From the Guidelines
The patient with seminoma diagnosed by biopsy of an inguinal lymph node and lymph node enlargement in both gastropathy and inguinal regions likely has stage III testicular cancer, and the recommended next steps include a complete staging workup followed by systemic chemotherapy with BEP (bleomycin, etoposide, and cisplatin) for 3-4 cycles, as per the most recent guidelines 1.
Diagnosis and Staging
The diagnosis of seminoma is confirmed by biopsy of the inguinal lymph node, and the presence of lymph node enlargement in both gastropathy and inguinal regions suggests metastatic disease.
- The staging workup should include:
- CT scans of the chest, abdomen, and pelvis
- Serum tumor markers (AFP, beta-hCG, LDH)
- A thorough physical examination
- Orchiectomy (surgical removal of the affected testicle) should be performed if not already done.
Treatment
The recommended treatment for stage III seminoma is systemic chemotherapy with BEP (bleomycin, etoposide, and cisplatin) for 3-4 cycles, as supported by the latest guidelines 1.
- The BEP regimen typically consists of:
- Bleomycin 30 units IV on days 1,8, and 15
- Etoposide 100 mg/m² IV on days 1-5
- Cisplatin 20 mg/m² IV on days 1-5, repeated every 21 days
Follow-up and Surveillance
After chemotherapy, a PET-CT scan should be performed to assess treatment response, with consideration for surgical resection of any residual masses larger than 3 cm, as recommended by recent studies 1.
- Regular follow-up with tumor markers and imaging will be needed for at least 5 years after treatment completion, as outlined in the guidelines 1.
From the Research
Diagnosis and Staging
- The patient has been diagnosed with seminoma, a type of testicular cancer, through a biopsy of an inguinal lymph node.
- The presence of lymph node enlargement in both the gastropathy (gastrointestinal) and inguinal regions suggests that the cancer has spread, indicating a clinical stage II seminoma 2.
- Clinical stage II seminoma is defined by the presence of pure seminoma accompanied by retroperitoneal lymph node metastases 2.
Treatment Options
- For clinical stage II seminoma, treatment options include radiotherapy, chemotherapy, and retroperitoneal lymph node dissection (RPLND) 2, 3, 4.
- Platinum-based chemotherapy is the widely accepted standard of care for patients with bulky disease (lymph nodes > 5 cm in diameter) 2.
- For patients with low-volume metastatic seminoma, RPLND has been proposed as a first-line treatment option, with promising results in recent studies 3, 4, 5.
- The choice of treatment depends on various factors, including the size of the lymph nodes, the presence of bulky disease, and the patient's overall health.
Next Steps
- Based on the diagnosis of clinical stage II seminoma, the next steps would be to discuss the treatment options with the patient and determine the best course of action.
- This may involve a multidisciplinary team approach, including urologists, oncologists, and radiologists, to determine the most effective treatment plan.
- The patient's treatment plan may include radiotherapy, chemotherapy, RPLND, or a combination of these options, depending on the specific characteristics of the cancer and the patient's overall health 2, 3, 4, 5.
Prognosis and Outcomes
- The prognosis for patients with clinical stage II seminoma is generally good, with excellent cure rates achieved with radiotherapy, chemotherapy, or RPLND 6, 5.
- However, the treatment options are associated with significant long-term morbidities, including cardiovascular, pulmonary, and neurologic toxicities, as well as an increased risk of secondary malignancies 4.
- Recent studies have shown that RPLND can be an effective treatment option for patients with low-volume metastatic seminoma, with favorable recurrence-free survival rates and low complication rates 3, 5.