What is a germ cell tumour in men?
This type of tumour is the most common in young men, with an increasing incidence in the western industrialised countries. In histology, the germ cell tumour is divided into seminomas and non-seminomas. The tumours occur in the testis in about 95 % of affected men, only about 5 % are primarily located extragonadally. For this reason, every man with an unclear primary tumour must be included in the differential diagnosis Testicular tumour, or more precisely extragonadal germ cell tumour .
How often does a germ cell tumour occur in men?
In Germany, about 4000 new cases are diagnosed every year. With 1.5 % of male germ cell tumours, the proportion is very low compared to all cancers, but it is the most common tumour that occurs between 20 and 45 years of age. At up to 10/100,000 men, the incidence has risen in recent years . About 1-2 % of patients have bilateral disease . The median age of onset is 38 years and about 150 affected persons die of this disease every year in Germany.
What risk factors play a role in germ cell tumours in men?
For the development of a germ cell tumour, only a few risk factors are known. However, according to the current state of science, environmental influences or lifestyle do not play a role. The following are the risk factors that are known:
- High altitude,
- family history of testicular cancer,
- genetic predisposition,
- Testicular intraepithelial neoplasia,
- Interfiliality,
- Klinefelter's syndrome.
What are the symptoms of a germ cell tumour in men?
At first the affected person notices a non-painful swelling, enlargement or hardening of the testicle. Only a few of the patients report complaints such as testicular pain, this often leads to the incorrect diagnosis of epididymitis. Only in exceptional cases are back pain, weight loss, dyspnoea, headache or hyperthyroidism reported in advanced disease.
How is germ cell tumour diagnosed in men?
If a germ cell tumour is suspected, various examination procedures are used to make a definite diagnosis .
Medical history and physical examination
The doctor will be told about all previous illnesses and complaints in a detailed conversation. This is followed by a green physical examination. This is followed by a blood sample to look for specific tumour markers in the laboratory.
Ultrasound
With the help of the ultrasound examination, a testicular tumour and any metastases that may have formed can be detected in a painless and radiation-free way . The primary aim of the examination is to find out whether the tumour has already spread to other organs.
Computer tomography
Thanks to the CT scan, it is possible to find out the size and exact location of the tumour and whether metastases have spread to the chest or abdomen. Since smaller metastases cannot be reliably detected, it is essential to repeat the CT examination after a few months.
Tissue sample
This tissue sample is indispensable for classifying the tumour. That is, to identify the malignancy and characteristics of the tumour. This enables a targeted treatment to be developed. Usually this tissue sample is taken when the testicle with the malignant tumour is removed.
How is a germ cell tumour in a man treated?
If there is an urgent suspicion of a germ cell tumour, the testicle is exposed through a surgical procedure. A pathologist then decides intraoperatively whether the entire diseased testicle needs to be removed on the basis of the frozen section examination. Regardless of the stage of the tumour, removal of the testicle is the first choice of treatment. At the same time, a biopsy of the other testicle is also performed, but in 95 % of men only one testicle is affected. By having one testicle removed , the patient has little to no side effects. After the surgical removal, further therapy can be decided thanks to a histology .
Seminomas
If there are metastases in the case of seminomas, it may be necessary to use chemotherapy after removal of the affected testicle. If there are only smaller metastases in the lymph nodes in the abdomen, radiotherapy or chemotherapy may be given. In the case of larger metastases in the abdomen, it is essential that chemotherapy is used. ?
Even if no metastases have formed at the time of diagnosis, a single course of radiotherapy or chemotherapy can be administered after surgery. Nowadays, however, it is more common to wait and monitor the course of the disease at regular intervals.
Non-seminomas
In non-seminomas, if metastases are present, in most cases chemotherapy consisting of several therapy cycles is necessary. A primary surgical removal of the tissue of the lymph nodes from the posterior abdominal cavity is nowadays only carried out if teratoma tissue can be assumed in the affected lymph nodes. This is because this tissue is known to be resistant to chemotherapy.
How is a germ cell tumour in a man followed up?
The type of examinations and also the intensity of aftercare depends on the therapy used and the prognosis.
The following aspects should be considered in the aftercare of a germ cell tumour:
- The most frequent recurrences occur in the first two years after the end of the therapy, so the primary goal is to be able to detect a recurrence early and treat it,
- even after more than five years after the end of therapy, so-called late recurrences can occur, so an annual follow-up is recommended for the rest of the patient's life,
- After surgical removal of the lymph nodes, recurrence is rare.
What is the prognosis for germ cell tumours in men?
With timely diagnosis and early treatment , more than 95 % of those affected can be cured. For this reason , germ cell tumours are among the cancers that have the best chances of being cured. Recurrence or progression of the tumour disease depends on the histopathological risk factors, the presence of metastases and the histological findings. The level of tumour markers in the blood is also decisive .