Treatment Options for Metastatic Seminoma
Dear OncoLink "Ask the Experts,"
My husband was diagnosed with Metastatic Seminoma today. I have been reading up on testicular cancer, and I don't really find his condition described. The doctor said it was advanced, I'm assuming it is Stage III. There is no mass in either testicle, so there will be no surgery (at this time?). It has spread to the lymph system and the bone marrow. He will begin chemotherapy next week.
This is all so new. I don't know what questions to ask. It seems to me that if this started in the testis, there should be something to take out, but the ultrasound showed no mass.
I would appreciate suggestions and treatment options.
Li Liu, MD OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
We are sorry to hear about your husband's disease. Fortunately, seminoma, even with metastases, is a highly treatable and curable disease. The majority of seminomas arise from the testicles. Fewer than 10% of all germ cell tumors (including seminoma and non-seminoma) originate from other sites. The mediastinum and retroperitoneum are the most common primary sites other than the testicles. The management of testicular seminoma and extragonadal seminoma is essentially the same.
Multiple staging systems are currently used to classify and manage patients with seminoma. When bone marrow is involved, it is Stage III based on the American Joint Committee on Cancer staging system. Patients are generally treated with cisplatin-based chemotherapy with a cure rate of 70% to 80% (Williams SD, et al. New England Journal of Medicine 1987; 316:1435). Adjunctive surgery and/or radiation therapy is reserved for the patients with residual bulky disease after chemotherapy to achieve a disease-free state.