of this cancer in our population.

Presented at the: 22 nd Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

15-18 March 2010

Testicular tumor patients at KFSH&RC - Jeddah and National Guard Hospital, Jeddah, Saudi Arabia: Disease features

Ghassan Barayan, Hassan Farsi, Anmar Nassir, Hesham Saada, Turki Almuhaisin,

Hesham Madani


Department of Urology, King Faisal Specialist Hospital, Jeddah, Umm Al-Qura University, Mecca, Saudi Arabia

Introduction: In Saudi Arabia, around 40 new cases of testicular cancer are reported annually. Although it is the most common malignancy in young males, it represents only about 1.3% of all male malignancies in the country. Such rarity has made a study of a large series difficult. Detailed epidemiological and clinical information is required to optimize the diagnostic and treatment modalities of this disease. We aim to present some important features of this disease in our population.

Materials and Methods: We reviewed, retrospectively, the files of all patients treated at KFSH&RC-Jeddah and National Guard Hospital, Jeddah, for testicular cancer from 2000 till 2010. The information regarding presenting features, histopathological pattern, stage of presentation, modality of treatment, and complications of treatment were collected and analyzed.

Results: Forty two patients were found in our records. Average age was 29.7 (+/- 10.2 SD), ranging between 19 and 60. Of the 42 patients, 15 had nonseminoma, 26 had seminoma and 1 had Leydig cell tumor. Sixteen patients presented with stage I, 15 patients presented with stage II, 10 patients presented with stage III disease. Post radical orchidectomy, 26 patients required chemotherapy, 5 patients received radiation therapy, 8 patients underwent RPLND and 2 patients were on surveillance, one of whom required chemotherapy one year later. The average follow up was 35 months, ranges between 5 and 91 months. Four patients were lost to follow up.

Conclusion: Testicular tumor is an important disease with good prognosis if treated properly. Multicenter study is strongly required to better understand the behavior of this cancer in our population.

Presented at the: 23 rd Saudi Urological Conference

King Fahd Specialist Hospital - Dammam

21-24 February 2011




 

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