Update On Testicular Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Conferences;  Men's health
Article Date: 10 Dec 2007 - 0:00 PDT

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UroToday.com - Dr. Brett Carver, M.D. presented "Testes Cancer Update" on behalf of Dr. Joel Sheinfeld. Germ cell tumors have the capacity to differentiate, which has biological and clinical implications.

Dr. Carver presented the data on teratoma. Embryonal carcinoma can differentiate along the somatic pathway to mature and immature teratoma. Mature teratoma represents adult somatic tissue, such as bone and cartilage. Immature teratoma represents fetal tissue. Over time, the incidence of teratoma in the retroperitoneum is increasing. This is in part due to more effective chemotherapy for viable tumor elements leaving teratoma present at the time of lymphadenectomy.

If teratoma is present in the retroperitoneum, then there is a 42% chance that there is teratoma outside this area. In the post-chemo setting, the teratoma is found in 40% of men undergoing RPLND and mandates removal of residual disease. Relapse following post-chemo RPLND will be teratoma in 50% of patients if they had teratoma in the retroperitoneal specimen. According to the MSKCC data, 20-23% of men with teratoma in the primary tumor and a normal CT scan following chemo will harbor teratoma in the RP. The disease specific survival is reduced if teratoma is left in the RP and presents for reoperation. The incidence of malignant transformation is 20% in men with late relapse. The survival outcome for these patients is clearly worse. Late relapse of testes cancer is commonly associated with malignant transformation and these patients have a worse prognosis.

The overall message in the presentation was that surgery remained a critical component to outcomes in testes cancer. A limited RPLND or inadequately performed ones lead to disease recurrence and inferior outcomes.

Presented at the 8th Annual Meeting of the Society of Urologic Oncology (SUO) - November 29 - December 1, 2007. Natcher Conference Center, National Institutes of Health - Bethesda, Maryland.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD

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